Endoscopic suture apparatus

Abstract

To provide an endoscopic suture apparatus capable of reliably performing a locking operation of a suture needle to arm parts, while using a wire for an operation.SOLUTION: Arm part 12 and 13 for holding a suture needle 17 in suturing a tissue by opening and closing an arm one-end side are switchable alternately. A holding part 18 of each comprises: a movable part 31 movable between a first position in the longitudinal direction of the arm parts 12 and 13 and a second position on the proximal side of the first position; a support part 32 disposed on the proximal side of the movable part 31 and holding the suture needle 17 with the movable part 31 at the second position; and operation parts 16a and 16b. Each of the operation parts 16a and 16b allows an operation of changing from an unlocked state where the movable part 31 is positioned on the distal side of the second position and does not hold one end of the suture needle 17 to a locked state where one end of the suture needle 17 is held between the movable part 31 at the second position and the support part 32.SELECTED DRAWING: Figure 5

Description

Technical Field

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

Background Art

[0002] Conventionally, a technique of performing suturing of an incision under an endoscope has been known in order to suppress the risk of occurrence of complications after the incision, and an endoscopic suturing device for performing suturing of 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] In this type of endoscopic suturing device, the suturing device on the distal side is operated via a long wire from an operation unit provided on the proximal side of the endoscope. The transmission of force by the wire is relatively good when pulling on the proximal side, but when applying a pushing force to the distal side of the wire, the transmission of force to the distal side decreases due to bending of the wire or the like. Therefore, the operation of fixing the suture needle to the arm portion has been relatively difficult.

[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 that can more reliably perform the operation of fixing the suture needle to the arm portion while using a wire for the operation.

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, 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 alternately switch the arm portions that hold the suture needle when closing and opening the one end side of the arm to suture tissue. Each of the holding portions has a movable portion movable between a first position in the longitudinal direction of the arm portion and a second position proximal to the first position, a support portion disposed proximal to the movable portion and holding the suture needle together with the movable portion at the second position, and an operation portion. Each of the operation portions can be operated to change from an unlocked state in which the movable portion is located distal to the second position and does not hold one end of the suture needle to a locked state in which one end of the suture needle is held between the movable portion and the support portion located at the second position. When one end of the suture needle is in a locked state by the holding portion of one arm portion, the other end of the suture needle inserted into the other arm portion is located distal to the one end, and when the movable portion holding one end of the suture needle in one arm portion moves from the first position to the second position, the movable portion abutting against the other end of the suture needle in the other arm portion is moved from the second position to the first position.

Advantages of the Invention

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

Brief Description of the Drawings

[0008]

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

[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 schematically shown and do not represent actual shapes, dimensions, etc.

[0010] 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.

[0011] (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.

[0012] The suturing device 1 is detachably provided at the distal end of a tubular insertion portion 2 that is inserted into a 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.

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

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

[0015] 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 and closing mechanism portion 14, an opening and closing wire 15, and operation wires 16a and 16b. The operation wires 16a and 16b are an example of an operation portion. The mounting portion 11, the first arm portion 12, the second arm portion 13, and the opening and closing mechanism portion 14 are arranged at the distal end of the tubular insertion portion 2.

[0016] The first arm portion 12 and the second arm portion 13 each have a holding portion 18 that holds one end of the suture needle 17 at the distal end portion. Further, the first arm portion 12 and the second arm portion 13 can be switched between a locked state in which the suture needle 17 is fixed to the holding portion 18 and an unlocked state (unlocked state) in which the suture needle 17 is not fixed to the holding portion 18. Details of the holding portion 18 will be described later.

[0017] 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 and closing mechanism portion 14.

[0018] The first arm portion 12 and the second arm portion 13 are supported by the opening and closing mechanism portion 14 in a V shape so as to protrude toward the distal side of the attachment 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 arranged on the movement line of the forceps 6 when the respective arm portions are in a closed state.

