Fastening device and endoscope system

Abstract

This fastening device comprises: a shaft that has a longitudinal axis; a fixing member that is configured to fix the shaft to an endoscope by mounting the shaft to the endoscope; a stapling unit that is attached to the distal end of the shaft and is able to rotate about the longitudinal axis; an operating unit that is provided at the proximal end of the shaft; and a rotation restricting mechanism that is configured to restrict the rotation of the stapling unit about the longitudinal axis with respect to the endoscope, by means of an operation of the operating unit.

Description

[Technical field]

[0001] The present disclosure relates to fastening devices, endoscopic systems, and suturing methods. [Background technology]

[0002] In recent years, in surgery to suture the digestive tract, etc., fastening devices such as medical staplers (hereinafter sometimes referred to as staplers) and endoscope systems equipped with such fastening devices have been used to suture tissue. By using an appropriate stapler, surgery to suture the digestive tract, etc. can be easily performed and the surgery time can be significantly reduced.

[0003] In the endoscopic suturing system described in Patent Document 1, a tissue retractor is advanceable relative to a suturing device, and the advanced tissue retractor draws the tissue to be sutured up to the suturing device to suture the tissue to be sutured. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] US Patent Application Publication No. 2018 / 0042603 Summary of the Invention [Problem to be solved by the invention]

[0005] In a procedure for treating tissue inside a body using an endoscope system equipped with a fastening device, the relative positional relationship between the fastening device and the endoscope may be adjusted in some cases. For example, when an endoscope is inserted into a body and the fastening device is inserted close to the tissue inside the body to be treated, the orientation of the stapler may be adjusted according to the direction in which the tissue is to be sutured. For example, in the process of treating the tissue, the tissue grasped by the fastening device may be observed from the fastening device side. In such a case, it is necessary to adjust the relative positional relationship between the endoscope and the fastening device attached to the tip side of the endoscope. More specifically, the fastening device may be rotated relative to the endoscope along the circumferential direction around the longitudinal axis of the endoscope.

[0006] On the other hand, during the process of inserting the endoscope into the body, it is necessary to prevent the fastening device attached to the tip of the endoscope from unintentionally coming into contact with tissue inside the body or the fastening device from blocking the endoscope's field of view.

[0007] In consideration of the above circumstances, an object of the present disclosure is to provide a fastening device that enables suitable adjustment of the relative positional relationship in the circumferential direction between an endoscope and a fastening device attached to the tip side of the endoscope during the process of performing treatment on internal tissue, an endoscopic system including such a fastening device, and a method for suturing internal tissue using an endoscopic system. [Means for solving the problem]

[0008] According to one aspect of the present disclosure, a fastening device includes a shaft having a longitudinal axis, a fixing member configured to be attached to an endoscope to fix the shaft to the endoscope, a staple unit attached to a tip of the shaft and rotatable around the longitudinal axis, an operating portion provided at a base end of the shaft, and a rotation restriction mechanism configured to restrict rotation of the staple unit about the longitudinal axis relative to the endoscope by operation of the operating portion.

[0009] According to another aspect of the present disclosure, an endoscopic system includes an endoscope, a shaft having a longitudinal axis along the endoscope, a staple unit attached to a tip of the shaft and rotatable around the longitudinal axis, an operating portion provided at a base end of the shaft, and a rotation restriction mechanism configured to restrict rotation of the staple unit about the longitudinal axis relative to the endoscope by operation of the operating portion.

[0010] According to a further aspect of the present disclosure, a method for suturing tissue with a fastening device comprising: a shaft having a longitudinal axis; a fixing member configured to be attached to an endoscope to fix the shaft to the endoscope; a staple unit attached to a tip of the shaft and rotatable about the longitudinal axis; an operation section provided at a base end of the shaft; and a rotation restriction mechanism configured to restrict rotation of the staple unit about the longitudinal axis relative to the endoscope by operation of the operation section, the method comprising the steps of: inserting the staple unit and the endoscope in a state in which the rotation about the longitudinal axis is restricted into a body; grasping at least a portion of the tissue with forceps; pulling the portion of the tissue relatively toward the base end of the endoscope to position the portion of the tissue grasped by the forceps within a range in which the fastening device can suture; releasing the state in which the rotation of the staple unit about the longitudinal axis is restricted; and firing staples by the staple unit to suture the tissue. Effect of the Invention

[0011] According to the fastening device, endoscopic system, and suturing method according to each of the above-mentioned aspects of the present disclosure, during the process of performing treatment on tissue inside the body, the fastening device attached to the tip side of the endoscope can be suitably switched between a state in which it can rotate about the longitudinal axis and a state in which the rotation of the fastening device about the longitudinal axis is restricted. [Brief description of the drawings]

[0012] [Figure 1]1 is a diagram showing an overall configuration of an endoscope system including a fastening device according to a first embodiment of the present disclosure. [Diagram 2] 2 is a perspective view showing a configuration of a wire sheath fixing portion of the endoscope system. FIG. [Diagram 3] 2 is a perspective view showing a configuration of a tip portion of a fastening device of the endoscope system. FIG. [Figure 4] 11 is a perspective view showing the fastening device attached to an endoscope with a gripping portion in a closed state. FIG. [Diagram 5] FIG. 2 is a perspective view showing the fastening device attached to an endoscope and a gripping portion in an open state. [Figure 6] 13A to 13C are diagrams illustrating an operation for releasing the rotation restriction on the fastening device. [Figure 7] 13 is a bottom view showing an operation for releasing the rotation restriction on the fastening device. FIG. [Figure 8] 8 is a cross-sectional view taken along line AA in FIG. 7. [Figure 9] 10 is a flowchart showing the flow of a method for suturing internal tissue using the fastening device according to the present embodiment. [Figure 10] 11A to 11C are diagrams illustrating a method for suturing internal tissue according to the embodiment. [Figure 11] 11A to 11C are diagrams illustrating a method for suturing internal tissue according to the embodiment. [Figure 12] 11A to 11C are diagrams illustrating a method for suturing internal tissue according to the embodiment. [Figure 13] 11A to 11C are diagrams illustrating a method for suturing internal tissue according to the embodiment. [Figure 14] 11A to 11C are diagrams illustrating a method for suturing internal tissue according to the embodiment. [Figure 15] 13A and 13B are diagrams illustrating a configuration of a fastening device according to a modified example of the first embodiment of the present disclosure. [Figure 16] FIG. 4 is a front view showing the configuration of a rotation restricting mechanism of the fastening device. [Figure 17] 13A to 13C are diagrams illustrating an operation for restricting rotation of the fastening device. [Figure 18] 13A to 13C are diagrams illustrating an operation for restricting rotation of the fastening device. [Figure 19] 13A to 13C are diagrams illustrating an operation for restricting rotation of the fastening device. [Figure 20] FIG. 11 is a bottom view showing the configuration of a fastening device according to a second embodiment of the present disclosure. [Figure 21] 13A to 13C are diagrams illustrating an operation for releasing the rotation restriction on the fastening device. [Figure 22] 13A to 13C are diagrams illustrating an operation for restricting rotation of the fastening device. [Diagram 23] FIG. 11 is a bottom view showing the configuration of a fastening device according to Modification 1 of the second embodiment of the present disclosure. [Figure 24] 13 is a bottom view showing an operation for restricting rotation of the fastening device. FIG. [Diagram 25] 13 is a bottom view showing an operation for releasing the rotation restriction on the fastening device. FIG. [Figure 26] FIG. 11 is a bottom view showing the configuration of a fastening device according to Modification 2 of the second embodiment of the present disclosure. [Figure 27] 13 is a bottom view showing an operation for releasing the rotation restriction on the fastening device. FIG. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0013] First embodiment Hereinafter, a first embodiment of the present disclosure will be described with reference to Fig. 1 to Fig. 8. Fig. 1 is a diagram showing an overall configuration of an endoscope system 300 including a fastening device 100 according to this embodiment.

