Living body suture apparatus

Abstract

To make it easy to release a suture.SOLUTION: In a living body suture apparatus, a suture needle 1 for suture insertion for feeding a suture 50 into a human body and a suture needle 2 for suture pull-out for pulling the suture 50 out of the human body are arranged in parallel. An operation part 40 includes an operation rod 20 for inserting / pulling a snare loop 10 whose long-size linear tip is formed in a loop shape into / from the human body. The snare loop 10 extends in a loop shape in a direction generally perpendicular to a vertically downward direction, and a circular suture engaging part 14 is obtained by twisting the tip of the loop shape in such a manner where an intersection part is not in contact. When the suture 50 having a higher stiffness than that of the snare loop 10 is pushed out of the operation rod 20 while being inserted in the suture engaging part 14, the suture 50 is pushed into the intersection part and disengaged from the suture engaging part 14 of the snare loop 10.SELECTED DRAWING: Figure 8

Description

[Technical Field]

[0001] The present invention relates to a biological suturing device used, for example, to suture the stomach wall and abdominal wall of a patient in order to temporarily fix the stomach wall to the abdominal wall, and in particular to a biological suturing device that can easily remove from the snare loop a suture that has been fed into the body using a suture-pulling puncture needle and held in the snare loop. [Background technology]

[0002] Generally, a biological suturing device is used, for example, when endoscopically forming a gastrostomy to allow food to flow into the stomach, to suture the stomach wall and abdominal wall of a patient to temporarily secure the stomach wall to the abdominal wall. A conventional biological suturing device, shown in Figure 9(a) and elsewhere, is used to temporarily secure a patient's abdominal wall 101 and stomach wall 102 together, and includes a suture insertion needle 1 that is inserted from outside the body so that its tip reaches the stomach and introduces a suture 50 into the stomach, a suture withdrawal needle 2 that withdraws the suture 50 introduced into the stomach by the suture insertion needle 1, a plate-shaped connecting member 3 that arranges the suture insertion needle 1 and the suture withdrawal needle 2 in parallel, and an operating unit 40 that inserts and removes a snare loop 10, the long tip of which is formed into a loop, into and from a cylindrical operating rod 20 that can be inserted and removed from the outside.

[0003] The suture insertion puncture needle 1 is cylindrical in shape and has an internal passageway passing therethrough in the axial direction for feeding the suture 50 from outside the body into the body, with an inlet connector 4 attached to its proximal end. The suture withdrawal puncture needle 2 is cylindrical in shape and has an internal passageway passing therethrough in the axial direction for withdrawing the tip of the suture 50 introduced into the stomach from inside the body to outside the body, with an inlet connector 5 attached to its proximal end.

[0004] The operating section 40 comprises a snare loop 10 formed into a loop at the distal end of a long material, a cylindrical operating rod 20 which passes through the snare loop 10, and a gripping section 30 attached to the proximal end of the snare loop 10 and which the operator can grip by hand. The snare loop 10 is an elastic wire such as a long, solid stainless steel wire having an open loop formed at its distal end for engaging with the vicinity of the distal end of the suture 50 to pull the suture 50, and is provided at its distal end with a suture engaging section for clamping and holding the suture 50. 10(a) and 10(b), the snare loop 10 is made of a long stainless steel wire and has a three-dimensional loop shape (heart or circular) at the tip, protruding from the tip and provided with a U-shaped suture engagement portion 15 having an inner diameter substantially the same as the diameter e of the snare loop 10 and a depth Z, and is shaped so that when inserted into the stomach, it extends in a direction substantially parallel to the stomach wall and abdominal wall (a direction substantially perpendicular to the downward vertical direction). Furthermore, the snare loop 10 can be passed through the internal passage of the suture withdrawal puncture needle 2 by elastically deforming the loop-shaped portion into a narrowed state.