[0019] The distal side of the first arm portion 12 and the second arm portion 13 is inclined inward in the radial direction with respect to the proximal side. For example, each arm portion is attached with an inclination of 0.5° to 50°, more preferably 3° to 35°, from a position substantially parallel to the longitudinal direction toward the inside in the radial direction. By attaching each arm portion with an inward inclination, the suturing device 1 is less likely to interfere with those on the outer side in the radial direction, and the passability when inserting the endoscope into an overtube or the body can be improved. Further, by attaching each arm portion with an inward inclination, the tip of each arm portion approaches the center of the viewing angle of the imaging portion of the endoscope, and the visibility during suturing can be improved. Further, even when the endoscope moves, is located at the 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.

[0020] Also, the location provided at the tip of each arm portion to which one end of the suture needle 17 is fixed is arranged within a range of 100% from the center of the viewing angle of the imaging portion of the endoscope. Specifically, with the distal end of the tubular insertion portion 2 as a reference, when the viewing angle of the imaging portion 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 location from deviating from the viewing angle of the imaging portion and the visibility during suturing from being reduced due to the influence of the aberration of the imaging portion.

[0021] In addition, for example, when performing suturing by largely involving living tissue such as full-thickness suturing, it is necessary to sufficiently draw the living tissue to be sutured by the forceps 6 of the endoscope toward the endoscope side. Therefore, a certain margin is required in the longitudinal dimension from the distal end of the tubular insertion portion 2 to the tip of each arm portion.

[0022] From such a viewpoint, 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 be 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 be 60 mm or less, it becomes easier to insert the tip of the arm without getting caught on the overtube.

[0023] 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.

[0024] The operating wire 16a is arranged longitudinally along the tubular insertion portion 2, and the distal side is connected to the holding portion 18 of the first arm portion 12. By pulling the operating wire 16a proximally, the holding portion 18 of the first arm portion 12 operates, and it is possible to switch between a locked state in which the suture needle 17 is fixed by the holding portion 18 of the first arm portion 12 and an unlocked state in which the lock is released.

[0025] The operating wire 16b is arranged longitudinally along the tubular insertion portion 2, and the distal side is connected to the holding portion 18 of the second arm portion 13. By pulling the operating wire 16b proximally, the holding portion 18 of the second arm portion 13 operates, and it is possible to switch between a locked state in which the suture needle 17 is fixed by the holding portion 18 of the second arm portion 13 and a state in which the lock is released.

[0026] The above-mentioned opening and closing wire 15, operating wires 16a and 16b can be operated independently. By performing the operations of the opening and closing mechanism section 14 and the holding section 18 with separate wires respectively, precise operation of the sewing device 1 becomes possible. Also, the holding sections 18 of the first arm section 12 and the second arm section 13 can be operated separately with different operating wires 16a and 16b. Therefore, compared with a configuration in which the holding sections 18 of both arm sections are interlocked, the sewing device 1 of the present embodiment can re-operate and recover the holding section 18 on the same side even when the needle lock fails in one arm section.

[0027] As materials for the attachment section 11, the first arm section 12, the second arm section 13, and the opening and closing mechanism section 14, metals having biocompatibility can be applied respectively, and examples include stainless steel, titanium, nitinol, and the like. Also, as the opening and closing wire 15 and the operating wires 16a and 16b, in addition to thin metal wires such as stainless steel, titanium, copper, and nitinol, thin wires of polymer fibers, fluorine tubes, polyethylene, polypropylene, nylon, and the like can be used. Note that the opening and closing wire 15 and the operating wires 16a and 16b may be formed of the same material or may be formed of different members.

[0028] FIG. 4 is a diagram schematically showing a configuration example of the opening and closing mechanism section 14 of the first embodiment. Note that the opening and closing mechanism section 14 is not limited to the configuration of FIG. 4, and may be by another mechanism that can be opened and closed by pulling the opening and closing wire 15.