[0014] The endoscope system 300 according to this embodiment is used for surgery to suture the digestive tract, etc. The medical system 300 includes a fastening device 100 (medical stapler, staple unit), an endoscope 200, an opening / closing operation section 250, a needle driving operation section 270, a wire sheath (shaft) 280, a resin sheath 290, and a wire sheath fixing section 260. The opening / closing operation section 250 is an operation section that operates the fastening device 100 by an opening / closing operation wire 5. The opening / closing operation wire 5 is composed of a wire and a coil sheath provided to cover the wire. The needle driving operation section 270 is an operation section that operates the fastening device 100 by a needle driving wire 6. The needle driving wire 6 is also composed of a wire and a coil sheath provided to cover the wire, similar to the opening / closing operation wire 5. In this embodiment, the fastening device 100 is configured as, for example, a medical stapler.

[0015] The endoscope 200 has the configuration of a known flexible endoscope. The endoscope 200 includes a long insertion section 210 that is inserted into the body from its tip, an operation section 220 provided at the base end of the insertion section 210, and a universal cord 240.

[0016] A treatment tool channel 230 through which an endoscopic treatment tool is inserted is formed in the insertion section 210. A forceps port 214, which is a distal end opening of the treatment tool channel 230, is provided in the distal end portion 212 of the insertion section 210. The treatment tool channel 230 extends from the distal end portion 212 of the insertion section 210 to the operation section 220.

[0017] The tip portion 211 of the insertion portion 210 includes an imaging unit (not shown) including a CCD or the like. An objective lens 215 of the imaging unit is exposed at the tip portion 212 of the insertion portion 210. The tip portion 211 of the insertion portion 210 includes a hard portion on the tip side.

[0018] A knob 223 for operating the insertion portion 210 and a switch 224 for operating the imaging unit, etc. are provided on the proximal end side of the operation portion 220. The surgeon can bend the insertion portion 210 in a desired direction by operating the knob 223.

[0019] A forceps insertion port 222 communicating with the treatment tool channel 230 is provided on the distal end side of the operation section 220. The surgeon can insert an endoscopic treatment tool into the treatment tool channel 230 from the forceps insertion port 222.

[0020] The universal cord 240 connects the operation unit 220 to an external peripheral device. For example, the universal cord 240 outputs an image captured by the imaging unit to an external device. The image captured by the imaging unit is displayed on a display device such as a liquid crystal display via an image processing device.

[0021] The opening / closing operation unit 250 is configured to open and close the fastening device 100 by operating the opening / closing operation wire 5. As shown in Fig. 1, the opening / closing operation unit 250 includes an opening / closing operation unit main body 252 and an opening / closing operation slider 253. A base end of the opening / closing operation wire 5 is connected to the opening / closing operation slider 253. The surgeon can advance and retract the opening / closing operation wire 5 by advancing and retracting the opening / closing operation slider 253 in the longitudinal direction relative to the opening / closing operation unit main body 252.

[0022] The needle launching operation unit 270 is configured to release staples S (see FIG. 25) from the fastening device 100 by operating the needle launching wire 6, and to suture the internal tissue that is the target of treatment. As shown in FIG. 1, the needle launching operation unit 270 includes a needle launching operation unit main body 272 and a release operation slider 273. The base end of the needle launching wire 6 is connected to the release operation slider 273. The surgeon can advance and retract the needle launching wire 6 by advancing and retracting the release operation slider 273 in the longitudinal direction relative to the needle launching operation unit main body 272.

[0023] The wire sheath 280 is a sheath through which the opening / closing operation wire 5 and the needle driving wire 6 are inserted. As shown in FIG. 8, the wire sheath 280 is formed with a coating layer 281 formed on the outer periphery and a coil sheath 282 formed inside the coating layer 281. The coating layer 281 is formed, for example, of a braided tube or a three-layer coil, and can rotate following the rotation operation by the surgeon. The coil sheath 282 is flexible and has an inner cavity through which two inner sheaths 283 described later can be inserted. In this embodiment, an example in which the coating layer 281 is formed on the outside of the coil sheath 282 in the radial direction of the wire sheath 280 will be described, but this embodiment is not limited to this configuration. For example, the coating layer 281 may be formed on the inside of the coil sheath 282 in the radial direction of the wire sheath 280.

[0024] Two inner sheaths 283 are inserted into the inner cavity formed in the wire sheath 280. The two inner sheaths 283 are made of a resin material and are flexible. The opening / closing operation wire 5 and the needle driving wire 6 are inserted into the two inner sheaths 283, respectively. The wire sheath 280 may be provided with a multi-lumen tube with two lumens instead of the two inner sheaths 283.

[0025] As shown in Fig. 1, the resin sheath 290 is a sheath through which the wire sheath 280 is inserted so as to be capable of advancing and retreating. The resin sheath 290 is formed of a resin material. As shown in Fig. 1, the tip side of the resin sheath 290 is connected to the insertion section 210 of the endoscope 200 by a band 291. The resin sheath 290 has a tip fixed to the cap 1 of the fastening device 100 and a base end fixed to the wire sheath fixing section 260.

[0026] 2 is a perspective view of the wire sheath fixing part 260. The wire sheath fixing part 260 is a fixing part that restricts unintended advancement / retraction or unintended rotation of the wire sheath 280 relative to the resin sheath 290. The wire sheath fixing part 260 includes a wire sheath fixing part main body 261 and a band attachment part 264.

[0027] The wire sheath fixing portion main body 261 is formed in a cylindrical shape, and includes a distal end opening 262 and a proximal end opening 263. The proximal end of a resin sheath 290 is fixed to the distal end opening 262. A wire sheath 280 is formed extending from the proximal end opening 263 toward the proximal end side.

[0028] The band attachment portion 264 is a member attached to the operation portion main body 261, and includes a band insertion hole 265. By attaching a band (not shown) that has passed through the band insertion hole 265 to the endoscope 200, the operation portion main body 261 can be easily fixed to the endoscope 200. By fixing the operation portion main body 261 to the endoscope 200, the wire sheath 280 and the resin sheath 290 can be prevented from being separated from the insertion portion 210 of the endoscope 200.