[0005] The biological suturing device configured as above allows a doctor to suture the stomach wall and abdominal wall by carrying out the following steps. (A) A first step in which a suture insertion needle 1 and a suture withdrawal needle 2 connected by a connecting member 3 are pierced from outside the body through the abdominal wall 101 and the stomach wall 102, so that the tips of the suture insertion needle 1 and the suture withdrawal needle 2 are lined up and open into the stomach, and then, as shown in Figure 9(a), a suture 50 is inserted from the entrance connector 4 to the rear end position of the suture insertion needle 1, and a snare loop 10 is inserted from the entrance connector 5 into the suture withdrawal needle 2, so that the loop portion of the snare loop 10 is extended toward the suture insertion needle 1 in a direction approximately parallel to the stomach wall and abdominal wall (horizontal direction). (B) In the first step, the loop portion of the snare loop 10 is extended from the tip of the suture-removal puncture needle 2 in a direction approximately parallel to the stomach wall and abdominal wall. In this second step, the suture 50 is protruded from the suture-insertion puncture needle 1 so as to pass through the loop portion of the snare loop 10 extending laterally from the suture-removal puncture needle 2, as shown in Figure 9(b). (C) As shown in Figure 9(c), the third step is to use the operating part 40 to pull out the snare loop 10 from the inlet nozzle 5 of the suture-pulling puncture needle 2, so that the end of the loop hooks the suture 50 and pulls it out of the body.

[0006] As shown in FIG. 10(a), the details of this third step are as follows: a suture 50 is inserted downward from the suture insertion puncture needle 1 into the opening of the snare loop 10, which has a U-shaped suture engagement portion 15 at its tip and is in a loop shape that is spread out laterally from below the suture withdrawal puncture needle 2; then, by pulling out the snare loop 10, the suture 50 is pulled into the U-shaped suture engagement portion 15 at the tip of the snare loop 10, as shown in FIG. 10(b), and is hooked by retaining and engaging with the suture engagement portion 15, which has a U-shaped opening with a dimension e that is approximately the same as the diameter of the suture 50; and the snare loop 10 is then pulled out from the suture withdrawal puncture needle 2. (D) Next, the doctor pulls out the suture insertion needle 1 and the suture withdrawal needle 2 from the body and knots the suture together, thereby suturing the abdominal wall 101 and the stomach wall 102 together.

[0007] The following Patent Documents 1 and 2 are examples of documents that describe the technology related to the aforementioned biological suturing device. [Prior art documents] [Patent documents]

[0008] [Patent Document 1] Japanese Patent Application Laid-Open No. 2007-50200 [Patent Document 2] Japanese Patent Application Laid-Open No. 2007-151615 Summary of the Invention [Problem to be solved by the invention]

[0009] Generally, when a biological suturing device is used to temporarily fix a patient's stomach wall to the abdominal wall by the above-mentioned operation, it may be necessary to first hold and engage the suture 50 in the suture engagement portion 15 and then remove the suture 50. However, the conventional biological suturing device described in Patent Document 1 has the problem that the suture 50 is clamped and held in the U-shaped suture engagement portion 15, making it difficult to remove (release) it from the suture engagement portion 15.

[0010] Furthermore, the biological suturing device described in Patent Document 2 describes a technique in which a highly rigid shape-memory wire, which is tied to a suture and has its shape memorized so as to curve in an arc, is inserted laterally into a snare loop hanging vertically downward, thereby engaging and gripping the tip of a puncture needle for suture insertion with the shape-memory wire, and then the puncture needle for suture insertion in this engaged state is pulled out, thereby pulling the suture connected to the shape-memory wire out of the stomach.The technique described in Patent Document 2 describes a technique in which the suture engagement portion at the tip of the snare loop is configured with a guide portion (annular portion) formed by rotating a thin wire once, but as described in paragraph 0038, this guide portion engages with the puncture needle for suture insertion and the shape-memory alloy wire to firmly grip them, and does not describe any other effects, nor does it suggest any problems or techniques for releasing the shape-memory wire after it has been engaged and gripped.

