Endoscopic surgical instruments

Abstract

By ensuring thorough cleaning and sterilization, and preventing serious accidents such as the retention of foreign objects in the patient's body due to the loss of small parts, we can achieve safe and reliable suture tying. [Solution] The endoscopic surgical instrument of the present invention has a main shaft portion that connects a gripping portion provided at the tip end and an operating handle portion provided at the base end, and is characterized in that a locking portion for locking a flexible fastening member is provided on the outer circumference of the main shaft portion.

Description

Technical Field

[0001] The present invention relates to a treatment instrument used for ligating a suture with a needle during an operation using an endoscope.

Background Art

[0002] Conventionally, in endoscopic surgery using laparoscopes, thoracoscopes, etc., a scope, forceps, scalpel, suture instrument, etc. are inserted through a trocar attached to the abdominal wall, and surgical procedures are performed in a narrow body cavity. Although endoscopic surgery places less burden on the patient compared to general open surgery, the operator needs to perform various operations through an endoscope and remotely, so it requires advanced techniques and experience.

[0003] < / When ligating a suture with a needle, cooperation between a needle holder held in the right hand and forceps held in the left hand is required. In open surgery, the directions of the needle holder and forceps can be changed relatively freely for operation, but in the body cavity using an endoscope, operation can only be performed with the trocar as a fulcrum, so there are limitations in the operation of the needle holder and forceps. Due to such limitations, the ligation work in endoscopic surgery is much more difficult than the ligation work in open surgery.

[0004] Especially in the ligation work in endoscopic surgery, it is not easy to wind the suture in an α shape while holding the needle holder. This is because the suture has elasticity, and the diameter of the main body shaft part of a normal needle holder in endoscopic surgery is about 5 mm. When trying to wind the suture around it, a force acts in the unwinding direction.

[0005] Therefore, as a technique using a conventional needle holder, there are known techniques for facilitating the winding of the suture, such as an example of arranging a first magnetic body on the suture side and a second magnetic body on the main body shaft part of the needle holder to increase the efficiency of winding the suture (see Patent Document 1), and an example of providing suture fixing means on the main body shaft part of the needle holder (Patent Document ).

Prior Art Documents

Patent Documents

[0006] [Patent Document 1] Japanese Patent Publication No. 2017-153942 [Patent Document 2] Japanese Utility Model Publication No. 5-88507 [Overview of the project] [Problems that the invention aims to solve]

[0007] In the technology described in Patent Document 1, the suture itself needs to be magnetized, making processing difficult. Furthermore, there is a concern that incorporating metal or other materials into the suture may have adverse effects on the patient. In addition, in the technology described in Patent Document 2, the fixing means simply hooks and secures the suture, so there is a risk that the suture may come loose with even slight movement of the needle holder. Moreover, since the fixing means itself is composed of relatively small metal pieces, pressure from the thread may be applied to a part of the metal piece, and if that metal piece breaks off inside the patient's body, there is a risk that the metal piece may remain inside the patient's body. Furthermore, repeated sterilization of the needle holder may cause bodily fluids such as blood or small tissues to adhere to the gaps between the small parts, making it difficult to clean and sterilize effectively.

[0008] Therefore, in view of the above-mentioned technical problems, the present invention aims to enable safe and reliable suture tying by allowing for effective cleaning and sterilization while preventing serious accidents such as the retention of foreign objects in the patient's body due to the loss of small parts. [Means for solving the problem]

[0009] To solve the above-mentioned technical problems, the endoscopic surgical instrument of the present invention has a main shaft portion that connects a gripping portion provided on the tip side of the endoscopic surgical instrument and an operating handle portion provided on the base end side, and is characterized in that a locking portion for locking a flexible fastening member is provided on the outer circumference of the main shaft portion. In this specification, the term "endoscopic surgical instrument" refers to an instrument that encompasses instruments used in endoscopic surgery, such as needle holders and forceps, and in a preferred embodiment, the endoscopic surgical instrument may be an endoscopic surgical needle holder or forceps used in endoscopic surgery.

[0010] In a preferred example of the endoscopic surgical instrument of the present invention, the fastening member may be made of, for example, a thread made of a disposable material, a natural polymer, or a synthetic resin, and in the case of such a thread, surgical sutures, particularly absorbable sutures, can be used.