[0029] A rubber plug 266 that comes into contact with the wire sheath 280 is provided at the proximal end opening 263 of the wire sheath 280. Frictional force generated between the wire sheath 280 and the rubber plug 266 can suppress unintended advance / retract movement and rotational movement of the wire sheath 280 during treatment.

[0030] 3 is a perspective view of the fastening device 100 according to this embodiment. The fastening device 100 includes a cap (fixing member) 1, a gripping portion (staple unit) 2, a staple releasing portion 3, a staple receiving portion 4, an opening / closing operation wire 5, and a releasing operation wire 6. The gripping portion 2 includes a first gripping member (first jaw, staple head) 21, a second gripping member (second jaw, anvil) 22, an opening / closing rotation shaft 23, and a movable pin (not shown). The first gripping member 21 and the second gripping member 22 are connected by the opening / closing rotation shaft 23 so as to be openable and closable. The first gripping member 21 and the second gripping member 22 rotate relatively to grip the target tissue. The opening / closing rotation shaft 23 is provided on the distal end side of the cap 1. The axial direction C of the opening / closing rotation shaft 23 is perpendicular to the axial direction A and the up-down direction B of the cap 1. The fastening device 100 is detachable from a tip portion 211 of an insertion portion 210 of an endoscope 200 .

[0031] The cap 1 is formed in a substantially cylindrical shape. The cap 1 has a first through hole 11 penetrating in the axial direction A and a second through hole 12 (see FIG. 6) penetrating in the axial direction A. The first through hole 11 is a hole into which the tip portion 211 of the insertion portion 210 is inserted. The shape of the first through hole 11 is formed to match the outer shape of the tip portion 211 of the insertion portion 210. Therefore, by inserting the tip portion 211 of the endoscope 200 into the first through hole 11, the cap 1 can be attached to the tip portion 211 of the endoscope 200. In this embodiment, the central axis of the first through hole 11 in the axial direction A is eccentric with respect to the central axis of the cap 1 in the axial direction A.

[0032] The second through hole 12 (see FIG. 6) is a hole into which the resin sheath 290 is inserted. The inner diameter of the second through hole 12 is approximately the same as the outer diameter of the resin sheath 290. The tip of the resin sheath 290 is inserted and fixed in the second through hole 12. The wire sheath 280, the opening / closing operation wire 5, and the releasing operation wire 6, which pass through the resin sheath 290, pass through the second through hole 12 and extend to the tip side.

[0033] The central axis of the second through hole 12 in the axial direction A is eccentric with respect to the central axis of the cap 1 in the axial direction A. The direction in which the central axis of the second through hole 12 is eccentric with respect to the central axis of the cap 1 is opposite to the direction in which the central axis of the intermediate first through hole 11 is eccentric with respect to the central axis of the cap 1. In other words, in this embodiment, the central axis of the first through hole 11 and the central axis of the second through hole 12 are disposed on both sides of the central axis of the cap 1 in the up-down direction B.

[0034] FIG. 4 is a perspective view showing a state in which the fastening device 100 according to this embodiment is attached to the tip of the insertion section 210 of the endoscope 200. The first gripping member 21 has a first tip portion 21a and a base end portion 21b, and is formed in a substantially T-shape in a plan view. The first tip portion 21a is disposed on the tip side of the base end portion 21b. The first tip portion 21a is formed in a substantially rectangular parallelepiped shape. The first tip portion 21a is formed in a rectangular shape extending in the axial direction C of the opening / closing rotation shaft 23 in a plan view. The first tip portion 21a is provided with a staple discharge portion 3. An opening of the staple discharge portion 3 is provided on the upper surface of the first tip portion 21a. The base end portion 21b is formed so as to be accommodated in the recess 1a of the cap 1 described later. As shown in FIG. 5, the first gripping member 21 further has an abutment pin 21c and a first engagement groove 21d. The abutment pin 21c is provided at the base end of the first main body portion 21b and abuts against the second gripping member 22 in the closed state to regulate the movable range of the second gripping member 22. The first engagement groove 21d is a groove that penetrates the first gripping member 21 in the axial direction C of the opening / closing rotation shaft 23. The first engagement groove 21d extends in the axial direction A.

[0035] The second gripping member 22 has a U-shaped member 22a formed in a substantially U-shape and a second main body portion 22b that rotatably supports the U-shaped member 22a. The U-shaped member 22a is formed in a substantially U-shape, with both ends connected to the second main body portion 22b and a central portion disposed on the tip side. The tip side of the central portion of the U-shaped member 22a is formed in a substantially rectangular parallelepiped shape and is provided with a staple receiving portion 4. The second main body portion 22b is rotatably attached to the first main body portion 21b of the first gripping member 21 by the opening / closing rotating shaft 23. The second main body portion 22b is formed with a guide groove 22d (see FIG. 6) into which the first main body portion 21b is inserted. As shown in FIGS. 5 and 6, second engagement grooves 22e are formed on both sides of the guide groove 22d of the second main body portion 22b.

[0036] When the fastening device 100 is attached to the tip of the insertion section 210 of the endoscope 200 and inserted into the body, the first gripping member 21 and the second gripping member 22 of the gripping section 2 are in a closed state and abut against the cap 1. More specifically, as shown in Fig. 4, the base end 21b of the first gripping member 21 is fitted into a recess 1a (see Fig. 6) formed on the tip side of the cap 1.

[0037] 4 and 5, when the cap 1 is attached to the tip portion 211 of the endoscope 200, the objective lens 215 and the forceps port 214 are exposed from the tip-side opening 13 of the first through-hole 11 of the cap 1. The surgeon can observe the treatment target through the objective lens 215 even in a state where the fastening device 100 is attached to the tip portion 211 of the endoscope 200.

[0038] As shown in Fig. 4, when the gripping portion 2 is in the closed state, the staple releasing portion 3 and the staple receiving portion 4 face each other. When the gripping portion 2 is in the closed state, a small gap is formed between the staple releasing portion 3 and the staple receiving portion 4. When the gripping portion 2 is in the closed state, the optical axis of the objective lens 215 passes outside the first gripping member 21 and the second gripping member 22. When the gripping portion 2 is in the closed state, the central axis of the forceps opening 214 is in a position that does not overlap the first gripping member 21 but overlaps the second gripping member 22.

[0039] 5, when the gripping portion 2 is in the open state, the staple receiving portion 4 is disposed on the base end side of the opening / closing rotation shaft 23. When the gripping portion 2 is in the open state, the staple releasing portion 3 and the staple receiving portion 4 are disposed on either side of the optical axis of the objective lens 215. When the gripping portion 2 is in the open state, the optical axis of the objective lens 215 passes through the visual field space 25. When the gripping portion 2 is in the open state, the central axis of the forceps port 214 passes through the visual field space 25.