[0011] In view of the above problems, the present invention aims to provide a biological suturing device that can easily remove a suture from a snare that has been inserted into the body through a suture withdrawal puncture needle. [Means for solving the problem]

[0012] In order to achieve the above object, the present invention provides a biological suturing device comprising an operating section including a snare loop made of a single stainless steel wire having a predetermined rigidity and a long, wire-like tip formed into a loop shape, and a cylindrical operating rod into which the snare loop can be inserted and removed; a suture insertion puncture needle having an internal passage passing therethrough in the axial direction for feeding a suture into a body; a suture withdrawal puncture needle arranged in parallel to the suture insertion puncture needle and having an internal passage passing therethrough in the axial direction for withdrawing the tip of the suture from the body, and into which the operating rod can be inserted and removed; and a connecting member for arranging the suture insertion puncture needle and the suture withdrawal puncture needle side by side, the snare loop extends in a loop shape from the tip of the operating rod in a direction substantially perpendicular to the vertically downward direction when protruding from the cylindrical operating rod, and has an annular suture engaging portion in which the tip of the loop shape is twisted at an angle of 30 degrees to less than 180 degrees within a range in which the intersecting portions do not come into contact with each other; The first feature is that the suture has higher rigidity than the snare loop, and when the snare loop is inserted into the suture engagement portion of the snare loop and pushed out from the operating rod, the suture is pushed into the intersection portion and disengaged from the suture engagement portion of the snare loop.

[0013] The present invention also provides a surgical instrument comprising: an operating section including a snare loop having a long, linear tip formed into a loop shape; and a cylindrical operating rod into which the snare loop can be inserted and removed; a suture insertion puncture needle having an internal passage passing therethrough in the axial direction for feeding a suture into a body; a suture withdrawal puncture needle having an internal passage passing therethrough in the axial direction for withdrawing the tip of the suture from the body, and through which the operating rod can be inserted and removed, and arranged in parallel to the suture insertion puncture needle; and a connecting member for arranging the suture insertion puncture needle and the suture withdrawal puncture needle side by side, the snare loop is made of a stainless steel solid wire set to a predetermined first diameter; a biological suturing device formed so as to extend in a loop shape from a tip of the operating rod in a direction substantially perpendicular to a vertically downward direction when protruding from the cylindrical operating rod, the suture is a long, resin-made single wire, and has a straight shape maintaining force that tends to maintain the straight shape when hanging down in an elongated shape in the vertically downward direction, and the straight shape maintaining force is set by a difference in diameter between the suture and the first diameter of the snare loop being 1.5 to 5 times larger, The second feature is that the snare loop has a circular suture engagement portion that protrudes from the tip of the loop shape, has an inner diameter set to a range of 1.5 to 5 times the diameter of the suture, and is twisted at an angle of 30 degrees to less than 180 degrees so that the intersections do not come into contact.

[0014] Furthermore, the present invention has a third feature in that, in the biological suturing device of the first or second feature, the snare loop is provided with a circular suture thread engaging portion formed by twisting at an angle of 80 to 100 degrees; a fourth feature in that, in the biological suturing device of the first or second feature, the snare loop is provided with a circular suture thread engaging portion formed by twisting at an angle of 170 to less than 180 degrees; a fifth feature in that, in the biological suturing device of the third feature, the suture thread engaging portion of the snare loop has an inner diameter set in the range of two to three times the diameter of the suture thread; and a sixth feature in that, in the biological suturing device of the fourth feature, the suture thread engaging portion of the snare loop has an inner diameter set in the range of two to three times the diameter of the suture thread. [Effects of the Invention]

[0015] The biological suturing device according to the first feature of the present invention has a circular suture engagement portion in which, when the snare loop protrudes from the operating rod, it extends in a loop shape from the tip in a direction approximately perpendicular to the downward vertical direction, and the tip of the loop shape is twisted so that the intersecting portions do not come into contact, and when the snare loop is pushed out while a suture having higher rigidity than the snare loop is inserted into the suture engagement portion, it is pushed into the intersecting portion and comes off the suture engagement portion of the snare loop, thereby making it possible to easily remove a suture that has been inserted into the snare from the snare.

