Ligation device

Abstract

Provided is a ligation device that makes it possible to reliably form loops of thread. When a fixed first thread loop LP1 and a fixed second thread loop LP2 have been formed by a loop formation part 71, a first thread hook 62 is moved through the first thread loop LP1 and the second thread loop LP2 and grips a thread L when a pinhole (a thread catching part) 38 on which the thread L is caught is at a specific position over a ligation target 30, and the thread L as gripped by the first hook 62 is passed through the first thread loop LP1 and the second thread loop LP2 such that a ligature is formed with the thread L. The first thread loop LP1 and the second thread loop LP2 that are formed by the loop formation part 71 are fixed, making it possible for the first thread loop LP1 and the second thread loop LP2 to be reliably formed without being affected, for example, by the surface tension, adhesion weight, etc. of a body fluid.

Description

[Technical Field]

[0001] The present invention relates to a ligating device capable of ligating a suture, and more particularly to a ligating device that enables stable formation of a loop of suture prior to ligation. [Background technology]

[0002] In the field of biological surgery and the like, suturing devices have been proposed that can suture the entire suturing portion of an object using thread without using metal staples, such as the suturing device proposed in Patent Document 1.

[0003] The suturing device proposed in Patent Document 1 includes a needle that holds a first thread and is capable of reciprocating in a predetermined direction, a holding part that holds a second thread, and a shuttle that has a first hook-shaped end and a second hook-shaped end provided on both sides of the holding part with the direction in which the needle reciprocates as its axis, and that is capable of rotating in both directions around the axis in which the needle reciprocates.

[0004] According to this suturing device, the shuttle has a first hook-shaped end and a second hook-shaped end provided on both sides of the holding portion, and is capable of rotating in both directions around an axis in the direction in which the needle reciprocates, so that by passing the first thread alternately through the holding portion from both directions, the second thread held by the holding portion and the first thread can be passed alternately from both directions relative to each other. Therefore, stitches or knots can be easily and reliably formed by mechanical operations based on simple manipulations. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Japanese Patent Application Publication No. 2018-029678 Summary of the Invention [Problem to be solved by the invention]

[0006] In the suturing device proposed in Patent Document 1, when the needle that has penetrated the biological tissue moves back a predetermined distance, the first thread extending from the tip of the needle separates from the tip of the needle, forming a semicircular loop. A shuttle holding a second thread is passed through the loop formed by the first thread, forming a stitch or knot.

[0007] However, since the loop formed by the first thread is maintained in its form by the rigidity of the thread itself, when it is affected by, for example, the surface tension or adhering weight of the body fluids of a living body, the shape of the loop can become unstable, which can hinder the reliable formation of a seam or knot.

[0008] The present invention has been made in light of the above circumstances, and an object of the present invention is to provide a ligation device that can stably form a loop of a suture when ligating the suture. [Means for solving the problem]

[0009] The gist of the ligation device of the present invention is that it comprises: (a) a holding section having a thread hooking section at its tip for hooking a thread, and holding the thread by hooking the thread on the thread hooking section; (b) a loop forming section that forms a loop of the thread in a fixed state; (c) a positioning section that positions the thread hooking section to which the thread is hooked in a specific position; and (d) a first thread hook that performs the following actions: moving inside the loop when the loop is formed; and grasping the thread when the thread hooking section to which the thread is hooked is positioned in the specific position; and (e) the thread grasped by the first thread hook passes inside the loop, thereby ligating the thread. [Effects of the Invention]

[0010] According to the ligation device of the present invention, when a loop is formed in a fixed state by the loop forming unit, a first suture hook moves inside the loop and grasps the suture while the suture hooking unit to which the suture is hooked is located at the specific position, and the suture grasped by the first suture hook passes inside the loop, thereby ligating the suture. As a result, the loop is formed in a fixed state by the loop forming unit, and is stably formed without being affected by, for example, the surface tension or adhered weight of bodily fluids. Furthermore, stably formed loops also ensure stable ligation of the suture. [Brief explanation of the drawings]