[0040] 6 is a diagram showing a state (first state) in which the engagement between the gripping part 2 and the cap 1 is released. As shown in FIG. 6, a recess 1a having a dimension in which at least a part of the base end 21b of the first gripping member 21 can be fitted is formed at the tip of the cap 1. The base end 21b of the first gripping member 21 is formed in a shape corresponding to the shape of the recess 1a of the cap 1. Therefore, when the gripping part 2 and the cap 1 are engaged with each other in a state in which at least a part of the base end 21b of the first gripping member 21 is accommodated in the recess 1a, the rotation of the gripping part 2 relative to the cap 1 is restricted (second state). In this embodiment, the base end 21b of the first gripping member 21 and the recess 1a of the cap 1 constitute a rotation restriction mechanism of the fastening device 100.

[0041] FIG. 7 is a bottom view showing a state in which the wire sheath 280 is disengaged from the cap 1. As shown in FIGS. 6 and 7, a slope 1b is formed in the circumferential direction of the recess 1a of the cap 1. A slope 21f corresponding to the slope 1b is formed in the circumferential direction of the base end 21b of the first gripping member 21. As described above, the gripping portion 2 and the cap 1 can be engaged in a state in which the slope 21f of the first gripping member 21 and the slope 1b of the cap 1 abut against each other. Therefore, as shown in FIG. 4, even if the surgeon tries to rotate the wire sheath 280 by operating the wire sheath fixing portion 260 in a state in which the gripping portion 2 and the cap 1 are engaged with each other, the rotation of the gripping portion 2 connected to the wire sheath 280 about the longitudinal axis is restricted.

[0042] 6 and 7, when the surgeon operates the wire sheath fixing portion 260 to cause the wire sheath 280 to protrude further distally than the cap 1, the grip portion 2 connected to the wire sheath 280 is also moved distally. This operation disengages the grip portion 2 from the cap 1. In other words, the surgeon can release the state in which rotation of the grip portion 2 around the longitudinal axis is restricted by operating the wire sheath fixing portion 260 to cause the wire sheath 280 to protrude further distally than the cap 1. At this time, the grip portion 2 enters a state (first state) in which it is rotatable around the longitudinal axis.

[0043] In this state, the surgeon can rotate the gripping portion 2 around the longitudinal axis by rotating the wire sheath 280. By such an operation, for example, the orientation of the gripping portion 2 can be adjusted to match the tissue. After that, the surgeon can treat the tissue to be treated by the same operation as that of a conventional fastening device. During this treatment process, the surgeon can observe the tissue to be treated grasped by the gripping portion 2 at a desired angle using the imaging unit of the endoscope 200 by rotating the wire sheath 280. For example, the surgeon can observe the tissue from the first gripping member 21 side by rotating the wire sheath 280.

[0044] When the treatment of the tissue to be treated using the fastening device 100 is completed and the fastening device 100 is removed from the body, it is preferable to remove the fastening device 100 in an integrated configuration by re-engaging the gripping portion 2 and the cap 1 in order to easily perform the removal operation and to avoid unintended contact with the internal tissue. For this reason, the surgeon rotates the wire sheath 280, aligns the base end portion 21b of the first gripping member 21 with the recessed portion 1a of the cap 1, and then retracts the wire sheath 280 toward the base end side. More specifically, for example, the surgeon can rotate the wire sheath 280 while observing the attitude of the gripping portion 2 with the imaging unit of the endoscope 200, thereby aligning the inclined surface 21f of the base end portion 21b of the first gripping member 21 with the inclined surface 1b formed in the recessed portion 1a of the cap 1. In this state, the surgeon retracts the wire sheath 280 toward the base end side, whereby the gripping portion 2 and the cap 1 are engaged with each other in a state in which the base end portion 21b of the first gripping member 21 is housed in the recess 1a of the cap 1. Thereafter, the surgeon can remove the gripping portion 2 and the cap 1 that have been engaged and integrated from the body.

[0045] According to the fastening device 100 of this embodiment, the engagement state between the cap 1 and the grip portion 2 can be appropriately switched. In a state in which the cap 1 and the grip portion 2 are engaged, even if the surgeon rotates the wire sheath 280, the rotation of the grip portion 2 around the longitudinal axis is restricted. In other words, in this state, the rotation of the grip portion 2 around the axis relative to the endoscope 200 is restricted. When the fastening device 100 of this embodiment is attached to the endoscope 200 and inserted into the body, it is possible to avoid obstructing the field of view of the imaging unit of the endoscope 200 and unintentionally contacting tissue inside the body.

[0046] When the surgeon moves the wire sheath 280 toward the distal end and causes the gripping portion 2 to protrude further toward the distal end than the cap 1, the cap 1 and the gripping portion 2 are disengaged. In this state, the surgeon can rotate the wire sheath 280 and the gripping portion 2 connected to the wire sheath 280 about the longitudinal axis. When the fastening device 100 according to this embodiment is inserted into the body and a treatment is performed on tissue, it is possible to align the direction of the gripping portion 2 with the direction in which the tissue is to be sutured, observe the tissue from a desired direction, and so on.

[0047] As described above, according to the fastening device 100 of this embodiment and the endoscopic system 300 having the fastening device 100, the surgeon can appropriately switch between a rotatable state and a rotation-restricted state of the fastening device 100 for the endoscope 200 simply by operating the wire sheath 280.

[0048] Next, the operation of the fastening device 100 according to the present embodiment described above will be described as an example with reference to Fig. 9 to Fig. 14. Fig. 9 is a flowchart showing a procedure of a procedure performed by an operator using the fastening device 100. Figs. 10 to 14 are views for explaining the operation of the fastening device 100.

[0049] 9, the surgeon attaches the fastening device 100 to the tip portion 211 of the endoscope 200 (attaching step S11). The surgeon inserts the fastening device 100 and the endoscope 200 into the body (insertion step S12).

[0050] The surgeon brings the tip 211 of the endoscope 200 to which the fastening device 100 is attached close to the treatment target T (an example of a target tissue). The surgeon operates the opening / closing operation part 250 to advance the opening / closing operation wire 5, thereby transitioning the gripping part 2 to an open state. Since the optical axis of the objective lens 215 passes through the visual field space 25, the surgeon can observe the treatment target T through the imaging unit of the endoscope 200. Since the central axis of the forceps port 214 passes through the visual field space 25, as shown in FIG. 10, the surgeon protrudes the grasping forceps (treatment tool) G from the forceps port 214 (protruding step S13), operates the grasping forceps G to bring the tip of the grasping forceps G close to the treatment target (advancing step S14), and grasps the treatment target T (grasping step S15).

[0051] The surgeon retracts the grasping forceps G while holding the treatment target T with the grasping forceps G. By retracting the grasping forceps G, the surgeon retracts the treatment target T so that the treatment target T is positioned at least in the visual field space 25 (retracting step S16). In this embodiment, the surgeon may retract the grasping forceps G until the tip of the grasping forceps G passes through the visual field space 25, thereby retracting the treatment target T until the treatment target T passes through the visual field space 25.