[0011] Furthermore, in a preferred example of the endoscopic surgical instrument of the present invention, the locking portion for locking the fastening member may have a notch, and the notch may be formed in a wedge shape, narrower at the base end and wider at the tip end. The locking portion is a member for holding the fastening member during surgery, and if the fastening member is a thread-like member, the fastening member can be clamped in the notch. The locking portion may also have a structure that includes a locking piece capable of gripping the fastening member, or it may have a structure that includes an opening for removing the fastening member. Moreover, the locking portion may have a structure that includes multiple locking points for locking multiple fastening members.

[0012] Furthermore, in a preferred example of the endoscopic surgical instrument of the present invention, the fastening member locked to the locking portion can be structured to tilt at an obtuse angle with respect to the outer circumference of the main shaft portion when the ligating thread is moved from the base end to the tip end on the main shaft portion, straddling the locking portion. This structure enables smooth and rapid ligating of the suture thread.

[0013] Furthermore, the locking portion can be a small hole formed on the outer circumference of the main shaft portion, and if a thread with a knot at one end is used as the fastening member, the knot can function as a stopper to prevent the thread from coming out of the small hole.

[0014] Furthermore, in a preferred example of the endoscopic surgical instrument of the present invention, the end of the thread without a knot can be made to protrude from a hole provided on the outer circumference of the main shaft portion so as to extend toward the base end. In addition, a groove for releasing the ligation thread or part of the fastening member can be formed in at least one of the main shaft portion and part of the needle holder portion, so that when the ligation thread is moved along the main shaft portion from the base end to the tip end, the thread can be released into the groove, thereby speeding up the surgery. [Brief explanation of the drawing]

[0015] [Figure 1] This is a schematic diagram showing an endoscopic surgical needle holder, which is an example of an endoscopic surgical instrument according to the first embodiment of the present invention. [Figure 2] Figure 1 is a side view showing the main parts of the endoscopic surgical needle holder, and depicts the device without the fastening member. [Figure 3] Figure 1 is a side view showing the main parts of the endoscopic surgical needle holder, illustrating the state with the fastening member inserted. [Figure 4] Figure 1 is a cross-sectional view showing the main part of the endoscopic surgical needle holder, illustrating the state with the fastening member inserted. [Figure 5] This is a cross-sectional view of a modified example of the needle holder for endoscopic surgery according to the first embodiment of the present invention. [Figure 6] This is a side view showing the main part of the needle holder for endoscopic surgery according to the second embodiment of the present invention, and is a diagram showing the needle in a state with the fastening member inserted. [Figure 7] Figure 6 is a cross-sectional view showing the main part of the endoscopic surgical needle holder, illustrating the state without the fastening member. [Figure 8] Figure 6 is a cross-sectional view showing the main part of the endoscopic surgical needle holder, illustrating the state with the fastening member inserted. [Figure 9]It is a cross-sectional view showing the axial direction of the main part of the needle holder for endoscopic surgery shown in FIG. 6, and shows a state where the fastening member is not passed through. [Figure 10] It is a side view showing the main part of the needle holder for endoscopic surgery shown in FIG. 6, and shows a state where the wound suture is pulled out in the tip direction. [Figure 11] It is a side view showing the main part of the needle holder for endoscopic surgery without a slit formed, and shows a state where the wound suture is pulled out in the tip direction. [Figure 12] It is a side view showing the main part of the needle holder for endoscopic surgery according to the third embodiment of the present invention, and shows a state where the fastening member is passed through. [Figure 13] It is a side view showing the main part of the forceps which is another example of the treatment tool for endoscopic surgery according to the fourth embodiment of the present invention, and shows a state where the fastening member is passed through. [Figure 14] It is a perspective view showing the main part of the treatment instrument for endoscopic surgery according to the fifth embodiment of the present invention. [Figure 15] It is a cross-sectional view showing the main part of the needle holder for endoscopic surgery shown in FIG. 14, and shows a state where the fastening member is not passed through. [Figure 16] It is a perspective view showing the main part of the needle holder for endoscopic surgery shown in FIG. 14, and shows a state where the fastening member is passed through. [Figure 17] It is a perspective view showing the main part of the needle holder for endoscopic surgery shown in FIG. 14, and shows a state where the ligating thread is wound around the main body. [Figure 18] It is a perspective view showing the main part of the needle holder for endoscopic surgery shown in FIG. 14, and shows a state where the fastening member is released into the groove.