[0029] The opening and closing mechanism section 14 of the first embodiment is a link mechanism that drives the first arm section 12 and the second arm section 13, and has a main body section 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 section 14 is line-symmetric on a plane with reference 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 section 2.

[0030] 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 that the link mechanism malfunctions 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 and closing mechanism portion 14.

[0031] 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.

[0032] Also, 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) at an interval 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 by the first support shaft 25. Further, the proximal end side of the second arm portion 13 is rotatably supported by the main body portion 21 by 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).

[0033] 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 and closing wire 15 is connected to the proximal end portion of the driving joint 22. Further, 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 and closing wire 15, and thereby relatively displaces in the longitudinal direction of the tubular insertion portion 2.

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

[0035] Also, the distal end portion of the first intermediate section 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.

[0036] Similarly, the distal end portion of the second intermediate section 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.

[0037] 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 suturing device 1 maintains a state in which the arm portions are open (FIG. 4(a)).

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

[0039] 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 section 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 section 24. As described above, the arm portion of the suturing device 1 changes from the opened state to the closed state by the pulling of the opening / closing wire 15 (FIG. 4(b)).

[0040] 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 suturing device 1 suitable for full-layer suturing. 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.

[0041] Next, referring to FIGS. 5 and 6, a configuration example of the holding portion according to the first embodiment of the present invention will be described. FIG. 5 is a cross-sectional view schematically showing an axial cross-section of the first arm portion and the second arm portion of the suturing device according to the first embodiment, and shows a state in which the suture needle 17 is locked on the second arm portion 13 side. FIG. 6 is a cross-sectional view schematically showing an axial cross-section of the first arm portion and the second arm portion of the suturing device according to the first embodiment, and shows a state in which the suture needle 17 is locked on the first arm portion 12 side. Note that since the configurations of the arm portion and the holding portion are common to the first arm portion 12 and the second arm portion 13, in the following description, the configuration of one of the first arm portion 12 and the second arm portion 13 will be described, and redundant descriptions regarding the configuration of the other may be omitted.

[0042] The first arm portion 12 has a hollow outer shell portion 30, and is configured to include a holding portion 18 inside the outer shell portion 30. A through hole 30a penetrating the outer shell portion 30 is provided at the tip (distal end portion) of the outer shell portion 30 of the first arm portion 12, at a position facing the second arm portion 13. One end of the suture needle 17 penetrates the through hole 30a and is accommodated inside the outer shell portion 30, and is fixed by the holding portion 18. Further, a portion on the proximal side of the through hole 30a in the outer shell portion 30 contacts the suture needle 17 and functions as a fulcrum portion (12a, 13a) described later. An elastic member (not shown) may be attached to the portion on the proximal side of the through hole 30a.

[0043] Here, the suture needle 17 has needle tips 17a formed at both ends and has a hole (not shown) for passing the suture thread in the central portion. Further, on both sides of the suture needle 17, at positions inside the needle tips 17a, there are formed constricted grooves 17b that extend in a direction intersecting the extending direction of the suture needle 17 and are annularly recessed in the circumferential direction.

[0044] In the first embodiment, the holding portion 18 is configured to have a first member 31 and a second member 32 inside the outer shell portion 30. The first member 31 is an example of a movable portion. The second member 32 is an example of a support portion. Further, the holding portion 18 has an operating wire 16a connected to the first member 31 on the distal side.

[0045] The first member 31 is provided on the distal side of the suture needle 17 inserted into the outer shell portion 30 within the outer shell portion 30, and sandwiches and holds the end portion of the suture needle 17 together with the second member 32. When the operating wire 16a is pulled proximally, the first member 61 is movable proximally. The first member 31 is movable between a first position in the longitudinal direction of the first arm portion 12 and a second position proximal to the first position. In FIG. 5, the first member 31 on the first arm portion 12 side is located at the first position, and the first member 31 on the second arm portion 13 side is located at the second position.