[0016] The biological suturing device according to the second aspect of the present invention has a straight shape maintaining force that tends to maintain the straight shape of the suture when it is hanging down in a thin, elongated shape in the vertical direction, and the straight shape maintaining force is set by a difference in diameter from the first diameter of the snare loop being 1.5 to 5 times larger, and the snare loop has an annular suture engaging portion that protrudes from the tip of the loop and has an inner diameter that is 1.5 to 5 times larger than the diameter of the suture, and is twisted at an angle of 30 degrees to less than 180 degrees so that the intersecting portions do not come into contact with each other, Once inserted into the snare, the suture can be easily removed from the snare. [Brief explanation of the drawings]

[0017] [Figure 1] 1A and 1B are diagrams illustrating the operation unit of the biological suturing device according to an embodiment of the present invention and the step of inserting a snare loop into a suture withdrawal puncture needle using the operation unit. [Figure 2] FIG. 2 is a diagram illustrating the structure of a snare loop according to the first embodiment of the biological suturing device of the present invention. [Figure 3] FIG. 2 is an enlarged view showing the tip portion of the snare loop according to the first embodiment. [Figure 4] FIG. 4 is a diagram illustrating the structure of a snare loop according to a second embodiment of the biological suturing device of the present invention. [Figure 5] FIG. 10 is an enlarged view showing the tip portion of the snare loop according to the second embodiment. [Figure 6] FIG. 2 is a view for explaining the suturing operation of the biological suturing device according to the first embodiment of the present invention. [Figure 7] FIG. 3 is a view for explaining the release operation of the biological suturing device according to the first embodiment of the present invention. [Figure 8] FIG. 2 is a diagram for explaining the operation of the suture engaging portion of the snare loop and the suture of the biological suturing device according to the first embodiment of the present invention. [Figure 9] 1A and 1B are diagrams for explaining the configuration and operation of a biological suturing device according to the prior art. [Figure 10] FIG. 10 is a diagram illustrating a suture engagement portion of a snare loop according to the prior art. DETAILED DESCRIPTION OF THE INVENTION

[0018] Hereinafter, a biological suturing device according to an embodiment of the present invention will be described in detail. [Basic configuration of a biological suturing device] As shown in FIG. 1(b), the biological suturing device of this embodiment comprises a suture insertion puncture needle 1 having an internal passage passing axially through it for feeding a suture 50 into the body, a suture withdrawal puncture needle 2 having an internal passage passing axially through it for withdrawing the tip of the suture 50 from the body and arranged in parallel to the suture insertion puncture needle 1, a plate-like connecting member 3 for arranging the suture insertion puncture needle 1 and the suture withdrawal puncture needle 2 side by side, and an operating section 40 including a snare loop 10 having a long, linear tip formed into a loop shape and a cylindrical operating rod 20 that can be inserted and removed through the internal passage of the suture withdrawal puncture needle 2 and can insert and remove the snare loop 10 from the outside.

[0019] 1(a), the operating section 40 comprises a snare loop 10, which is a long stainless steel wire with a looped tip, a cylindrical operating rod 20 that passes through the snare loop 10, and a gripping section 30 attached to the rear end of the operating rod 20 and which the operator can grip by hand. When viewed axially of the operating rod 20, the snare loop 10 has a suture engaging section 14 at its tip, which is a twisted U-shaped protrusion.

[0020] [Snare loop of the first embodiment] As shown in the oblique view of Figure 2(a) and the side view of Figure 2(b), the snare loop 10 protruding from the operating portion 40 is shaped so that when viewed from an oblique angle, it extends laterally (in a direction approximately parallel to the stomach wall and abdominal wall and approximately perpendicular to the downward vertical direction) from the tip of the operating rod 20, and is provided with a suture engaging portion 14 that protrudes in a direction twisted 90 degrees from the tip and forms a circular portion whose intersecting portions intersect without contacting each other.

[0021] 3, the snare loop 10 of the biological suturing device according to the first embodiment of the present invention has a large loop-shaped tip extending in the XY plane (snare loop plane direction) that is approximately perpendicular to the downward vertical direction, and a U-shaped protrusion having an inner diameter about 1.5 to 5 times the outer diameter of the suture 50, which is twisted 90 degrees in the direction of rotation about the Y axis so that the intersecting portions do not contact each other (half twist formation), thereby providing an annular suture engaging portion 14 that extends in the Z direction perpendicular to the XY plane and whose intersecting portions (with a gap) do not contact each other. The twist angle of the suture engaging portion 14 may be close to 90 degrees, may be in the range of 80 to 100 degrees, or may be in an even wider range.