Embodiments for Carrying Out the Invention

[0016] Embodiments of the present invention will be described while referring to the drawings. First Embodiment The endoscopic surgical instrument of this embodiment, as shown in Figures 1 to 4, is an example of a needle holder that uses absorbable sutures as fastening members and locks them into a wedge-shaped notch as a locking part. The endoscopic surgical needle holder of this embodiment is an instrument mainly used in surgery using an endoscope, and is used to insert a needle-attached suture, forceps, and the endoscopic surgical needle holder 100 of this embodiment into a body cavity via a trocar to perform the procedure.

[0017] First, the endoscopic surgical needle holder 100, one of the surgical instruments for endoscopic surgery, as shown in Figure 1, has a hollow rod-shaped main shaft portion 101, a first operating handle portion 102 that extends substantially perpendicularly from the longitudinal base end of the main shaft portion 101 and has a finger insertion portion 102a for inserting the surgeon's right index finger, and a first pivot portion 101a at the longitudinal base end of the main shaft portion 101 that is rotatably supported and allows the surgeon's right thumb to be inserted. The device comprises a second operating handle portion 103 with a finger insertion portion 103a, a needle gripping portion 104 formed at the tip opposite the longitudinal base end of the main shaft portion 101 on which a pivot portion 101a is formed, for gripping the needle of a needle-attached suture (not shown), and an operating wire portion 108 formed on a portion of the main shaft portion 101 on the needle gripping portion 104 side, for transmitting the operating force transmitted by the second operating handle portion 103 to the needle gripping portion 104 via the hollow main shaft portion 101.

[0018] Here, the needle gripping portion 104 for gripping the needle-attached suture is composed of an upper gripping portion 104a and a lower gripping portion 104b. The gripping piece portion 106a, which extends from the upper gripping portion 104a, and the gripping piece portion 106b, which extends from the lower gripping portion 104b, are pivotally supported via a second pivot support portion 105. Specifically, the gripping pieces 106a and 106b are connected to the operating wire 108. As the second operating handle 103 is driven in the direction of arrow X in the figure, the operating wire 108 is pulled in the direction of arrow Y in the figure, causing the gripping pieces 106a and 106b to rotate via the second pivot 105, and the upper gripping portion 104a extending from the gripping piece 106a and the lower gripping portion 104b extending from the gripping piece 106b to fit together. The fitting of the upper gripping portion 104a and the lower gripping portion 104b allows the needle to be gripped. On the other hand, by operating the operating handle 103 in the opposite direction to arrow X in the figure, the upper gripping portion 104a and the lower gripping portion 104b are separated, and the needle can be released.

[0019] When performing ligation work, a thread member 107, which is a fastening member, is locked through a pair of wedge-shaped notches 110a and 110b at a position 30 mm to 200 mm from the tip of the main shaft portion 101, preferably at a position 30 mm to 100 mm. In the endoscopic surgical needle holder 100 of this embodiment, a pair of wedge-shaped notches 110a and 110b and an elongated hole-shaped opening 112 provided between them are formed as through-holes on the outer circumference of the main shaft portion 101, and these constitute a locking part that assists in ligation work. The pair of wedge-shaped notches 110a and 110b are each formed in a wedge shape, with a narrower base end and a wider tip end. After positioning the thread member 107 so that it passes through the wider tip end of each notch 110a and 110b, the thread member 107 can be pushed into the narrower base end end, thereby being clamped and locked between the notches 110a and 110b. In this embodiment, the longitudinal direction of the pair of wedge-shaped notches 110a and 110b is parallel to the axial direction of the main shaft 101, but it may also be inclined in a V-shape, and the positions of the notches 110a and 110b may be slightly offset in the axial direction. Furthermore, the wider tip end of the notches 110a and 110b may have a rounded corner. The spacing between the pair of wedge-shaped notches 110a and 110b depends on the thickness of the main shaft portion 101, but for example, if the diameter of the main shaft portion 101 is about 5 mm, the spacing is about 1.5 mm to 4.5 mm. The elongated opening 112 is for releasing the locking state of the notches 110a and 110b of the thread member 107 using a thin-tipped member when removing the thread member 107 at the end of surgery, and has the function of facilitating the removal of the thread member 107 from the endoscopic surgical needle holder 100.