[0052] In this state, the operator moves the wire sheath 280 toward the distal end, thereby releasing the engagement between the cap 1 and the grip portion 2 (rotation restriction release step S17). This allows the operator to rotate the wire sheath 280 by manipulating it, thereby allowing the grip portion 2 to rotate around the longitudinal axis. This allows the operator to adjust the orientation and posture of the grip portion 2 to match the direction in which the operator wants to suture the treatment target T.

[0053] In the retracting step S16, the surgeon may retract the treatment target T by advancing the gripping portion 2 relative to the gripping forceps G. That is, in the retracting step S16, the surgeon retracts the gripping forceps G relatively to the gripping portion 2 to retract the treatment target T. As shown in FIG. 11, since the first gripping member 21 presses down on the periphery of the treatment target T, the surgeon can easily retract the treatment target T with the gripping forceps G.

[0054] With the treatment target T grasped by the grasping forceps G, a large amount of tissue can be taken into the grasping part by advancing the grasping part. Even when the treatment target T cannot be approached, the treatment target T can be approached by advancing the grasping part. When the treatment target T is retracted by advancing the gripping portion 2 relative to the gripping forceps G, the rotation restriction release step is substantially performed before the retraction step S16. In this embodiment, the rotation restriction release step S17 may be performed before the retraction step S16 or after the retraction step S16.

[0055] 12, the surgeon operates the opening / closing operation part 250 to retract the opening / closing operation wire 5, thereby transitioning the gripping part 2 to a closed state. The treatment target T is sandwiched between the staple releasing part 3 of the first gripping member 21 and the staple receiving part 4 of the second gripping member 22.

[0056] When the gripping portion 2 is in the closed state, a part of the treatment target T gripped by the gripping forceps G can be accommodated in a space (visual space 25) formed by the U-shaped member 22a and the second main body portion 22b of the second gripping member 22. Therefore, the treatment target T sandwiched between the staple releasing portion 3 and the staple receiving portion 4 is unlikely to escape. In this state, the restriction on the rotation of the gripping portion 2 about the longitudinal axis is released, so that the surgeon can rotate the wire sheath 280 to observe the treatment target T from a desired angle.

[0057] With the treatment target T sandwiched between the staple release portion 3 and the staple receiving portion 4, the surgeon operates the release operation portion 270 to pull the release operation wire 6, thereby releasing the stored staple S toward the staple receiving portion 4. The needle tip S1 of the staple S penetrates the treatment target T and is bent by contacting the pocket 41 (see FIG. 5) of the staple receiving portion 4. As a result, as shown in FIG. 12, the treatment target T is sutured (suturing step S18).

[0058] 13, the surgeon operates the opening / closing operation unit 250 to open the gripping unit 2 again. The surgeon then removes the gripping forceps G from the treatment target T to complete the suturing treatment. As shown in FIG 14, the surgeon may remove the gripping forceps G via the forceps opening 214, and then protrude a treatment tool such as a snare wire or a high-frequency knife from the forceps opening 214 to resect the sutured treatment target T.

[0059] Thereafter, the surgeon rotates the wire sheath 280 so that the base end 21b of the first gripping member 21 and the recess 1a of the cap 1 are aligned, and then retracts the wire sheath 280 toward the base end. In this state, the surgeon retracts the wire sheath 280 toward the base end, so that the gripping portion 2 and the cap 1 engage with each other with the base end 21b of the first gripping member 21 housed in the recess 1a of the cap 1. This restricts the rotation of the gripping portion 2 around the longitudinal axis (rotation restriction step S19).

[0060] The fastening device 100 and the endoscope 200, whose rotation has been restricted by the engagement between the cap 1 and the gripping portion 2, are removed from the body (removal step S20). After that, the surgeon completes the suturing method for the treatment target T through necessary steps (end S21).

[0061] The suturing method for the treatment target T according to this embodiment has been described using a flowchart as shown in Fig. 9, but is not limited thereto. As described above, the rotation restriction release step S17 may be performed before the retraction step S16 or after the retraction step S16. The surgeon can adjust each step appropriately in consideration of the actual treatment situation.

[0062] (Modification) Hereinafter, the configuration of a fastening device 100A according to a modified example of this embodiment will be described with reference to Figures 15 to 19. Regarding the fastening device 100A according to this modified example, the same reference numerals are given to the same components as those of the fastening device 100 according to the above-described first embodiment, and the description thereof will be omitted. Only the differences between the fastening device 100A according to this modified example and the fastening device 100 according to the first embodiment will be described.

[0063] Fig. 15 is a diagram showing the configuration of the fastening device 100A according to this modified example. Fig. 16 is a front view for explaining the operation of using the fastening device 100A according to this modified example. Fig. 17 is a diagram for explaining the operation of using the fastening device 100A according to this modified example. Fig. 18 is an enlarged cross-sectional view of a portion of the configuration of the fastening device 100A according to this modified example. Fig. 19 is a diagram for explaining the operation of using the fastening device 100A according to this modified example.

[0064] 15, in the fastening device 100A according to this modification, a slope inclined with respect to the longitudinal axis of the wire sheath 280 is formed on each of the base end 21b of the first gripping member 21 and the recess 1a of the cap 1. The base end 21b of the first gripping member 21 is formed with a slope 21g inclined with respect to the longitudinal axis of the wire sheath 280. The recess 1a of the cap 1 is formed with a slope 1c corresponding to the slope 21g and inclined with respect to the longitudinal axis of the wire sheath 280. The other configurations of the fastening device 100A according to this modification are the same as those of the fastening device 100 according to the first embodiment described above.

[0065] The inclined surfaces 21g and 1c may be inclined at substantially the same angle with respect to the longitudinal axis of the wire sheath 280. When the surgeon retracts the wire sheath 280 toward the base end side from the state shown in Fig. 9, i.e., the state in which the engagement between the gripping portion 2 and the cap 1 is released, the base end portion 21b of the first gripping member 21 is similarly pulled toward the base end side. With this operation, the base end portion 21b of the first gripping member 21 engages with the recessed portion 1a of the cap 1 with the inclined surfaces 21g and 1c in contact with each other.

[0066] When the surgeon engages the gripping portion 2 with the cap 1 again after performing a treatment on tissue using the fastening device 100 according to the above-described first embodiment, it is necessary to operate the wire sheath 280 and adjust the attitude of the gripping portion 2 so that the inclined surface 21f formed on the base end portion 21b of the gripping portion 2 faces the inclined surface 1b formed on the recessed portion 1a of the cap 1. As shown in Fig. 10, if the relative positional relationship in the circumferential direction between the gripping portion 2 and the cap 1 is misaligned, the surgeon needs to adjust the position of the gripping portion 2 while observing the state and attitude of the gripping portion 2, and engage it with the cap 1.