[0011] [Figure 1] 1 is a perspective view showing a ligation device according to an embodiment of the present invention, viewed obliquely from above. [Figure 2] 2 is a perspective view of the ligation device of FIG. 1, seen obliquely from below. FIG. [Figure 3] FIG. 2 is a front view of the ligation device of FIG. 1. [Figure 4] FIG. 2 is a plan view of the ligation device of FIG. 1. [Figure 5] FIG. 2 is a view showing the distal end face of the ligation device of FIG. 1. [Figure 6] FIG. 2 is a view showing the proximal end face of the ligation device of FIG. 1. [Figure 7] FIG. 5 is a cross-sectional view taken along the line AA in FIG. 4. [Figure 8] FIG. 4 is a cross-sectional view taken along the line BB in FIG. 3. [Figure 9] FIG. 4 is a cross-sectional view taken along the line CC in FIG. [Figure 10] FIG. 2 is an enlarged view showing the distal end of the ligation device of FIG. 1 in an open state. [Figure 11] 2 is a perspective view showing a curved needle used in the ligation device of FIG. 1. FIG. [Figure 12] 2 is a perspective view showing a main part of a knot pusher used in the ligation device of FIG. 1. FIG. [Figure 13] FIG. 13 is a cross-sectional view showing a main part of the knot pusher of FIG. 12. [Figure 14]2 is a perspective view showing an outer cylinder constituting a first suture hook used in the ligation device of FIG. 1. FIG. [Figure 15] 15 is a diagram showing a grip operation member housed in the outer cylinder of FIG. 14. FIG. [Figure 16] 16 is a view showing a semi-gripped state of a first thread hook formed by the outer tube of FIG. 14 and the gripping operation member of FIG. 15. FIG. [Figure 17] 16 is a view illustrating a completely gripped state of the first thread hook formed by the outer tube of FIG. 14 and the grip operation member of FIG. 15. FIG. [Figure 18] 2 is a partially cutaway view illustrating the configuration of a second suture hook used in the ligation device of FIG. 1. FIG. [Figure 19] 2 is a perspective view showing a first suture loop shaft and a second suture loop shaft used in the ligation device of FIG. 1, viewed obliquely from above. FIG. [Figure 20] 20 is a perspective view showing the first thread loop shaft and the second thread loop shaft of FIG. 19 from diagonally below. FIG. [Figure 21] 21 is a view showing the state before the rotation operation of the second suture loop shaft shown in FIGS. 19 and 20, viewed from the proximal end side of the ligation device of FIG. 1. FIG. [Figure 22] 22 is a view showing the state after a quarter-turn operation from the second suture loop axis shown in FIG. 21, as viewed from the proximal end side of the ligation device of FIG. 1. FIG. [Figure 23] 22 is a view showing the state after a 1 / 2 rotation operation from the second suture loop axis shown in FIG. 21, as viewed from the proximal end side of the ligation device of FIG. 1. FIG. [Figure 24] 22 is a view showing the state after a 3 / 4 rotation operation from the second suture loop axis shown in FIG. 21, as viewed from the proximal end side of the ligation device of FIG. 1. FIG. [Figure 25] 2 is a perspective view showing a suture presser used in the ligation device of FIG. 1. FIG. [Figure 26] 2 shows the distal end of the ligation device of FIG. 1 in an open state. [Figure 27] 1 shows a grasping preparation step in which the distal end of the ligation device of FIG. 1 grasps a body to be ligated. [Figure 28]1. FIG. 2 is a diagram showing a loop forming step in which the first thread loop shaft and the second thread loop shaft rotate to fixedly form the first thread loop and the second thread loop, and a needle puncturing step in which the curved needle punctures the body to be ligated in the ligation device of FIG. [Figure 29] FIG. 2 is a diagram showing a first suture hook grasping step in the ligation device of FIG. 1, in which the first suture hook, which has moved inside the first suture loop and the second suture loop toward the distal end of the ligation device, grasps the suture protruding together with the curved needle from the object to be ligated. [Figure 30] FIG. 2 is a diagram showing a first suture hook retraction step in which the first hook moves toward the base end of the ligation device of FIG. 1, causing the suture held by the first suture hook to pass through the inside of the first suture loop and the second suture loop, and a cutting step in which the curved needle is further protruded and the suture is cut by the first cutter. [Figure 31] 1. FIG. 4 is a view showing a needle accommodating step in which the curved needle is accommodated in the needle accommodating hole, and the first thread loop shaft and the second thread loop shaft move while rotating toward the second cover member in the ligation device of FIG. [Figure 32] 32 is a diagram showing the first half of a first thread loop moving step in which the first portion of the thread is pulled by the first thread hook, thereby moving the first thread loop toward the body to be ligated, in the state of FIG. 31. FIG. [Figure 33] 32 is a diagram showing the latter half of the first suture loop moving step in which the first portion of the suture is pulled by the first suture hook, causing the first suture loop to reach the object to be ligated, in the state of FIG. 31. FIG. [Figure 34] FIG. 34 is a plan view showing the relationship between the second thread loop and the knot pusher that pushes it in the state shown in FIG. 33. [Figure 35] 10 is a diagram showing a state in which the knot pusher is in contact with the thread presser while pushing the second thread loop during the second thread loop moving step. FIG. [Figure 36] 10 is a diagram showing a state in which the knot pusher has further moved and the thread presser has been rotated around a fourth rotation axis during the second thread loop moving step. FIG. [Figure 37] FIG. 37 is a vertical cross-sectional view showing the state of FIG. 36 during the second thread loop moving step. [Figure 38]10 is a view showing a state in which the knot pusher has moved the second suture loop to the body to be ligated during the second suture loop moving step. FIG. [Figure 39] 10 is a diagram showing the configuration of a knot formed when the knot pusher moves the second suture loop to the object to be ligated, with the suture untied. FIG. [Figure 40] This is a diagram showing the knot of Figure 39 in the form of a man's knot. [Figure 41] 10 is a diagram showing a step of releasing the ligated object in which the second jaw is moved away from the first jaw to cut the area between the knot and the first and second thread hooks, thereby releasing the ligated object. FIG. [Figure 42] FIG. 10 is a view showing a state in which the second suture hook has been moved toward the distal end of the ligation device to grip the end of the suture protruding from the second gripping surface of the second jaw during the second suture hook gripping step. [Figure 43] FIG. 10 is a view illustrating a state in which a wire loop protrudes from the tip of the second yarn hook during the second yarn hook gripping step. [Figure 44] FIG. 10 is a view showing a state in which the end of the yarn protruding from the second gripping surface of the second jaw is gripped by the second yarn hook during the second yarn hook gripping step. [Figure 45] FIG. 10 is a view showing a state in which the second suture hook, which has gripped the end of the suture protruding from the second gripping surface of the second jaw, has been moved toward the base end of the ligation device. [Figure 46] FIG. 12 is a perspective view showing another embodiment of the curved needle of FIG. [Figure 47] FIG. 12 is a perspective view showing another embodiment of the curved needle of FIG. [Figure 48] 13A and 13B show another embodiment of the knot pusher of FIG. 12. DETAILED DESCRIPTION OF THE INVENTION