[0020] One example of a fastening member is the thread member 107, which is, of course, flexible in order to hook the needle-attached suture within the body cavity and ligate the needle-attached suture. In particular, the thread member 107 can be made from a thread made of a disposable material, such as a natural polymer or synthetic resin. Furthermore, as an example of such a thread, surgical sutures, especially absorbable sutures, can be used for safety reasons, taking into consideration detachment or retention within the body cavity. By making the thread member 107 from a disposable material, after the surgery is completed, the thread member 107 can be removed from the notches 110a and 110b and discarded, and the material can be reused for cleaning and sterilization without the thread member 107. In particular, when using absorbable sutures as surgical sutures, using absorbable sutures as the thread member 107 is a relatively easy choice because they are readily available.

[0021] As an example of such fastening members, a thread shape is preferred, but a flexible band-shaped member can also be used, and it may be a band-shaped member with a taper, or one with knots or curves that do not pose a problem in securing the suture. The fastening member is not limited to surgical sutures in particular, but can be made of flexible and pliable monofilaments of synthetic resin materials such as nylon, polypropylene, PDS (polydioxanone), and polyglyconate. Furthermore, when absorbable sutures are used as the material, the bioabsorbable material can be, for example, polyglycolide, polylactide, poly-ε-caprolactone, lactide-glycolic acid copolymer, glycolide-ε-caprolactone copolymer, lactide-ε-caprolactone copolymer, polydioxanone, glycolide / trimethylene carbonate / lactide copolymer, glycolide / trimethylene carbonate / dioxanone copolymer, polycitric acid, polylactic acid, polymalic acid, poly-α-cyanoacrylate, poly-β-hydro Examples of absorbable sutures include synthetic polymers such as xic acid, polyhydroxybutyric acid, polytrimethylene oxalate, polytetramethylene oxalate, polyorthoester, polyorthocarbonate, polyethylene carbonate, poly-γ-benzyl-L-glutamate, poly-γ-methyl-L-glutamate, poly-L-alanine, and polyglycol sebastic acid; polysaccharides such as starch, alginic acid, hyaluronic acid, chitin, pectic acid and their derivatives; and natural polymers such as gelatin, collagen, albumin, and fibrin. The thickness of these absorbable sutures can be selected in the range of 1-0 to 5-0, preferably 2-0 to 4-0. When attaching to the endoscopic surgical needle holder 100 of this embodiment, the original thread of the suture member is cut to a length of, for example, 20 mm to 60 mm, and the cut suture member 107 is attached in the manner described above. The attachment of this endoscopic surgical needle holder 100 is, in principle, done during the preparation stage before the start of surgery.

[0022] In this embodiment of the endoscopic surgical needle holder, the needle and suture (not shown) may be configured in a detachable form suitable for knot suturing, or in a non-detachable form suitable for continuous suturing. The shape of the needle tip is not particularly limited, and for example, round needles, square needles, inverted triangular needles, tapered cuts, blunt needles, etc., can be appropriately selected. Similarly, there are no restrictions on the selection of sutures, and for example, twisted threads made of natural materials such as silk, twisted threads made of synthetic materials such as Neurolon (nylon material), Ethibond (polyester material), Vicryl (polyglucin 910), Dexon (polyglycolic acid), Monocryl, or monofilaments made of synthetic materials such as nylon, proline (polypropylene), polydioxanone, Maxon, etc. can be used.

[0023] Figures 2 and 3 show the main parts of the endoscopic surgical needle holder 100 of this embodiment. Figure 2 shows the state in which the thread member is not locked, and Figure 3 shows the state in which the thread member 107 is locked. As a preparation step before the start of surgery, when attaching the thread member 107, which is a flexible fastening member, to the endoscopic surgical needle holder 100, the thread member 107, which has been cut to a predetermined length, is sequentially inserted through the wide area at the tip of a pair of wedge-shaped notches 110a and 110b, and once inserted, it is pressed against the narrow base end side of the wedge-shaped notches 110a and 110b, and locked as shown in Figure 3, thus completing the preparation. At this time, as shown in Figure 4, the thread member 107 is locked to the pair of wedge-shaped notches 110a and 110b.