[0046] The first member 31 has a first contact portion 31c, a guiding portion 31b, and a stepped portion 31a on one proximal surface facing the suture needle 17. The first contact portion 31c is a portion that contacts at least a part of the end of the suture needle 17 in the later-described locked state. The first contact portion 31c is recessed inward from the guiding portion 31b and has a taper corresponding to the tip shape of the suture needle 17. The guiding portion 31b is located near the through-hole 30a rather than the first contact portion 31c and is a portion that guides the suture needle 17 when the suture needle 17 is inserted into the first arm portion 12. The guiding portion 31b has a tapered inclined surface that inclines proximally such that the side farther from the through-hole 30a (or the insertion side of the suture needle 17) is closer to the proximal side than the side closer to the through-hole 30a (or the insertion side of the suture needle 17). Further, the stepped portion 31a is a stepped portion that connects the guiding portion 31b and the first contact portion 31c. The stepped portion 31a functions to restrict the movement of the suture needle 17 in the direction of coming out of the arm portion by fitting into the groove 17b of the suture needle 17 in the later-described locked state.

[0047] The second member 32 is provided proximal to the suture needle 17 inserted into the outer shell portion 30 within the outer shell portion 30 and is disposed to face the first member 31. The second member 32 is fixed to the outer shell portion 30 with, for example, an adhesive. The second member 32 may be the same component as the outer shell portion 30. The second member 32 holds the needle tip 17a of the suture needle 17 together with the first member 31 at the second position.

[0048] The second member 32 has a second contact portion 32a on one distal surface facing the suture needle 17, which contacts at least a part of the end of the suture needle 17 in the locked state. The second contact portion 32a has a taper corresponding to the tip shape of the suture needle 17, similar to the first contact portion 31c. In the present embodiment, the first contact portion 31c and the second contact portion 32a contact the tip of the suture needle 17 and sandwich the suture needle 17 in the locked state. Thus, the holding portion 18 can stably and reliably hold the suture needle 17.

[0049] In FIG. 5, the first arm portion 12 is in an unlocked state where the holding portion 18 does not hold one end of the suture needle 17, and the second arm portion 13 is in a locked state where the holding portion 18 holds one end of the suture needle 17. The locked state of the second arm portion 13 is a state where the operating wire 16b is pulled proximally to move the first member 31 proximally, and the tip 17a of the suture needle 17 is held between the first member 31 and the second member 32.

[0050] Each of the operating wire 16a and the operating wire 16b as an example of the operating portion can be operated to change from an unlocked state where the first member 31 is located distally of the second position and does not hold one end of the suture needle 17 to a locked state where one end of the suture needle 17 is held between the first member 31 and the second member 32 located at the second position. Further, in the suturing device 1, by operating each of the pair of independently provided operating wires 16a and 16b, the holding portion 18 corresponding to the operated operating wire can be switched to the locked state.

[0051] When the first arm portion 12 is in the unlocked state (a state where the operating wire 16a is not pulled proximally) and the first arm portion 12 and the second arm portion 13 are brought closer (closing the one end side of the arm), as shown in the first arm portion 12 of FIG. 5, the tip 17a of the suture needle 17 is inserted into the outer shell portion 30 from the through hole 30a. By inserting the suture needle 17 into the first arm portion 12, even when the first member 31 is located at the second position, the first member 31 can be moved to the first position.

[0052] When the operating wire 16a is pulled proximally from the state of FIG. 5, the first member 31 on the first arm portion 12 side moves proximally. When the first member 31 moves proximally from the state of FIG. 5, the first member 31 of the first arm portion 12 pushes one end of the suture needle 17 proximally. When the first member 31 pushes one end of the suture needle 17 proximally, one end of the suture needle 17 moves proximally and contacts and stops at the second member 32 as shown in FIG. 6. At this time, the stepped portion 31a of the first member 31 fits into the groove 17b of the suture needle 17, and the holding portion 18 on the first arm portion 12 side becomes the locked state. The locked state of the holding portion 18 in the first arm portion 12 can be maintained by continuously pulling the operating wire 16a proximally.