[0012] An embodiment of the present invention will now be described in detail with reference to the drawings. [Example]

[0013] 1 to 9, ligation device 10 in one embodiment of the present invention is longitudinal in shape overall, and is configured so that its tip can open and close to grasp an object to be ligated 30 (see FIG. 26, etc.) and form knots or stitches in the object to be ligated 30. Ligation device 10 also functions as a suturing device for object to be ligated 30. In this embodiment, as shown in FIG. 1, the direction perpendicular to the longitudinal direction x of ligation device 10 and parallel to the open surface of the tip is defined as height direction z, and the direction perpendicular to the longitudinal direction x and height direction z is defined as width direction y.

[0014] The ligation device 10 comprises a main body 14 having a first jaw 12 on the underside of its tip, a first cover member 18 fixed to both sides of the base side of the main body 14 by six first fastening screws 16 so as to cover the bottom surface, which is one surface of the base side of the main body 14, a second cover member 22 fixed to both sides of the base side of the main body 14 by six second fastening screws 20 so as to cover the top surface, which is the other surface of the base side of the main body 14, and a second jaw 28 having a pivot shaft 26 that is detachably received in a concave bearing surface 24 formed in the center of the main body 14 in the longitudinal direction x and that is rotatable about the pivot shaft 26 so as to move toward and away from the first jaw 12.

[0015] 3, first and second gripping protrusions 12a and 28a are formed at the distal ends of first and second jaws 12 and 28, respectively, and protrude toward each other in the height direction z. The first and second gripping protrusions 12a and 28a have first and second gripping surfaces 12b and 28b that face each other. When the first and second jaws 12 and 28 are in a closed state in which the first gripping surface 12b of the first gripping protrusion 12a and the second gripping surface 28b of the second gripping protrusion 28a are close to each other, a space is formed between the portions of the first jaw 12 other than the first gripping protrusion 12a and the portions of the second jaw 28 other than the second gripping protrusion 28a to prevent the first and second jaws 12 and 28 from contacting the ligation target 30. During ligation, a body to be sutured or ligated 30, which is at least a part of a living body such as biological tissue or a blood vessel, is grasped by the first grasping surface 12b and the second grasping surface 28b. Fig. 10 shows a state in which the second jaw 28 is separated from the first jaw 12 to the maximum angle at which suturing or ligating operation is possible. The (minimum) distance La between the first grasping protrusion 12a and the second grasping protrusion 28a is smaller than the distance Lb between the base of the first jaw 12 and the base of the second jaw 28 (La ≦ Lb). It is set.

[0016] As shown in detail in Figure 7, an arc-shaped needle receiving hole 32 is formed at the tip of the second jaw 28, one end of which opens into the center of the second gripping surface 28b. An arc-shaped curved needle 34 that functions as a sewing needle is movably received within the needle receiving hole 32. The curved needle 34 corresponds to a holding part that holds the thread L (see Figures 8 and 26) by having the thread L hooked through a needle eye 38 (see Figure 11) that functions as a thread hook.

[0017] 11, the curved needle 34 has a sharply pointed tip 34a and a base end 34b that is connected to the needle operating member 36 of Fig. 7 that drives and operates the curved needle 34. The tip 34a is formed with a needle hole 38 that functions as the thread hook, and a recess 40 that is formed adjacent to the needle hole 38 on the inside of the curved needle 34 to avoid interference with a first suture hook 62, described below, that grips the suture L between the curved needle 34 and the object to be ligated 30. The base end 34b is formed with an engaging protrusion 44 that engages with an engaging hole 42 of Fig. 7 that is formed in the tip of the needle operating member 36.

[0018] 7, needle operating member 36 is a flexible member made, for example, of a leaf spring material cut into a tape shape of a fixed width, and protrudes rearward from the rear end face of ligation device 10, passing through needle operating member guide hole 46 formed in second jaw 28 and needle operating member guide hole 48 formed in second cover member 22. Needle operating member 36 corresponds to a positioning portion that positions the thread hooking portion (needle hole 38) around which thread L is hooked, at a specific position, i.e., the position where curved needle 34 protrudes from ligation target body 30 after puncturing.