[0067] On the other hand, according to the fastening device 100A of this modification, even in the state shown in Fig. 16, the surgeon only has to perform an operation of retracting the wire sheath 280, and as a result, as shown in Fig. 18, the inclined surface 21g formed on the base end 21b of the gripping portion 2 comes into contact with the inclined surface 1c formed on the tip side of the recessed portion 1a of the cap 1, so that the base end 21b of the first gripping member 21 slides into and is accommodated in the recessed portion 1a. As a result, the gripping portion 2 and the cap 1 are engaged with each other, as shown in Figs. 17 and 19. According to the fastening device 100A of this modification, the surgeon does not need to observe the state and posture of the gripping portion 2 in the operation of engaging the gripping portion 2 and the cap 1.

[0068] The fastening device 100A according to this modification has the same configuration as the fastening device 100 according to the first embodiment and has the same effects. An endoscope system including the fastening device 100A according to this modification has the same effects as the endoscope system 300 according to the first embodiment.

[0069] Second Embodiment 20 to 22, the configuration of a fastening device 100B according to a second embodiment of the present disclosure will be described. In the fastening device 100B according to this embodiment, the same reference numerals are given to the same components as those of the fastening device 100 according to the first embodiment described above, and the description thereof will be omitted. Only the differences between the fastening device 100B according to this embodiment and the fastening device 100 according to the first embodiment will be described.

[0070] Fig. 20 is a bottom view of the fastening device 100B according to this embodiment. Fig. 21 and Fig. 22 are views for explaining the operation of the fastening device 100B according to this embodiment. The fastening device 100B according to this embodiment differs from the fastening device 100 according to the first embodiment described above in that one rotation adjustment wire 292 is connected to the base end portion 21b of the first gripping member 21.

[0071] As shown in FIG. 20, a flexible rotation adjustment wire 292 is connected to the base end 21b of the first gripping member 21. The rotation adjustment wire 292 may be connected to the base end 21b of the first gripping member 21 by various known methods such as welding and adhesion. Although not shown, the rotation adjustment wire 292 is inserted into a resin sheath 293 arranged in parallel with the resin sheath 290 and extends to the wire sheath fixing portion 260 on the base end side. In this embodiment, although not shown, the resin sheath 293 may be attached to the rubber plug 266 on the base end side. The rotation adjustment wire 292 may be configured to be operated by the wire sheath fixing portion 260, or an operation portion that adjusts only the rotation adjustment wire 292 may be configured.

[0072] 20, in a state in which the grip portion 2 protrudes further toward the distal end side than the cap 1, the rotation adjustment wire 292 is loosened and connected to the base end portion 21b of the first grip member 21 of the grip portion 2. In this state, the grip portion 2 and the cap 1 are disengaged, and therefore the grip portion 2 can rotate around the longitudinal axis of the wire sheath 280 by an operator rotating the wire sheath 280. That is, in the fastening device 100B according to this embodiment, when the grip portion 2 is moved to the distal end side than the cap 1, the operator operates the rotation adjustment wire 292 to be loosened, and the restriction on the rotation of the grip portion 2 around the longitudinal axis direction is released.

[0073] At this time, the surgeon can use the gripping portion 2 to treat the tissue. When the surgeon performs treatment on the tissue and removes the fastening device 100B from the body, the gripping portion 2 and the cap 1 are engaged again. For example, as shown in FIG. 21, when the relative positional relationship between the gripping portion 2 and the cap 1 in the circumferential direction is shifted, the surgeon pulls the position adjustment wire 292 toward the base end side, and the force (pulling force) acting on the position adjustment wire 292 is transmitted to the gripping portion 2. The force with which the surgeon pulls the position adjustment wire 292 toward the base end side causes the position adjustment wire 292 to transition from a loosened state to a substantially straight state as shown in FIG. 16. At the same time, the force acting on the position adjustment wire 292 acts on the gripping portion 2, and a moment that rotates the gripping portion 2 around the longitudinal axis direction is generated. As a result, as shown in FIG. 22, the relative positions of the base end portion 21b of the gripping portion 2 and the recessed portion 1a formed in the cap 1 in the circumferential direction coincide with each other. In this state, when the surgeon retracts the wire sheath 280 toward the base end side, the base end 21b of the grip portion 2 is housed in the recess 1a formed in the cap 1, and the grip portion 2 and the cap 1 are engaged with each other.

[0074] According to the fastening device 100B of this embodiment, a traction force acting on the position adjustment wire 292 toward the base end side acts as a rotation moment on the grip part 2 on the tip side, causing the grip part 2 to rotate around the longitudinal axis. Therefore, when the surgeon engages the grip part 2 with the cap 1, the operation of aligning the relative positions of the base end part 21b of the grip part 2 and the recess 1a of the cap 1 becomes easy.

[0075] The fastening device 100B according to this embodiment has the same configuration as the fastening device 100 according to the first embodiment and has the same effects. The endoscope system including the fastening device 100B according to this embodiment has the same effects as the endoscope system 300 according to the first embodiment.

[0076] (Variation 1) Hereinafter, the configuration of a fastening device 100C according to Modification 1 of this embodiment will be described with reference to Figures 23 to 25. Regarding the fastening device 100C according to this modification, the same reference numerals are given to the same components as those of the fastening device 100B according to the above-mentioned second embodiment, and the description thereof will be omitted. Only the differences between the fastening device 100B according to this modification and the fastening device 100B according to the second embodiment will be described.

[0077] Fig. 23 is a bottom view showing a state in which the grip 2 and the cap 1 are engaged in the fastening device 100C according to this modification. Fig. 24 is a bottom view showing a state in which the grip 2 is disengaged from the cap 1 and rotation of the grip 2 about the longitudinal axis is restricted by moving the grip 2 further toward the tip side than the cap 1 in the fastening device 100C according to this modification. Fig. 25 is a bottom view showing a state in which the grip 2 is disengaged from the cap 1 and rotation of the grip 2 about the longitudinal axis is no longer restricted in the fastening device 100C according to this modification.

[0078] 23, the fastening device 100C according to this modification is different from the fastening device 100B according to the second embodiment described above in that a rotation restriction wire 294 having higher strength is inserted into a resin sheath 293 instead of the rotation adjustment wire 292. The fastening device 100C according to this modification has a port 295 at the base end 21b of the gripping part 2, which opens toward the base end side and into which the rotation restriction wire 294 can be inserted.

[0079] The rotation restriction wire 294 according to this modification is preferably flexible so that the fastening device 100C can smoothly pass through a curved lumen when inserted into the body. On the other hand, the rotation restriction wire 294 is preferably rigid enough to be moved further distal than the cap 1 and inserted into a port 295, as shown in FIG. 19, which will be described later. The rotation restriction wire 294 is inserted through a through hole and a resin sheath 293 formed in the cap 1 and extends to the wire sheath fixing portion 260 on the proximal side. In this modification, although not shown, the rotation restriction wire 294 may be configured to be operated by the wire sheath fixing portion 260, or an operation portion for adjusting only the rotation restriction wire 294 may be configured.