[0053] Also, when shifting the first arm portion 12 to the locked state, the suture needle 17 contacts the proximal side of the through hole 30a of the first arm portion 12. At this time, the fulcrum portion 12a that contacts the first arm portion 12 serves as the fulcrum of this lever, the portion pressed against the first member 31 by the first arm portion 12 serves as the force point of this lever, and the end portion of the suture needle 17 located within the second arm portion 13 serves as the point of application of this lever. Thereby, when shifting from the state of FIG. 5 to the state of FIG. 6, when the end portion of the suture needle 17 is pushed proximally within the first arm portion 12, with the position contacting the fulcrum portion 12a as the fulcrum of this lever, the end portion of the suture needle 17 moves distally within the second arm portion 13. Then, the other end of the suture needle 17 that moves distally pushes the first member 31 on the second arm portion 13 side distally. When the other end of the suture needle 17 pushes the first member 31 distally, the first member 31 moves distally, the stepped portion 31a disengages from the groove 17b, and the holding portion 18 of the second arm portion 13 becomes unlocked.

[0054] Similarly, when shifting the second arm portion 13 to the locked state, the suture needle 17 contacts the proximal side of the through hole 30a of the second arm portion 13. At this time, the fulcrum portion 13a that contacts the second arm portion 13 serves as the fulcrum of this lever, the portion pressed against the first member 31 by the second arm portion 12 serves as the force point of this lever, and the end portion of the suture needle 17 located within the first arm portion 12 serves as the point of application of this lever. Thereby, when shifting from the state of FIG. 6 to the state of FIG. 5, when the end portion of the suture needle 17 is pushed proximally within the second arm portion 13, with the position contacting the fulcrum portion 13a as the fulcrum of this lever, the end portion of the suture needle 17 moves distally within the first arm portion 12. Then, the other end of the suture needle 17 that moves distally pushes the first member 31 on the first arm portion 12 side distally. When the other end of the suture needle 17 pushes the first member 31 distally, the first member 31 moves distally, the stepped portion 31a disengages from the groove 17b, and the holding portion 18 of the first arm portion 12 becomes unlocked. As described above, according to the present embodiment, by simply pulling either one of the operating wires 16a and 16b to lock one end side of the suture needle 17, the other end side can be unlocked.

[0055] The effects of the suturing device 1 of the first embodiment will be described below.

[0056] According to the present embodiment, it is possible to provide an endoscopic suturing device 1 that can more reliably perform the operation of fixing the suture needle 17 to the arm portions (the first arm portion 12 and the second arm portion 13) while using wires (operation wires 16a and 16b) for the operation.

[0057] In addition, by operating the operation portions (operation wires 16a and 16b), the locked state can be maintained, and by simply locking one end of the suture needle 17, the other end can be unlocked.

[0058] In addition, by configuring the suture needle 17 such that when one end is lowered, the other end is raised by the lever action, the locked state and the unlocked state can be easily switched. For this reason, the number of parts can be reduced, the space within the arm portions (the first arm portion 12 and the second arm portion 13) can be reduced, and the size of the outer shell (outer shell portion 30) of the arm portions (the first arm portion 12 and the second arm portion 13) can be reduced along with the reduction of the space within the arm portions (the first arm portion 12 and the second arm portion 13). Furthermore, the miniaturization of the arm portions (the first arm portion 12 and the second arm portion 13) can contribute to less invasiveness.

[0059] In addition, the holding portion 18 can be locked with a simple configuration and operation of pulling the operation wires 16a and 16b.

[0060] In addition, by operating either one of the pair of operation wires 16a and 16b, the operation of locking by the holding portion 18 can be surely performed.