[0022] The snare loop 10 according to this embodiment is a single wire made of austenitic stainless steel (SUS304WP-8) containing, for example, 18.00 to 20.00 chromium (Cr), 8.00 to 10.50 nickel (Ni), and 0.080 or less carbon (C), with an elastic modulus (elastic modulus) of 74 GPa and a tensile strength of approximately 1700 to 2500 N / mm2, and has a diameter (referred to as the first diameter in this application) of, for example, 0.16±0.005 mm.

[0023] This snare loop 10 can be formed by, for example, wrapping and twisting a straight stainless steel cylinder of a predetermined diameter at any position to define the inner diameter, thereby forming a twisted shape (annular portion) at a predetermined angle, and then molding it into a loop shape to take in the suture thread 50, thereby forming the protruding U-shape into a shape twisted in a direction rotating around the Y-axis (the direction twisting the snare loop plane).

[0024] The suture 50 according to this embodiment is made of nylon, a polyamide resin formed from a thermoplastic polymeric material whose main chain is composed of repeated amide bonds, and has a diameter of, for example, 0.35 mm. Therefore, the force that maintains the straight shape of the suture 50 when hanging down vertically (referred to as the "straight shape maintaining force" in this invention) is set to be greater due to the difference in material diameter and rigidity compared to the snare loop 10, which is made of stainless steel wire with a diameter of 0.16 mm, which is about half the diameter of the nylon. The inner diameter of the annular portion of the suture engaging portion 14 is preferably about 1.5 to 5 times the outer diameter of the suture 50 (0.35 mm), which is approximately three times larger. In the drawing, it is about 1 mm.

[0025] [Stitching action] The biological suturing device according to this embodiment configured as described above sutures the stomach wall and abdominal wall by carrying out the following surgical steps shown in FIG.

[0026] (A) The doctor pierces the suture insertion needle 1 and the suture withdrawal needle 2, which are connected to the abdominal wall 101 and the stomach wall 102 by connecting member 3, into the abdomen from outside the body, so that the tips of the suture insertion needle 1 and the suture withdrawal needle 2 are lined up and open into the stomach, and then inserts the suture 50 from the entrance mouthpiece 4 to the rear end position of the suture insertion needle 1, and inserts the snare loop 10 into the suture withdrawal needle 2 from the entrance mouthpiece 5, so that the loop portion of the snare loop 10 (the portion that takes in the suture) is extended in a direction approximately parallel to the stomach wall and abdominal wall (horizontal direction) and toward the suture insertion needle 1. Next, as shown in Figure 6(a), the doctor further inserts the suture 50 vertically downward from the suture insertion puncture needle 1, thereby passing the suture 50 through the loop portion of the snare loop 10 extending horizontally from the suture withdrawal puncture needle 2 in the direction of arrow (i).

[0027] (B) Next, as shown in Figure 6(b), the doctor pulls out the knob 30 of the operating part 40 inserted into the suture-pulling puncture needle 2 in the direction of the arrow B, thereby gradually pulling out the annular part of the snare loop 10, which is the suture 50 extending from the suture-insertion puncture needle 1, toward the exit of the operating rod 20. (C) A third step in which the doctor further pulls out the suture 50 from the second step, as shown in Figure 6(c), so that the suture 50 fits into and engages with the semi-twisted, annular suture engagement portion 14 provided at the tip of the snare loop 10.