[0080] When the fastening device 100C according to this modification is inserted into the body, as shown in Fig. 23, the engagement between the grip portion 2 and the cap 1 is maintained in a state in which the rotation restricting wire 294 is inserted into a port 295 formed in the base end portion 21b of the grip portion 2. In this state, the rotation of the grip portion 2 around the longitudinal axis direction is restricted. The fastening device 100C according to this modification is inserted into the body up to the vicinity of the tissue to be treated in a state in which the grip portion 2 and the cap 1 are engaged and integrated.

[0081] 24, when the surgeon pushes the wire sheath 280 toward the distal end of the fastening device 100C according to this modification while the fastening device 100C is inserted close to the tissue, the gripping portion 2 connected to the wire sheath 280 moves toward the distal end together with the wire sheath 280. This disengages the gripping portion 2 from the cap 1. However, because the rotation restriction wire 294 is inserted into the port 295 formed in the base end portion 21b of the gripping portion 2, the restriction on rotation of the gripping portion 2 about the longitudinal axis direction is maintained.

[0082] 25, when the surgeon moves the rotation restriction wire 294 toward the base end side, the rotation restriction wire 294 is pulled out from the port 295. This releases the restriction on the rotation of the gripping portion 2 about the longitudinal axis. As a result, when the surgeon operates to rotate the wire sheath 280, the gripping portion 2 can rotate about the longitudinal axis. Then, as in the above-described embodiments and modifications, the surgeon can use the fastening device 100C to perform treatment on internal tissue.

[0083] Although not shown, when the surgeon completes the treatment of the internal tissue using the fastening device 100C and removes the fastening device 100C from the body, the surgeon again engages the cap 1 with the gripping portion 2. When the surgeon engages the cap 1 with the gripping portion 2, for example, the surgeon operates to rotate the wire sheath 280, aligns the position of the port 295 formed in the base end portion 21b of the gripping portion 2 with the position of the rotation restriction wire 294, and then can push the rotation restriction wire 294 toward the port 295. Then, when the surgeon moves the wire sheath 280 toward the base end side in a state in which the rotation restriction wire 294 is inserted into the port 295, that is, in a state in which the rotation around the longitudinal axis of the gripping portion 2 is restricted, the base end portion 21b of the gripping portion 2 is accommodated in the recess 1a of the cap 1, and the gripping portion 2 and the cap 1 are engaged with each other. The surgeon can remove the fastening device 100C in which the gripping portion 2 and the cap 1 are engaged with each other from the body.

[0084] The fastening device 100C according to this modification has the same configuration as the fastening device 100B according to this embodiment, and therefore has the same effects. An endoscope system including the fastening device 100C according to this modification has the same effects as the endoscope system according to this embodiment.

[0085] (Variation 2) Hereinafter, the configuration of a fastening device 100D according to Modification 2 of this embodiment will be described with reference to Figures 26 and 27. Regarding the fastening device 100D according to this modification, the same reference numerals are given to the configurations common to the fastening device 100C according to the above-mentioned Modification 1, and the description thereof will be omitted. Only the points different from the fastening device 100D according to this modification and the fastening device 100C according to Modification 1 will be described.

[0086] Fig. 26 is a bottom view showing a state in which the gripping portion 2 is disengaged from the cap 1 and the rotation of the gripping portion 2 about the longitudinal axis is restricted by moving the gripping portion 2 further toward the tip side than the cap 1 in the fastening device 100D according to this modification. Fig. 27 is a bottom view showing a state in which the restriction on the rotation of the gripping portion 2 about the longitudinal axis is released in the fastening device 100D according to this modification.

[0087] A fastening device 100D according to this modification differs from the above-described modification 1 in the manner of restricting rotation about the longitudinal axis of the grip portion 2. More specifically, the fastening device 100D according to this modification has a protrusion 297 formed on the base end portion 21b of the grip portion 2, and forceps (rotation restricting member) 296 capable of gripping the protrusion 297.

[0088] In the fastening device 100D according to this modification, a protrusion 297 is formed at the base end 21b of the gripping member 2 in a direction intersecting the longitudinal axis of the wire sheath 280, i.e., protruding radially outward. On the other hand, the forceps 296 is inserted through a through hole formed in the cap 1 and a resin sheath 293, and is formed to extend to the wire sheath fixing part 260 on the base end side by being inserted through a through hole formed in the cap 1 and a resin sheath 293. In this modification, although not shown, the forceps 296 may be configured to be operated by the wire sheath fixing part 260, or an operating part that operates only the forceps 296 may be configured. The forceps 296 according to this modification may be configured by providing a pair of forceps capable of gripping the protrusion 297 at the tip of the rotation restriction wire 294 according to the above-mentioned modification 1 of the present embodiment. However, the forceps 296 according to this modification is not limited to this configuration. For example, a hook capable of being caught by the projection 297 may be provided at the tip of a flexible wire having a predetermined strength.

[0089] The fastening device 100D according to this modification is inserted close to the tissue in the body to be treated with the gripping portion 2 and the cap 1 engaged and integrated. When the fastening device 100D according to this modification is inserted into the body, the base end portion 21b of the gripping portion 2 is accommodated in the recess 1a formed in the cap 1, and the forceps 296 grips the protrusion 297. This restricts the rotation of the gripping portion 2 around the longitudinal axis.

[0090] When the fastening device 100D according to this modification is inserted close to tissue, as shown in Fig. 26, when the surgeon pushes the wire sheath 280 toward the distal end, the gripping portion 2 connected to the wire sheath 280 moves toward the distal end together with the wire sheath 280. This releases the engagement between the gripping portion 2 and the cap 1. However, since the forceps 296 continues to grip the protrusion 297, the restriction on the rotation of the gripping portion 2 about the longitudinal axis direction is maintained.

[0091] 27, the surgeon can release the forceps 296 from gripping the protrusion 297 by manipulating the forceps 296. This operation releases the restriction on rotation of the gripping portion 2 around the longitudinal axis. As a result, when the surgeon operates to rotate the wire sheath 280, the gripping portion 2 can rotate around the longitudinal axis. Then, as in the above-described embodiments and modifications, the surgeon can use the fastening device 100D to perform treatment on internal tissue.

[0092] When the surgeon completes the treatment of the internal tissue using the fastening device 100D and removes the fastening device 100D from the body, the surgeon again engages the cap 1 with the gripping portion 2. When the surgeon again engages the cap 1 with the gripping portion 2, for example, the surgeon operates the wire sheath 280 so as to rotate, aligns the position of the protrusion 297 formed on the base end portion 21b of the gripping portion 2 with the position of the forceps 296, and then moves the forceps 296 toward the base end portion 21b of the gripping portion 2 to grip the protrusion 297. Then, when the surgeon moves the wire sheath 280 toward the base end side in a state in which the forceps 296 grips the protrusion 297, that is, in a state in which the rotation of the gripping portion 2 around the longitudinal axis is restricted, the base end portion 21b of the gripping portion 2 is accommodated in the recess 1a of the cap 1, and the gripping portion 2 and the cap 1 are engaged with each other. The surgeon can then remove the fastening device 100D, with the grip portion 2 and the cap 1 engaged, from the body.