[0061] In addition, when the suture needle 17 is inserted into the arm portions (the first arm portion 12 and the second arm portion 13) to move the movable portion (the first member 31) to the first position, there is no need to separately provide a configuration for moving the movable portion (the first member 31) to the first position, and the number of parts can be reduced.

[0062] In addition, the taper of the guiding portion 31b enables smooth insertion of the suture needle 17 into the arm portions (the first arm portion 12 and the second arm portion 13) of the suture needle 17.

[0063] In addition, when the first contact portion 31c and the second contact portion 32a contact the tip of the suture needle 17, the suture needle 17 can be stably and reliably held.

[0064] In addition, since the tapers of the first contact portion 31c and the second contact portion 32a are shaped according to the tip shape of the suture needle 17, the suture needle 17 can be held more stably and reliably.

[0065] In addition, when the stepped portion 31a of the movable portion (the first member 31) fits into the groove 17b of the suture needle 17, it is possible to prevent the suture needle 17 from coming out of the arm portions (the first arm portion 12 and the second arm portion 13).

[0066] In addition, the elastic members of the fulcrum portions 13a and 12a can assist the movement of the suture needle 17.

[0067] Note that the present invention includes combinations of the respective configurations of the above-described embodiments.

[0068] 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 shown not by the above description but by the claims, and it is intended that all modifications within the meaning and scope equivalent to the claims are included.

[0069] Note that the disclosure of the above embodiments includes the following technical ideas. (1) An endoscopic suturing device provided at the distal end of the 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 alternately switch the arm portions that hold the suture needle when closing and opening the one end side of the arm to suture tissue. Each of the holding parts has a movable part movable between a first position in the longitudinal direction of the arm part and a second position proximal to the first position, a support part arranged proximal to the movable part and holding the suture needle together with the movable part at the second position, and an operation part. Each of the operation parts can be operated to change from an unlock state in which the movable part is located distal to the second position and does not hold one end of the suture needle to a lock state in which one end of the suture needle is held between the movable part located at the second position and the support part. When one end of the suture needle is in the locked state at the holding part of one arm part, the other end inserted into the other arm part is located distal to the one end. When the movable part holding one end of the suture needle in one arm part moves from the first position to the second position, the movable part abutting on the other end of the suture needle in the other arm part is moved from the second position to the first position. Endoscopic suturing device. (2) The arm part has a fulcrum part between one end and the other end of the suture needle. The suture needle uses one end as the force point of a lever, the position in contact with the fulcrum part as the fulcrum of the lever, and the other end as the action point of the lever. The endoscopic suturing device according to (1) above. (3) The operation part has an operation wire arranged along the tubular insertion part. The operation part moves the movable part proximally by pulling the operation wire proximally with respect to the device main body part. The endoscopic suturing device according to (1) or (2) above. (4) The operation wire is composed of a pair of operation wires provided independently for each of the pair of arm parts. The holding part can switch the holding part corresponding to the operated operation wire to the locked state by operating each of the pair of independently provided operation wires. The endoscopic suturing device according to (3) above. (5) The suture needle moves the movable part to the first position when the suture needle is inserted into the arm part. The endoscopic suturing device according to any one of (1) to (4) above. (6) The movable part has a guiding part for guiding the suture needle when the suture needle is inserted into the arm part. The guiding part has a taper that inclines proximally such that the side farther from the suture needle is closer to the proximal side than the side closer to the suture needle. The endoscopic suturing device according to (5) above. (7) The movable part has a first contact surface part that contacts at least a part of the end of the suture needle when the suture needle is in the locked state. The support part has a second contact surface part that contacts at least a part of the end of the suture needle when the suture needle is in the locked state. The endoscopic suturing device according to any one of (1) to (6) above. (8) The first contact surface part and the second contact surface part have a taper corresponding to the tip shape of the suture needle. The endoscopic suturing device according to (7) above. (9) The movable part has a stepped part that restricts movement of the locked suture needle in the direction of coming out of the arm part. The endoscopic suturing device according to (2) above. (10) The fulcrum part has an elastic member at a location where it contacts the suture needle. The endoscopic suturing device according to (2) above. (11) The pair of operating wires can be operated independently of the opening and closing wire that opens and closes the arm part. The endoscopic suturing device according to (4) above. (12) 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 (11) above.