[0028] The third step of retaining and engaging the suture thread engaging portion 14 at the tip of the snare loop 10 will be described in detail with reference to FIG. 8, which shows an enlarged view of the vicinity of the suture thread engaging portion 14. In the third step of holding and engaging the suture 50 with the suture engagement portion 14, as shown in Figure 8(a), as the surgeon pulls out the snare loop 10 in the direction of the arrow T, the snare loop 10 moves in the direction of the arrow T, and the intersection of the twisted portion of the snare loop 10 causes the suture 50 to hit the circular edge of the operating rod 20 of the operating portion 40, and by further pulling the snare loop 10, the suture 50 is pushed (fitted) into the gap in the suture engagement portion 14. As the suture engaging portion 14 continues to be fitted into the gap, in the biological suturing device of this embodiment, the suture 50 has a greater ability to maintain its straight shape due to the difference in diameter, hardness, and rigidity compared to the snare loop 10, so the snare loop 10 side within the operating rod 20 undergoes a rotational deformation, and the suture 50 behaves as if it is being fitted into the circular portion of the half-twisted suture engaging portion 14 of the snare loop 10, as shown in Figure 8(b).

[0029] As shown in Figure 8(b), the biological suturing device of this embodiment holds the suture 50 by fitting it into the circular portion of the semi-twisted suture engagement portion 14 of the snare loop 10, and since the inner diameter of this suture engagement portion 14 is sufficiently larger than the diameter of the suture (approximately 1.5 to 5 times, approximately 3 times in the drawing), the suture 50 is held loosely within the suture engagement portion 14 and can move within the suture engagement portion 14.

[0030] (D) Furthermore, the doctor pulls out the snare loop 10, which has loosely held and engaged the suture 50 in the suture engagement portion 14 in this third step, from the suture withdrawal puncture needle 2, and pulls out the suture insertion puncture needle 1 and the suture withdrawal puncture needle 2 to the outside of the body, and then ties the suture together, thereby suturing the abdominal wall 101 and the stomach wall 102.

[0031] [Release behavior] Generally, in biological suturing procedures, there are cases where it is necessary to release (release) the suture 50 after it has been held and engaged in the suture engagement portion 14. This suture release operation will be described with reference to Figure 7.

[0032] This release operation is performed by the doctor pushing the snare loop 10 strongly in the direction of arrow ⅘ from the operating rod 20, as shown in Figure 7(d), from a state in which the suture 50 shown in Figure 6(c) is held and engaged with the annular suture engagement portion 14 of the snare loop 10.

[0033] In the biological suturing device of this embodiment, by strongly pushing out the snare loop 10, as shown in Figure 7(d), the suture engagement portion 14 of the snare loop 10 is pushed toward the side of the arrow E so that it passes over the position of the suture 50, and the suture 50 is pushed into the intersection of the annular suture engagement portion 14. By further pushing out the snare loop 10, (1) the suture 50 maintains its straight state so that it hangs down due to its straight shape maintaining force (the suture 50 has higher rigidity than the snare loop 10), (2) the suture 50 is loosely held within the diameter of the snare loop 10, and (3) there is a gap in the twisted portion at the intersection of the semi-twisted suture engagement portion 14, so that the suture 50 behaves as if it is pushed into the intersection from a state in which it is held and engaged with the annular suture engagement portion 14 of the snare loop 10 and released. If the snare loop 10 cannot be released by pushing it out once, this release operation can be facilitated by repeating the pushing and pulling, as the suture 50, which has a strong ability to maintain its straight shape, will come into strong contact with the twisted part of the suture engagement portion 14.

[0034] That is, in the prior art, the suture engaging portion tightly clamps the suture in a U-shape, making it difficult to release the suture from the suture engaging portion, but the biological suturing device of this embodiment loosely holds the suture without clamping it, utilizes the straight shape maintaining force (rigidity) of the suture 50, and semi-twists the suture engaging portion 14 to create a gap, so that the suture can be easily released by pushing the snare loop 10 out of the operating rod 20. In other words, in the biological suturing device of this embodiment, the suture 50 has higher rigidity than the snare loop 10, and when the suture engaging portion 14 is inserted into the annular portion of the suture engaging portion 14 and is operated to push it out of the operating rod 2, the suture 50 comes into contact with and enters the gap in the annular portion, and then the suture engaging portion 14 is rotated to disengage from the annular portion 14, thereby facilitating release.