[0019] 1, 5, and 7, a slot 50 is formed in the center of the first jaw 12 in the width direction y, cutting from the tip along the longitudinal direction x. When the needle manipulation member 36 is pushed toward the tip of the ligation device 10 with the second jaw 28 closed, the pointed end 34a of the curved needle 34 protrudes from the second gripping surface 28b (see FIG. 7), where the opening of the needle receiving hole 32 is located, and reaches the slot 50 of the first jaw 12, as shown in FIG. 28, which will be described later. When the needle manipulation member 36 is pulled out from the base end of the ligation device 10 along the longitudinal direction x to the outside of the base end, the curved needle 34 is housed in the needle receiving hole 32. In relation to the fact that the curved needle 34 protrudes most from the second gripping surface 28b (see Figure 7) of the second jaw 28 when the second jaw 28 is closed, a first cutter 51 is provided within the first jaw 12, which protrudes from the ligation target body 30 together with the needle hole 38 (see Figure 11) of the curved needle 34 and cuts the thread L pulled out by the first thread hook 62.

[0020] As shown in detail in Fig. 7, a sector 52 formed of a sector gear and a second cutter 54 are fixed to the base end of the second jaw 28. Also, as shown in Fig. 8, a rack 56 that meshes with the sector 52 is disposed within the main body 14 so as to be movable in the longitudinal direction x of the main body 14. The rack 56 is connected to an opening / closing operation rod 60 that is guided by an opening / closing operation rod guide hole 58 formed in the first cover member 18 in the longitudinal direction x. When the opening / closing operation rod 60 is pushed toward the main body 14, the second jaw 28 opens as shown in Fig. 26 (described later), and when the opening / closing operation rod 60 is pulled away from the main body 14, the second jaw 28 closes as shown in Figs. 1 to 6.

[0021] The opening / closing operation rod 60 is preferably composed of a cylindrical member that abuts against the rear end surface of the rack 56, and a wire (not shown) that is connected to the rear end surface of the rack 56 shown in Fig. 8 and inserted into the cylindrical member. In this case, the cylindrical member is used exclusively to operate the rack 56 toward the distal end of the ligation device 10, and the wire is used exclusively to operate the rack 56 toward the proximal end of the ligation device 10.

[0022] As shown in detail in Figure 7, a first guide hole 64 for guiding the first thread hook 62 is formed in the first cover member 18, parallel to the longitudinal direction x of the main body 14. Furthermore, a second guide hole 70 for guiding the knot pusher 66 and the second thread hook 68 is formed in the surface of the main body 14 facing the first cover member 18, parallel to the longitudinal direction x. The first thread hook 62 passes distally inside a first thread loop LP1 and a second thread loop LP2 (described later), and then moves back in a direction away from the ligation target body 30 together with the curved needle 34 in a semi-gripped state, loosely gripping the thread that has passed through the ligation target body 30. Furthermore, even after the gap between the curved needle 34 and the first thread hook 62 is severed, the first thread hook 62 further moves back in a semi-gripped state, loosely gripping the thread, and passes through the pair of first thread loop LP1 and second thread loop LP2. Thereafter, the first suture hook 62 waits in a completely gripped state in which it firmly grips the suture L, and advances a first suture loop LP1 (described later) in a direction approaching the body 30 to be ligated.

[0023] 12 and 13, the knot pusher 66 includes a pressing portion 66a formed at the front end and having a large width; a shaft portion 66b formed contiguous with the pressing portion 66a and having a smaller width than the pressing portion 66a; and a guide groove 66c formed on the upper surfaces of the pressing portion 66a and the shaft portion 66b at the center in the width direction y, penetrating in the longitudinal direction x, for receiving a second suture hook 68. The guide groove 66c guides the second suture hook 68 (see FIG. 7) in the longitudinal direction x of the ligation device 10. When the knot pusher 66 pushes the second suture loop LP2, the guide groove 66c captures the suture L. When the shaft portion 66b is operated forward, the knot pusher 66 moves a second suture loop LP2 (described below) and brings it closer to the first suture loop LP1, thereby forming a knot M (see FIGS. 39 and 40). After the object 30 to be ligated, on which the knot M has been formed, has been moved from between the first jaw 12 and the second jaw 28, the second thread hook 68 moves forward to grip the thread L protruding from the second gripping surface 28b of the second jaw 28. Thereafter, the second thread hook 68 moves backward to engage the thread L with the thread engaging groove 72c of the first thread loop shaft 72 and the thread engaging groove 74c of the second thread loop shaft 74, which will be described later.

[0024] The first thread hook 62 includes a longitudinal outer tube 62a having a diagonally cut tip as shown in Fig. 14, and a gripping operation member 62b shown in Fig. 15 inserted into the outer tube 62a so as to be slidable in the longitudinal direction x and in the rotational direction about its own axis. The gripping operation member 62b is made of a single wire and includes a spring portion 62c at its tip that can be exposed from the tip opening of the outer tube 62a. The spring portion 62c includes a close-coupled spring portion 62d spirally wound in close contact with each other, and a locking spring portion 62e, following the close-coupled spring portion 62d, wound spaced apart from each other and configured as a return spring whose tip is bent with a reverse lead.