[0024] When tying a suture with a needle after the start of surgery, the suture with a needle is manipulated with forceps (not shown) and the endoscopic surgical needle holder 100 of this embodiment. The suture is wrapped around the main shaft portion 101 while holding the endoscopic surgical needle holder 100 to make a knot. The thread member 107 that consequently protrudes from the main shaft portion 101 functions as a retainer, allowing the surgical suture to be easily wrapped around the main shaft portion 101, then the endoscopic surgical needle holder 100 to be pulled out, and finally the suture to be pulled to make a knot to be made efficiently.

[0025] After the ligation procedure is complete and the surgery is finished, the thread member 107 is secured to the notches 110a and 110b. This thread member 107 is removed from the main shaft 101 and discarded because it has come into contact with the patient's blood, etc. Therefore, cleaning and sterilization can be performed without such a component, and the endoscopic surgical needle holder 100 of this embodiment can be reused. Furthermore, even if the thread member 107 falls off during surgery, if the material of the thread member 107 is the same as that of absorbable sutures, or if absorbable sutures are partially cut and used, the detached thread member 107 will be absorbed by the body, thus preventing problems such as the retention of components in the patient's body. In particular, the endoscopic surgical needle holder 100 of this embodiment is suitable for single-stage endoscopic surgery.

[0026] Figure 5 is a cross-sectional view of a modified example of the needle holder for endoscopic surgery according to the first embodiment of the present invention. Multiple locking points are formed on the outer circumference of one main body shaft portion 101, and in addition to the notches 110a and 110b, a pair of other notches 110c and 110d are formed. One thread member 107 can be placed in the notches 110a and 110b, and another thread member 107 can be placed in the other pair of notches 110c and 110d. In this way, the number of locking points of the locking portion can be increased, and when using a highly rigid suture, the number of locking points increases, making the ligation work easier.

[0027] In this embodiment of the endoscopic surgical needle holder, an example has been described in which one or more pairs of notches with wedge-shaped openings are formed. However, if the thread member can be sufficiently locked during the ligation process, it is also possible to have only one notch for gripping the thread member, and the other hole may be an elongated hole. Furthermore, as will be described later, a taper or other inclination can be provided on the tip side of the notch to facilitate the removal of the wound ligament.

[0028] Second Embodiment The endoscopic surgical instrument of the second embodiment is an endoscopic surgical needle holder, and as shown in Figures 6 to 10, a pair of slits 124a and 124b, which are elongated holes penetrating the outer circumference of the main shaft portion 102, are provided in the vertical direction in the figures, and a locking claw portion 120 is formed in the hollow portion of the main shaft portion 101 as a locking portion, and the thread member 107 inserted into the interior of the main shaft portion 101 through the respective slits 124a and 124b is locked to the locking claw portion 120.

[0029] The locking claw portion 120 is a protruding piece provided on the inner wall of the outer circumference of the main shaft portion 101. It is a U-shaped piece with a thin tip and a thicker base, with the base connected to the inner wall of the outer circumference. The tip of the locking claw portion 120 is thin and open, and the tip is narrow in width in the circumferential direction of the shaft. As shown in Figure 9, the locking claw portion 120 can create a wedge-shaped space between itself and the inner wall of the outer circumference when viewed in cross-section, and a fastening member can be inserted into this wedge-shaped space. That is, a fastening member such as the thread member 107 can be inserted through the narrow part that is open between the main shaft portion and the inner wall of the outer circumference, and the thread member 107 can be locked to the locking claw portion 120 by pulling it towards the base. Figure 7 shows a cross-section near the locking claw portion 120 in a state where the thread member 107 is not locked. Figure 8 shows a cross-section near the locking claw portion 120, illustrating the state in which the thread member 107 is locked by the locking claw portion 120. The thread member 107 is initially introduced by passing it through the slits 124a and 124b, which are elongated holes, and after introduction, it is locked to the locking claw portion 120 by pulling it toward the proximal end. For example, when removing the thread member 107 after surgery, it can be removed by pulling it out, or if that is not easy, the thread member 107 can be moved slightly toward the tip using a thin needle-like instrument through the opening 122 and then pulled out. Since the locking claw portion 120 is formed on the inside of the outer circumference of the main shaft portion 101, there is no portion that protrudes outward from the outer circumference of the main shaft portion 101. Because there is no such external protrusion, there is no risk of unintentionally damaging the patient's tissue with a protruding portion, and there is no accumulation of tissue or cleaning fluid at protruding portions during cleaning and other processes. Therefore, the endoscopic surgical needle holder of this embodiment is an extremely user-friendly instrument.