[0035] [Snare loop of second embodiment] In the above-described embodiment, an example was described in which a vertical suture engagement portion was provided in which the U-shaped portion was half-twisted, but the configuration of the suture engagement portion according to the present invention is not limited to this. A suture engagement portion may be employed in which the U-shaped portion is twisted nearly less than 180 degrees to the extent that the intersecting portion does not come into contact in the planar direction of the snare loop. A second embodiment of a biological suturing device employing a snare loop 10 twisted nearly less than 180 degrees will be described with reference to FIGS. 4 and 5.

[0036] As shown in the oblique view of Figure 4(a) and the side view of Figure 4(b), the snare loop 10 of this second embodiment is formed so that when viewed from an oblique angle, it extends laterally (in a direction approximately perpendicular to the downward vertical direction) as seen from the tip of the operating rod 20, and is provided with a suture engaging portion 141 that extends laterally (in a direction approximately perpendicular to the downward vertical direction) and has a U-shaped portion that protrudes at the tip and opens wider than the diameter of the suture, and is formed by twisting the U-shaped portion at the tip to nearly 180 degrees but less than 180 degrees so that the intersecting parts do not come into contact (formed by almost full twist).

[0037] 5, which shows an enlarged perspective view of the distal end of the snare loop 10 of the biological suturing device according to the second embodiment, the snare loop 10 is configured to have a ring-shaped suture engagement portion 141 at the distal end of a large loop portion extending in the horizontal XY plane. The U-shaped protrusion has an inner width (inner diameter) approximately 1.5 to 3 times the outer diameter of the suture 50 and is twisted nearly 180 degrees (less than 180 degrees) so that the intersections do not contact each other. The intersecting region (intersection portion) E of the twisted stainless steel wires of the suture engagement portion 141 is twisted nearly 180 degrees (less than 180 degrees), so that the intersections of the twisted stainless steel wires are spaced apart without contact. Furthermore, the materials, diameters, elastic moduli, and other properties of the snare loop 10 and suture 50 according to this embodiment are the same as those of the first embodiment. In addition, the twist angle of the suture engaging portion 14 in this embodiment may be close to 180 degrees so that the intersections do not come into contact, and may be in the range of, for example, 170 degrees to less than 180 degrees, or in an even wider range less than 180 degrees.

[0038] [Operation of the second embodiment] The biological suturing device according to the second embodiment configured in this manner can perform the suturing operation and the release operation in the same manner as the first embodiment. For example, the suturing procedure involves the steps of: a) pulling the snare loop 10 in, causing the circular edge of the rod 20 of the operating unit 40 to abut against the suture 50; b) further pulling out the snare loop 10, causing the circular edge of the rod 20 to push the suture 50 and force the suture 50 into (fit) the minute gap in the suture engagement portion 141; c) further pushing the suture 50 with the circular edge of the rod 20, causing the straight shape of the suture 50 to maintain its shape, thereby deforming (rotating) the snare loop 10 and fitting the suture 50 into the minute gap in the suture engagement portion 141; and d) pulling out the snare loop 10, which holds and engages the suture 50 with the suture engagement portion 141, and drawing the suture 50 out of the body; and tying the suture together, thereby suturing the abdominal wall 101 and the stomach wall 102.

[0039] Furthermore, the suture 50 can be released by the surgeon by pushing the snare loop 10 strongly out from the operating rod 20, bringing the annular suture engagement portion 141 into contact with the suture 50, and then further pushing the snare loop 10 out, which causes the suture 50, which is relatively highly rigid compared to the snare loop 10, to maintain a straight state so that it hangs down due to the straight shape maintaining force F, and since there is a minute gap in the suture engagement portion 14 which loosely holds the suture 50 against its inner diameter and is twisted by less than 180 degrees, the suture engagement portion 141 of the snare loop 10 behaves as if it were pushed into the minute gap in the suture engagement portion 141 from a state in which it was loosely holding the suture 50, and then released, and if the snare loop 10 cannot be released by pushing it out once, the release can be facilitated by repeating the pushing and pulling.

[0040] In the biological suturing device of this embodiment, the gap at the twisted intersection of the suture thread engaging portion 141 is smaller than in the first embodiment, so it is relatively more difficult to release than the suture thread engaging portion 14 of the first embodiment. However, conversely, during suturing, the suture thread 50 does not easily slip into the small gap from the suture thread engaging portion 141 and is less likely to come off, making it easier to pull out the snare loop 10 from the suture withdrawal puncture needle 2.