[0025] 16 shows the semi-gripped state of the first yarn hook 62. In the semi-gripped state, a part of the locking spring portion 62e, which locks the yarn L, is exposed from the end face of the outer tube 62a, and the spring portion 62c is retracted into the outer tube 62a. In this semi-gripped state, the first yarn hook 62 loosely locks the yarn L, allowing the yarn L to slide with a tension equal to or greater than a predetermined value.

[0026] 17 shows the complete grip state of the first yarn hook 62. In the complete grip state, the yarn L is locked by the contact spring portion 62d, and the entire spring portion 62c is retracted into the outer tube 62a. In this complete grip state, the first yarn hook 62 tightly hooks the yarn L, and the yarn L cannot slip even when a tension greater than a predetermined value is applied.

[0027] As shown in Figure 18, the second thread hook 68 includes a longitudinal outer tube 68a and a wire 68b inserted into the outer tube 68a so as to be slidable in the longitudinal direction x. The wire 68b has a wire loop 68c at its tip, into which the thread L can be inserted. When the wire 68b is advanced toward the tip of the second jaw 28, the wire loop 68c is exposed from the outer tube 68a and opens by elastic return, as shown in Figure 41, which will be described later.

[0028] As shown in Figures 7 and 8, and Figures 24 and 25 described below, the main body 14 of the ligation device 10 is provided with a loop forming section 71 that forms multiple loops (in this embodiment, a pair of first thread loops LP1 and second thread loops LP2) in a fixed state in the thread L pulled by the second thread hook 68 through the needle hole 38 of the curved needle 34.

[0029] The loop forming unit 71 includes a first thread loop shaft 72 and a second thread loop shaft 74, as well as a first gear 76 and a second gear 78, which will be described in detail in Figures 13 and 14. As shown in Figure 8, a first bearing hole 80 and a second bearing hole 82 are formed in the main body 14, spaced apart in the longitudinal direction x of the ligation device 10 and parallel to the height direction z. The first thread loop shaft 72 and the second thread loop shaft 74 are fitted into the first bearing hole 80 and the second bearing hole 82, and are provided so as to be rotatable about a first rotation axis C1 and a second rotation axis C2, respectively, which are spaced apart in the longitudinal direction x and parallel to the height direction z, and to be movable in the first rotation axis C1 direction and the second rotation axis C2 direction, respectively. The first gear 76 and the second gear 78 are fitted into the first yarn loop shaft 72 and the second yarn loop shaft 74 so that they cannot rotate relative to each other and can move in the directions of the first rotation axis C1 and the second rotation axis C2. The first gear 76 and the second gear 78 are supported by the main body 14 so as to be immovable in the directions of the first rotation axis C1 and the second rotation axis C2, and are meshed with each other. The first gear 76 and the second gear 78 are an example of a driving rotor. The first yarn loop shaft 72 and the second yarn loop shaft 74 are an example of a rotation shaft of the loop forming unit 71.

[0030] 19 and 20, a pair of flat surfaces 72a formed parallel to each other in the direction of the first rotation axis C1 and a pair of flat surfaces 74a formed parallel to each other in the direction of the second rotation axis C2 are formed long in the height direction z on the outer circumferential surfaces of the first thread loop shaft 72 and the second thread loop shaft 74. The first gear 76 and the second gear 78 are formed with fitting holes 76a and 78a having the same cross-sectional shapes as the first thread loop shaft 72 and the second thread loop shaft 74. The first thread loop shaft 72 and the second thread loop shaft 74 are fitted into the fitting holes 76a of the first gear 76 and the fitting holes 78a of the second gear 78 so as to be movable in the direction of the first rotation axis C1 and the direction of the second rotation axis C2, respectively. The first thread loop shaft 72 and the second thread loop shaft 74 have tapered surfaces 72e and 74e at their ends on the first cover member 18 side, i.e., the lower side in Figures 19 and 20, which become smaller in diameter as they approach the ends.

[0031] The end face of the first thread loop shaft 72 on the first cover member 18 side is provided with a hook groove 72b having a U-shaped cross section that penetrates in a direction perpendicular to the first rotation axis C1 for inserting the first thread hook 62, and a thread engagement groove 72c that penetrates in a direction perpendicular to the first rotation axis C1 and perpendicular to the penetration direction of the hook groove 72b and is shallower than the hook groove 72b, at the shaft end on the first cover member 18 side. The hook groove 72b and the thread engagement groove 72c are cut in the direction of the first rotation axis C1 from the end face of the first thread loop shaft 72 on the first cover member 18 side, and the cutting depth of the hook groove 72b is greater than the cutting depth of the thread engagement groove 72c.

[0032] 7 and 26, a pair of spiral cam grooves 80a are formed in a spiral shape on the inner peripheral surface of the first bearing hole 80. A pair of cam protrusions 72d are fitted into the pair of spiral cam grooves 80a and protrude in opposite directions from the end of the flat surface 72a of the first thread loop shaft 72 facing the second cover member 22. The pair of cam protrusions 72d function as cam followers that rotate along the spiral cam groove 80a. When the first thread loop shaft 72 rotates together with the first gear 76 around the first rotation axis C1, the cam protrusions 72d receive a thrust from the spiral cam groove 80a in the direction of the first rotation axis C1 toward the first cover member 18. As a result, the first thread loop shaft 72 moves toward the first cover member 18 while rotating around the first rotation axis C1. In this way, when the first thread loop shaft 72 is rotated 3 / 4 of a turn, the thread L pulled through the eye 38 of the curved needle 34 by the second thread hook 68 is wound around the outer surface of the first thread loop shaft 72, and the first thread loop LP1 is fixedly formed (see Figure 24 described below).