[0030] In the second embodiment of the endoscopic surgical needle holder, as shown in Figure 10, when the suture thread 130, which has been wound around the main shaft portion 101 for ligation, is pulled out by moving it along the main shaft portion 101 from the proximal end to the distal end, crossing the combined portion of the locking claw portion 120 and the thread member 107, the thread member 107 is moved along the slits 124a and 124b at an obtuse angle α with respect to the outer circumference of the main shaft portion 101. d This allows the suture member 107w to bend flexibly. As a result, frictional resistance with the suture thread 130 is reduced, and the suture thread 130 can be smoothly pulled out. In contrast, as shown in Figure 11, in a structure where the thread member 107w does not bend without a slit, even if the thread member 107w oz 12 bends, the thread member 107w is maintained at almost a right angle just outside the main shaft portion 101, and that portion acts as a stopper against the suture thread 130, i.e., a resistance, and as a result, the suture thread 130 cannot be smoothly pulled out.

[0031] Figure 12 is a side view showing the main part of an endoscopic surgical needle holder, which is an example of an endoscopic surgical instrument according to the third embodiment. The locking portion of the endoscopic surgical needle holder of the third embodiment has a notch 128 that is cut out in a generally U-shape and a locking piece 126 located in the center of the notch, and an opening 132 is formed in the center of the locking piece 126. The notch 128 is shaped so that the width of the notch narrows from the tip side to the base side, and the thread member 107, which serves as a fastening member, can be locked to the locking piece 126 by pushing the thread member 107 towards the base side. The opening 132 can be used when removing the thread member after surgery. The locking piece 126 does not protrude from the outer circumference of the main shaft portion 101 and does not pose an obstacle during surgery.

[0032] The notch 128 can be formed by cutting a part of the outer circumference of the main shaft portion 101, and at least the notch 128 on the tip side has an opening larger than the diameter of the thread member to be inserted, and at the base end side of the notch 128, the width of the notch 128 should be narrower than the diameter of the thread member to be inserted.

[0033] Figure 13 is a side view showing the main part of an endoscopic surgical forceps 200, which is an example of an endoscopic surgical instrument according to the fourth embodiment. A pair of notches 210a and 210b, which constitute a locking portion, are provided on the outer circumference near the tip of the hollow main body shaft portion 201 that extends from the gripping portion 204. These pair of wedge-shaped notches 210a and 210b are openings consisting of through holes for locking a thread member 207, which is a flexible fastening member, similar to the needle holder 100 of the first embodiment. The thread member 207 is inserted through the wide opening at the tip of the pair of wedge-shaped notches 210a and 210b, and after insertion, the thread member 207 is pulled towards the base end of the forceps 200, thereby locking the thread member 207 into the narrow area of ​​the pair of wedge-shaped notches 210a and 210b. An opening 212 is provided as a through-hole in the region between the notches 210a and 210b, and is used when removing the suture member 207 after surgery.

[0034] In this embodiment as well, the thread member 207 can be a monofilament of synthetic resin material that is flexible and pliable, and in particular, by using absorbable suture as the material, there is no risk of the thread member being left behind in the patient's body even if it comes off during surgery. In this way, even with endoscopic surgical forceps, the thread member 207 that is consequently protruding from the main shaft portion 201 functions as a retainer, making it easy to wrap the surgical suture around the main shaft portion 201, then pull out the endoscopic surgical forceps 200, and finally pull the suture to make a knot, and the work can be carried out efficiently.

[0035] Figures 14 to 18 show a fifth embodiment of an endoscopic surgical needle holder. The endoscopic surgical needle holder 300, which is one of the instruments used in endoscopic surgery, has a hollow rod-shaped main body shaft portion 301 and an openable and closable needle gripping portion 304 disposed at the tip of the main body shaft portion 301. An operating wire portion 308, which contains a wire for transmitting the operation of a handle portion (not shown) to the needle gripping portion 304, is located at the center of the main body shaft portion 301. The operating wire portion 308 is also a cylindrical metal member, and the wire to be operated is inserted through the hollow portion.