Explanation of Signs

[0070] 1...Suturing device, 2...tubular insertion part, 3...objective lens, 4...lighting part, 5...forceps mouth, 6...forceps, 11...attachment part, 12...first arm part, 12a...fulcrum part, 13...second arm part, 13a...fulcrum part, 14...opening and closing mechanism part, 15...opening and closing wire, 16a, 16b...operating wire (operating part), 17...suture needle, 17a...needle tip, 17b...groove, 18...holding part, 31...first member (movable part), 31b...guide part, 32...second member (support part)

Claims

1. An endoscopic suturing device provided at the 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 portions for holding the suture needle can be alternately switched when the one end side of the arm is opened and closed to suture tissue; each of the holding portions has a movable portion movable between a first position in the longitudinal direction of the arm portion and a second position proximal to the first position, a support portion disposed proximal to the movable portion and holding the suture needle together with the movable portion at the second position, and an operation portion; each of the operation portions is capable of an operation of changing from an unlocked state in which the movable portion is located distal to the second position and does not hold one end of the suture needle to a locked state in which one end of the suture needle is held between the movable portion located at the second position and the support portion; when one end of the suture needle is in a locked state at the holding portion of one arm portion, the other end inserted into the other arm portion is located distal to the one end; when the movable portion holding one end of the suture needle in one arm portion moves from the first position to the second position, the movable portion abutting against the other end of the suture needle in the other arm portion is moved from the second position to the first position An endoscopic suturing device.

2. The arm portion has a fulcrum portion between one end and the other end of the suture needle, the suture needle has one end as the effort point of a lever, the position contacting the fulcrum portion as the fulcrum of the lever, and the other end as the action point of the lever The endoscopic suturing device according to Claim 1.

3. The operation portion has an operation wire disposed along the tubular insertion portion, and the operation portion moves the movable portion proximally by pulling the operation wire proximally with respect to the device main body portion. The endoscopic suturing device according to Claim 1.

4. The operation wire is composed of a pair of operation wires provided independently for each of the pair of arm portions, and the holding portion can be switched to the locked state for the holding portion corresponding to the operated operation wire by operating each of the pair of independently provided operation wires. The endoscopic suturing device according to Claim 3.

5. The suture needle moves the movable portion to the first position when the suture needle is inserted into the arm portion. The endoscopic suturing device according to Claim 1.

6. The movable portion has a guiding portion for guiding the suture needle when the suture needle is inserted into the arm portion. The guiding portion has a taper that inclines proximally such that a side farther from the suture needle is closer to the proximal side than a side closer to the suture needle. The endoscopic suturing device according to claim 5.

7. The movable portion has a first contact surface portion that contacts at least a part of an end portion of the suture needle when the suture needle is in the locked state. The support portion has a second contact surface portion that contacts at least a part of an end portion of the suture needle when the suture needle is in the locked state. The endoscopic suturing device according to claim 1.

8. The first contact surface portion and the second contact surface portion have a taper corresponding to a tip shape of the suture needle. The endoscopic suturing device according to claim 7.

9. The movable portion has a stepped portion that restricts movement of the suture needle in the locked state in a direction of coming out of the arm portion. The endoscopic suturing device according to claim 2.

10. The fulcrum portion has an elastic member at a location where it contacts the suture needle. The endoscopic suturing device according to claim 2.

11. The pair of operating wires can be operated independently of an opening and closing wire that causes the arm portion to perform an opening and closing operation. The endoscopic suturing device according to claim 4.

12. The endoscopic suturing device is detachable from a tubular insertion portion of the endoscope. The endoscopic suturing device according to claim 1.

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