[0093] The fastening device 100D according to this modification has the same configuration as the fastening device 100B according to this embodiment, and therefore has the same effects. An endoscope system including the fastening device 100D according to this modification has the same effects as the endoscope system according to this embodiment.

[0094] Although the embodiments of the present disclosure and the modifications corresponding to the embodiments have been described in detail above with reference to the drawings, the specific configurations are not limited to these embodiments, and design changes and the like that do not depart from the gist of the present invention are also included. In addition, the components shown in the above-mentioned embodiments and modifications can be appropriately combined to form a configuration.

[0095] For example, the configuration of the fastening device 100B according to the modified example of the first embodiment of the present disclosure can be applied to the second embodiment and each modified example. More specifically, in each of the base end portion 21b of the first gripping member 21 and the recessed portion 1a of the cap 1 of the fastening devices 100B, 100C, and 100D according to the second embodiment and each modified example of the present disclosure, a slope inclined with respect to the longitudinal axis of the wire sheath 280 may be formed. This eliminates the need for the surgeon to rotate the wire sheath 280 and align the cap 1 and the gripping portion 2 in the circumferential direction when engaging the cap 1 with the gripping portion 2. As a result, the operation by the surgeon becomes easier.

[0096] The operation of the fastening device 100 according to the first embodiment has been described as an example of the suturing method for the treatment target T according to the present disclosure, but the present disclosure is not limited thereto. For example, the fastening devices according to the modified example of the first embodiment, the second embodiment, and each modified example of the second embodiment of the present disclosure can be applied to each embodiment and the corresponding modified examples of the present disclosure by appropriately changing the step of restricting the rotation of the gripping portion 2 about the longitudinal axis and the step of releasing the restriction on the rotation of the gripping portion 2 about the longitudinal axis.

[0097] Although each embodiment of the present disclosure and each corresponding modified example have been described in detail above with reference to the drawings, the present disclosure is not limited to these embodiments and modified examples. Addition, omission, substitution, and other modifications of the configuration are possible within the scope of the present disclosure. The present disclosure is not limited by the above description, but is limited only by the scope of the attached claims. [Industrial Applicability]

[0098] The present disclosure can provide a fastening device, an endoscopic system, and a suturing method that, when treating tissue inside the body, can suitably switch between a state in which the fastening device attached to the tip side of the endoscope is rotatable about the longitudinal axis direction and a state in which rotation of the fastening device about the longitudinal axis is restricted. [Explanation of symbols]

[0099] 1 Cap 1a Recess 1b,1c Slope 2 Grip part 21 First gripping member (first jaw) 22 Second gripping member (second jaw) 21a First tip 21b Proximal end 21c Contact pin 21d First engagement groove 21d, 21f slope 22a U-shaped member 23 Opening and closing rotating shaft 25 Visual Space 3 Staple ejection section 4 Staple Receptacle 41 Pocket 5 Opening and closing operation wire 6 Ejection control wire 100, 100A, 100B, 100C, 100C Fastening device (medical stapler, stapler unit) 200 Endoscope 210 Insertion section 211 Tip 214 Forceps mouth 215 Objective Lens 260 Wire sheath fixing part 266 Rubber stopper 280 Wire Sheath 290,293 Resin sheath 292 Rotation adjustment wire 294 Rotation Control Wire 295 Port 296 Forceps 297 Protrusion 300 Medical Systems

Claims

1. a shaft having a longitudinal axis; a fixing member configured to be attached to an endoscope to fix the shaft to the endoscope; a staple unit attached to a tip of the shaft and rotatable about the longitudinal axis; An operation unit provided at a base end of the shaft; a rotation restriction mechanism configured to restrict rotation of the staple unit around the longitudinal axis relative to the endoscope by operation of the operation portion; Equipped with Fastening device.

2. an elastic member provided closer to the base end of the endoscope than the fixing member and having a through hole penetrating in a direction along the longitudinal axis; The shaft is inserted through the through hole. The fastening device according to claim 1 .

3. The fixing member is A first through hole formed in a direction along the longitudinal axis and through which the shaft is inserted; a second through hole formed to penetrate in the direction along the longitudinal axis and through which the endoscope is inserted; Equipped with The fastening device according to claim 1 .

4. The first through hole is formed at a position eccentric to a central axis of the fixing member. The fastening device according to claim 3.

5. The first through hole is provided with a slit. The fastening device according to claim 3.

6. The rotation restriction mechanism includes: an engaged portion formed to be recessed from a distal end surface of the fixing member toward a proximal end side of the endoscope in a region including a position where the first through hole is formed; an engaging portion formed at a base end of the staple unit and capable of engaging with the engaged portion; Equipped with The fastening device according to claim 3.

7. When the operating portion is operated, the engaging portion and the engaged portion are engaged with each other, so that the rotation of the staple unit around the longitudinal axis is restricted, the engagement between the engaging portion and the engaged portion is released by operating the operating portion, whereby the staple unit becomes rotatable around the longitudinal axis. The fastening device according to claim 6.

8. the rotation restriction mechanism includes a rotation restriction wire that is connected to a base end of the staple unit and extends toward the base end side of the shaft; The fastening device according to claim 1 .

9. The rotation restriction mechanism has a third through hole formed to penetrate in a direction along the longitudinal axis and through which the rotation restriction wire is inserted. The fastening device according to claim 8.

10. The rotation restricting wire is pulled by operating the operating portion, and a first tension is generated in the rotation restricting wire, thereby restricting the rotation of the staple unit around the longitudinal axis; the operation portion is operated to release the traction applied to the rotation restriction wire, and a second tension smaller than the first tension is generated in the rotation restriction wire, thereby making the staple unit rotatable about the longitudinal axis. The fastening device according to claim 8.

11. The rotation restriction mechanism includes: a protrusion provided on the staple unit and protruding in a direction intersecting a direction along the longitudinal axis of the shaft; Forceps for gripping the protrusion; having The fastening device according to claim 1 .

12. When the operating portion is operated, the forceps grip the protrusion, and the rotation of the staple unit around the longitudinal axis is restricted. When the forceps are moved away from the protrusion by operating the operating portion, the staple unit becomes rotatable around the longitudinal axis. The fastening device according to claim 11.

13. An endoscope and a shaft having a longitudinal axis along the endoscope; a staple unit attached to a tip of the shaft and rotatable about the longitudinal axis; An operation unit provided at a base end of the shaft; a rotation restriction mechanism configured to restrict rotation of the staple unit around the longitudinal axis relative to the endoscope by operation of the operation portion; Equipped with Endoscopy system.

Images