[0036] Near the tip of the hollow rod-shaped main shaft portion 301, four holes are provided that penetrate the outer circumference of the main shaft portion 301. These four holes consist of a pair of small holes 306a and 306b and a pair of through holes 307a and 307b. The pair of small holes 306a and 306b are small holes with a diameter about the size of a suture needle hole. As will be described later, when a knot is made in the suture, the knot cannot pass through the small holes 306a and 306b and functions as a retainer. On the other hand, the through holes 307a and 307b are larger than the small holes 306a and 306b. They allow the other end of a suture, with one end secured by a knot, to be led outside the main shaft portion 301 and function as a locking part. They also allow the knot of the suture to be formed outside the main shaft portion 301 and then housed inside the main shaft portion 301. The positions of the pair of pores 306a and 306b can be aligned in the axial direction of the main shaft portion 301, and the positions of the pair of through holes 307a and 307b can also be aligned in the axial direction of the main shaft portion 301. Between the pair of pores 306a and 306b, a groove 306c can be provided on the outer circumferential surface of the main shaft portion 301 along the axial direction, so that when a suture is passed between the pores 306a and 306b, the suture can be contained within the groove 306c. Similarly, between the pair of through holes 307a and 307b, a groove 307c can be provided on the outer circumferential surface of the main shaft portion 301 along the axial direction, so that when a suture is extended from the through hole 307a, the suture can be contained within the groove 307c. The depth of these grooves 306c and 307c is, for example, about 0.5 mm, and they may be valley-shaped grooves, or grooves with a rectangular or U-shaped cross-section. The pair of pores 306a and 306b and the pair of through-holes 307a and 307b can each be circular, but they may also be elongated or nearly rectangular holes that do not damage the suture thread passing through them.

[0037] Here, the axial position of the tip-side pore 306a is approximately 5 mm to 50 mm axially from the boundary with the needle-holding portion 304, and the axial position of the tip-side through-hole 307a is approximately 0 to 5 mm closer to the base end than the axial position of the tip-side pore 306a. By positioning the through-hole 307a closer to the base end than the pore 306a, as shown in Figure 16, when the suture is inserted, it can be made to protrude in a direction that naturally returns it to the base end, and by holding it in that direction, the work of pulling the suture to make a knot can be carried out efficiently. A taper or the like can also be provided on the inner wall surface of the through-hole 307a to make it easier to pull out in the predetermined direction.

[0038] Furthermore, the endoscopic surgical needle holder 300 of this embodiment is provided with a thread retraction groove 309 that extends from the through-hole 307a at the tip to a part of the needle gripping portion 304, making it even easier to handle the suture. When the suture is finally wound around the main shaft portion 301 and the main shaft portion 301 is pulled out to leave the knot inside the patient's body, the suture that functions as a fastening member as described above will cross the wound suture. In this case, to prevent the thread that crosses the wound suture from sliding unnecessarily, a thread retraction groove 309 is formed extending from the through-hole 307a at the tip to a part of the needle gripping portion 304 to allow the crossing thread to escape. With this structure, the wound suture can be quickly pulled out from the main shaft portion 301 and moved to the knot.

[0039] First, as a method for forming a knot 315 at the end of a suture thread 317 using the endoscopic surgical needle holder 300 of this embodiment, with the operating wire portion 308 not inserted into the main shaft portion 301, the suture thread 317 is passed through the proximal through-hole 307b to the proximal narrow hole 306b, the suture thread 317 is inserted again into the main shaft portion 301 through the groove 306c connecting the narrow hole 306b to the narrow hole 306a, and the inserted suture thread 317 is removed from the tip-side through-hole 307a. Next, the suture thread 317 coming out of the proximal through-hole 307b is cut, and a knot 315 is formed at its end. After the knot 315 is formed, if the suture thread 317 coming out of the through-hole 307a at the tip is pulled, the knot 315 will reach the pore 306b through the through-hole 307b at the base end. However, since the size of the pore is smaller than the knot 315, the knot 315 acts as a stopper, and when the operating wire portion 308 is inserted, the suture thread 317 will be held inside the main shaft portion 301 as shown in Figure 16.