[0033] Similar to the first thread loop shaft 72, the second thread loop shaft 74 has a hook groove 74b, a thread engagement groove 74c, and a pair of cam protrusions 74d that fit into a spiral cam groove 82a formed on the inner circumferential surface of the second bearing hole 82. Also, as shown in Figures 7, 9, and 26, a pair of spiral cam grooves 82a are formed on the inner circumferential surface of the second bearing hole 82, and are spirally shaped in the opposite direction to the spiral cam groove 80a. The pair of cam protrusions 74d function as cam followers that rotate along the spiral cam groove 82a in the opposite direction to the pair of cam protrusions 72d. When the second thread loop shaft 74 is rotated around the second rotation axis C2 together with the second gear 78, the cam protrusion 74d receives a thrust from the spiral cam groove 82a in the direction of the second rotation axis C2 toward the first lid member 18, so that the second thread loop shaft 74 moves toward the first lid member 18 while rotating around the second rotation axis C2. Figure 21 shows the state before the second gear 78 rotates, Figure 22 shows the state after the second gear 78 has rotated 1 / 4 of a turn from the state in Figure 21, Figure 23 shows the state after the second gear 78 has rotated 1 / 2 of a turn from the state in Figure 21, and Figure 24 shows the state after the second gear 78 has rotated 3 / 4 of a turn from the state in Figure 21. When the second thread loop shaft 72 is rotated 3 / 4 of a turn in this manner, the thread L pulled through the eye 38 of the curved needle 34 by the second thread hook 68 is wound around the outer circumferential surface of the second thread loop shaft 74, as shown in Figure 24, and the second thread loop LP2 is fixedly formed.

[0034] An operating gear 84 that meshes with the second gear 78 is provided on the main body 14 so as to be rotatable about a third axis C3 parallel to the first rotation axis C1 and the second rotation axis C2 while meshing with the second gear 78. A portion of the outer periphery of the operating gear 84 is exposed and operable through a window 86 (see FIGS. 1 and 3) provided on the side of the main body 14. This causes the overlap of the yarn L in the first yarn loop LP1 to be reversed from the overlap of the yarn L in the second yarn loop LP2.

[0035] When the operating gear 84 is rotated toward the base end of the ligation device 10 as indicated by the arrow in FIG. 3, the second gear 78 rotates in the opposite direction to the operating gear 84, and the first gear 76 rotates in the same direction as the operating gear 84. FIGS. 21 to 24 are views illustrating the operation of the second thread loop shaft 74 as viewed from the base end of the ligation device 10. FIG. 21 is a view showing a state before the second thread loop shaft 74 is rotated, in which the second thread loop shaft 74 is positioned on the second cover member 22 side (upper side along the height direction Z in FIG. 21). In FIG. 21, the thread L in the fourth thread groove 100 of the main body 14 is threaded through the thread engagement groove 72c of the second thread loop shaft 74. FIG. 24 is a view showing a state after the second thread loop shaft 74 is rotated, in which the second thread loop shaft 74 is positioned on the first cover member 18 side. Figure 24 shows a state in which the cam protrusion 74d receives a thrust from the spiral cam groove 82a toward the first lid member 18 and moves toward the first lid member 18, while the second thread loop shaft 74 is rotated three-quarters of a turn clockwise around the second rotation axis C2 toward the first lid member 18. In Figure 24, the thread L is wound around the outer peripheral surface of the second thread loop shaft 74, forming a second thread loop LP2.

[0036] Unlike the second thread loop shaft 74, the first thread loop shaft 72 is rotated 3 / 4 of a turn counterclockwise around the first rotation axis C1 toward the first cover member 18, but otherwise, like the second thread loop shaft 74, the first thread loop LP1 is formed with the thread L wound around the outer peripheral surface of the first thread loop shaft 72, as shown in Figures 21 to 24.

[0037] In this state, when the first thread hook 62 is moved toward the tip end and moves through the hook groove 74b of the second thread loop shaft 74 and the hook groove 72b of the first thread loop shaft 72, the first thread hook 62 passes through the inside of the second thread loop LP2 and the first thread loop LP1 that are fixedly formed by being wound around the outer peripheral surfaces of the second thread loop shaft 74 and the first thread loop shaft 72, respectively.

[0038] A pair of brackets 90 protrude from the base end face of the main body 14 and rotatably support a bobbin 88 (an example of a thread supply unit) around which the thread L is wound for supplying the thread L. A resistance member 92 made of an elastic member such as synthetic rubber or a spring is interposed between the bobbin 88 and the bracket 90 to apply rotational resistance to the bobbin 88. The resistance member 92 generates a predetermined tension in the thread L pulled out from the bobbin 88 to prevent slack.