[0041] [Other embodiments] In the above-described embodiments, a first embodiment is described in which a suture engaging portion 14 is provided that is half twisted (twisted by 90 degrees), and a second embodiment is described in which a suture engaging portion 141 is provided that is twisted to nearly 180 degrees. However, the suture engaging portion of the biological suturing device according to the present invention is not limited to the structure of the above-described embodiments. Taking into consideration the material and diameter of the suture and snare loop used in the procedure, the twist angle may be set to a range of, for example, 30 degrees or more and less than 180 degrees, as long as the intersecting portions do not come into contact, depending on the balance between the ease of inserting and releasing the suture into the suture engaging portion and the physician's preference for operability. [Explanation of symbols]

[0042] 1 puncture needle for inserting suture thread, 2 puncture needle for withdrawing suture thread, 3 connecting member, 4 entrance cap, 5 entrance cap, 10 snare loop, 14 suture thread engaging portion, 15 suture thread engaging portion, 20 operating rod, 30 picking portion, 40 operating part, 50 suture, 101 abdominal wall, 102 stomach wall, 141 suture engagement part

Claims

1. a suture insertion needle having an internal passage passing therethrough in the axial direction for feeding a suture into a body; a suture withdrawal needle arranged in parallel to the suture insertion needle, and having an internal passage passing therethrough in the axial direction for withdrawing the tip of the suture from the body, and through which the operation rod can be inserted and removed; and a connecting member for arranging the suture insertion needle and the suture withdrawal needle side by side, the snare loop extends in a loop shape from the tip of the operating rod in a direction substantially perpendicular to the vertically downward direction when protruding from the cylindrical operating rod, and has an annular suture engaging portion in which the tip of the loop shape is twisted at an angle of 30 degrees to less than 180 degrees within a range in which the intersecting portions do not come into contact with each other; The suture thread has a higher rigidity than the snare loop, and when the snare loop is pushed out from the operating rod while inserted into the suture thread engagement portion of the snare loop, the suture thread is pushed into the intersection portion and disengaged from the suture thread engagement portion of the snare loop.

2. the suture insertion needle has an internal passage passing therethrough in the axial direction for feeding the suture into the body; the suture withdrawal needle has an internal passage passing therethrough in the axial direction for withdrawing the tip of the suture from the body, and the operating rod is insertable and detachable therethrough, and the suture insertion needle is disposed in parallel to the suture insertion needle; and a connecting member for arranging the suture insertion needle and the suture withdrawal needle side by side, the snare loop is made of a stainless steel solid wire set to a predetermined first diameter; a biological suturing device formed so as to extend in a loop shape from a tip of the operating rod in a direction substantially perpendicular to a vertically downward direction when protruding from the cylindrical operating rod, the suture is a long, resin-made single wire, and has a straight shape maintaining force that tends to maintain the straight shape when hanging down in an elongated shape in the vertically downward direction, and the straight shape maintaining force is set by a difference in diameter between the suture and the first diameter of the snare loop being 1.5 to 5 times larger, The snare loop protrudes from the tip of the loop shape and has an inner diameter set to a range of 1.5 to 5 times the diameter of the suture thread, and has a circular suture thread engagement portion formed by twisting at an angle of 30 degrees to less than 180 degrees so that the intersections do not come into contact.

3. 3. The biological suturing device according to claim 1, wherein the snare loop has a circular suture thread engaging portion formed by twisting at an angle of 80 to 100 degrees.

4. 3. The biological suturing device according to claim 1, wherein the snare loop has a circular suture thread engaging portion formed by twisting at an angle of 170 degrees to less than 180 degrees.

5. 4. The biological suturing device according to claim 3, wherein the inner diameter of the suture engaging portion of the snare loop is set to be two to three times the diameter of the suture.

6. 5. The biological suturing device according to claim 4, wherein the inner diameter of the suture engaging portion of the snare loop is set to be two to three times the diameter of the suture.

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