[0040] Figure 17 shows the state in which the ligation thread 320 is wrapped around the main body. A surgical needle is used to suture the affected area, and the ligation thread 320 is wrapped around the shaft portion 301 of the main body in order to leave a knot at the suture site.

[0041] Next, the ligating thread 320 wound around the main shaft portion 301 is gathered and moved toward the tip of the needle gripping portion 304 to form a knot. At this time, as shown in Figure 18, the suture thread 317, which functions as a fastening member, crosses with the wound ligating thread 320. However, the suture thread 317 is guided to escape into the groove of the thread escape groove 309, which is formed from the through hole 307a at the tip to a part of the needle gripping portion 304, thereby reducing friction between threads that are under a certain degree of tension. By allowing the crossing threads to escape in this way, the ligating thread 320 can be handled as intended, shortening the time required for surgical procedures and enabling suturing without errors even by surgeons who are not highly skilled in surgical suturing.

[0042] As described above, according to each of the embodiments described, when performing intraperitoneal knots in endoscopic surgery such as laparoscopic surgery, particularly intraperitoneal ligation, it becomes possible to easily and reliably wrap and tie sutures around needle holders or forceps, thereby enabling smooth and safe suturing. [Explanation of symbols]

[0043] 100 Endoscopic surgical needle holders 101 Main shaft 101a First pivot 102 First operating handle section 102a Finger insertion section 103 Second operating handle section 103a Finger insertion section 104 Needle gripping part 104a Upper grip part 104b Lower grip part 105 Second axis support 106a Grip piece 106b Grip piece 107, 107w thread component 108 Operating wire section 110a, 110b, 110c, 110d Notches 112, 122, 132 openings 120 Engaging claw portion 124a, 124b Slit 126 Locking part 128 Notch 130 sutures 200 Endoscopic surgical forceps 201 Main shaft 204 Gripping part 207 Thread component 210a, 210b Notches 212 Opening 300 Endoscopic surgical needle holder 301 Main shaft 304 Needle gripping part 306a, 306b pores 307a, 307b through hole 306c, 307c groove 308 Operating wire section 309 Thread escape groove 315 knot 317 Suture thread 320 Ligation thread

Claims

1. An endoscopic surgical instrument characterized by having a main shaft portion connecting a gripping portion provided at the tip and an operating handle portion provided at the base, and having a locking portion on the outer circumference of the main shaft portion for engaging a flexible fastening member.

2. An endoscopic surgical instrument according to claim 1, characterized in that the fastening member is made of a thread of a natural polymer or synthetic resin.

3. An endoscopic surgical instrument according to claim 2, characterized in that the thread that serves as the fastening member is made of surgical suture thread.

4. An endoscopic surgical instrument according to claim 3, characterized in that the surgical suture is made of absorbable suture.

5. An endoscopic surgical instrument according to claim 1, characterized in that the locking portion has a notch provided on the outer circumference of the main body shaft portion.

6. An endoscopic surgical instrument according to claim 5, characterized in that the notch is formed in a wedge shape with a narrow base end and a wide tip end.

7. An endoscopic surgical instrument according to claim 1, characterized in that the locking portion has a locking piece capable of gripping the fastening member.

8. An endoscopic surgical instrument according to claim 1, characterized in that the locking portion has an opening for removing the fastening member.

9. An endoscopic surgical instrument according to claim 1, characterized in that the fastening member, which is locked to the locking portion, can be tilted at an obtuse angle with respect to the outer circumference of the main body shaft portion when moving the ligation thread from the base end to the tip end on the main body shaft portion, straddling the locking portion.

10. An endoscopic surgical instrument according to claim 1, characterized in that the locking portion has a plurality of locking points for locking a plurality of fastening members.

11. An endoscopic surgical instrument according to claim 1, wherein the locking portion is a pore formed on the outer circumference of the main body shaft, and the fastening member is a thread with a knot at one end, the knot preventing the pore from coming loose.

12. An endoscopic surgical instrument according to claim 11, characterized in that the end of the thread without a knot protrudes from a hole provided on the outer circumference of the main body shaft so as to extend toward the base end.

13. An endoscopic surgical instrument according to claim 1, characterized in that when the ligation thread is moved along the main body shaft from the base end to the tip end, a groove for releasing the ligation thread or a part of the retaining member is formed in at least one of the main body shaft and a part of the needle holder.

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