[0039] 4 and 5, in order to guide the thread L, a first thread groove 94 is formed on the outer surface of the second cover member 22 opposite the main body 14 side, a second thread groove 96 is formed on the outer surface of the second jaw 28, a third thread groove 98 is formed on the tip surface of the second jaw 28, and a fourth thread groove 100 is formed on the surface of the main body 14 facing the first cover member 18, in that order. The thread L pulled out from the bobbin 88 passes through the first thread groove 94, second thread groove 96, and third thread groove 98 in that order, and is guided to the needle eye 38 of the curved needle 34. The thread L that passes through the needle eye 38 and is pulled by the second thread hook 68 is positioned in the fourth thread groove 100.

[0040] The fourth thread groove 100 is formed in the center of the width direction y of the wall surface of the second guide hole 70 on the second cover member 22 side, for example, the upper wall surface in Figure 6, and has a rectangular cross section that is smaller than the width dimension of the second guide hole 70 and the height of the second guide hole 70.

[0041] As shown in Fig. 8, in the longitudinal direction of the main body 14, a thread presser 102 is provided between the first thread loop shaft 72 and the second thread loop shaft 74 to be rotatable about a fourth axis C4 parallel to the first rotation axis C1 and the second rotation axis C2. As shown in Fig. 25, the thread presser 102 includes a pair of shafts 102a protruding in the direction of the fourth axis C4, a relatively long thread presser portion 102b protruding from the shafts 102a in a direction perpendicular to the fourth axis C4, and an engaging protrusion 102d that is shorter than the thread presser portion 102b and protrudes from the shafts 102a to form an angle of approximately 90 degrees around the fourth axis C4 with respect to the thread presser portion 102b in order to form an engaging recess 102c between the thread presser portion 102b and the thread presser portion 102b.

[0042] When the knot pusher 66, into which the engaging protrusion 102d has pushed the second yarn loop LP2, moves back, the pressing portion 66a of the knot pusher 66 presses the engaging protrusion 102d, causing the thread presser 102 to rotate until the longitudinal direction of the thread presser portion 102b becomes parallel to the width direction y. In this rotated position, the thread presser portion 102b presses the yarn L in the fourth yarn groove 100. This prevents the yarn L from falling out of the fourth yarn groove 100, regardless of movement of the first yarn loop shaft 72 and the second yarn loop shaft 74 toward the first cover member 18 in the directions of the first rotation axis C1 and the second rotation axis C2, i.e., toward the loop formation side.

[0043] The ligating operation of the ligating device 10 configured as above will be described below with reference to FIGS.

[0044] 26 shows a grasping preparation step in which the second jaw 28 of the ligation device 10 moves away from the first jaw 12 and grasps the object to be ligated 30. The thread L is in its initial state. The thread L unwound from the bobbin 88 is guided by the thread grooves 94, 96, and 98, passes through the needle hole 38 of the curved needle 34 housed in the needle housing hole 32, and is guided by the thread groove 100. The end of the thread L guided by the thread groove 100 is grasped by the second thread hook 68.

[0045] Next, with the gap between second jaw 28 and first jaw 12 open, opening / closing operation rod 60 is operated toward the base end of needle operating member 36. As a result, as shown in Figure 27, operation of needle operating member 36 toward the distal end brings second jaw 28 of ligation device 10 closer to first jaw 12, and the body to be ligated 30 is grasped between second jaw 28 and first jaw 12. Figure 27 shows the process of grasping body to be ligated 30.

[0046] Next, by operating the operating gear 84 in the direction shown by the arrow in Fig. 3, the yarn L is wound around the outer peripheral surface of the first yarn loop shaft 72, which rotates and moves toward the first lid member 18, to form a first yarn loop LP1 in a fixed manner, as shown in Figs. 21 to 24, and the yarn L is wound around the outer peripheral surface of the second yarn loop shaft 74, which rotates and moves toward the first lid member 18, to form a second yarn loop LP2 in a fixed manner. Fig. 28 shows this loop formation process.

[0047] Next, with the object to be ligated 30 held between the second jaw 28 and the first jaw 12, the needle operating member 36 is manipulated to a specific position on the distal side. As a result, the tip of the curved needle 34 is caused to pierce the object to be ligated 30 together with the suture L, as shown in Figure 28. In this state, the suture L forms a straight line between the needle hole 38 and the object to be ligated 30, so a gap S is formed between the recess 40 formed at the tip of the curved needle 34 and the suture L, making it easy to grasp the suture L with the first suture hook 62. Figure 28 shows the needle puncture process in which the tip of the curved needle 34 is caused to pierce the object to be ligated 30 together with the suture L. As shown by the dashed lines in Figure 28, the curved needle 34 is manipulated to be positioned at the specific position so that at least a portion of the body to be ligated 30 is positioned within a first planar space SP1 formed by two straight lines of thread L placed between the needle hole 38 of the curved needle 34 and the position of the first thread loop LP1, and an imaginary line connecting the needle hole 38 and the position of the first thread loop LP1.

[0048] Next, the outer tube 62a of the first hook 62 is moved toward the tip of the ligation device 10, whereby the outer tube 62a of the first hook 62 passes through the inside of the second thread loop LP2 and the first thread loop LP1 and reaches the thread L that is spaced by the gap S from the recess 40 formed at the tip of the curved needle 34. Next, in this state, the gripping operation member 62b is rotated a predetermined amount relative to the outer tube 62a, whereby the thread L that is spaced by the gap S from the recess 40 is loosely gripped by the first hook 62. Figure 29 shows a first hook gripping step in which the first hook 62 grips the thread L that is engaged at the tip of the curved needle 34 through the inside of the second thread loop LP2 and the first thread loop LP1. As shown by the dashed line in Figure 29, the position at which the first thread loop LP1 grips the thread L is set so that at least a part of the body to be ligated 30 is not positioned within a second planar space SP2 surrounded by imaginary lines connecting the needle eye 38 of the curved needle 34, the position of the first thread loop LP1, and the position at which the first thread hook grips the thread L.

[0049] Next, the curved needle 34 is operated to be pulled into the second gripping surface 28b of the second jaw 28 until the thread L between the eye 38 of the curved needle 34 and the tip of the first hook 62 does not come into contact with the first cutter 51, and the first hook 62 is then moved toward the base end of the ligation device 10. At this time, the thread L is loosely gripped by the first hook 62 in a semi-gripped state as shown in Figure 16, and therefore the thread L is supplied from the bobbin 88 as the first hook 62 moves.

[0050] When the tip of the first hook 62 reaches between the curved needle 34 and the first thread loop shaft 72, the gripping member 62b of the first hook 62 is further rotated to grip the thread L in a semi-gripped state. Thereafter, as the thread L passes through the first thread loop LP1 and the second thread loop LP2, the thread L is tightly gripped by the first hook 62 in a fully gripped state, as shown in FIG. 17 . Next, in this state, the curved needle 34 is further protruded from the second gripping surface 28b of the second jaw 28. As a result, the thread L between the eye 38 of the curved needle 34 and the tip of the first hook 62 is cut by the first cutter 51. Next, as the first hook 62 is rotated toward the base end of the ligation device 10 parallel to the longitudinal direction x, the first portion L1 of the thread L gripped at the tip of the first hook 62 is pulled out through the inside of the first loop LP1 and the second loop LP2 formed by the second portion L2 of the thread L. 30 shows the retraction step of the first thread hook 62 in which the first thread hook 62 pulls the thread L through the inside of the first thread loop LP1 and the second thread loop LP2, and the cutting step in which the thread L is cut. In Fig. 30, of the thread L separated after cutting by the first cutter 51, the thread that is held by the first thread hook 62 on the first jaw 12 side of the ligation target body 30 is referred to as the first portion L1 of the thread L, and the thread that is held by the second thread hook 68 on the second jaw 28 side of the ligation target body 30 is referred to as the second portion L2 of the thread L.

[0051] The first cutter 51 is positioned so that the length of the thread L protruding from the needle hole 38 after cutting is longer than the distance between the needle hole 38 of the curved needle 34 and the tip of the curved needle 34 and shorter than the maximum opening distance between the first jaw 12 and the second jaw 28, so that a sufficient length of thread L protruding from the second gripping surface 28b after cutting is obtained.

[0052] Next, as shown in Figure 31 , the needle operating member 36 is further operated in parallel to the longitudinal direction x toward the base end of the ligation device 10, and the curved needle 34 is completely housed in the needle housing hole 32 of the second jaw 28. Also, as shown in Figure 31 , the operating gear 84 is operated in the direction opposite to the arrow in Figure 3, and the first thread loop shaft 72 and the second thread loop shaft 74 are moved toward the second cover member 22. Figure 31 shows the needle housing step in which the curved needle 34 is housed in the needle housing hole 32. In this state, the first thread loop LP1 and the second thread loop LP2 that were wound around the first thread loop shaft 72 and the second thread loop shaft 74 are properly maintained in their loop shapes because the thread L2 between them is engaged by the thread presser portion 102b of the thread presser 102.

[0053] In this state, when the first suture hook 62 is further moved toward the base end of the ligation device 10, the suture L1 is pulled by the first suture hook 62, and as shown in Fig. 32, the first suture loop LP1, which is closest to the body to be ligated 30 out of the first suture loop LP1 and the second suture loop LP2, starts to move in a direction approaching the body to be ligated 30. Subsequently, by further moving the first suture hook 62 toward the base end of the ligation device 10, the first suture loop LP1 reaches the body to be ligated 30, as shown in Fig. 33. Figs. 32 and 33 show the first suture loop movement step.

[0054] After the first suture loop LP1 reaches the object to be ligated 30, the knot pusher 66 is operated toward the distal end of the ligation device 10, as shown in Figures 34 to 38. As a result, while tension is being applied to the first portion L1 of the suture L by the first suture hook 62, the second suture loop LP2 captured by the knot pusher 66 starts to move in a direction approaching the object to be ligated 30, i.e., in a direction approaching the first gripping protrusion 12a along the longitudinal direction x. Until the knot pusher 66 starts to move the second suture loop LP2, as shown in Figure 34, the thread presser portion 102b of the thread presser 102 holds the thread L2 between the first thread loop LP1 and the second thread loop LP in the thread groove 100, thereby preventing the thread L from falling off.

[0055] During the operation process in which the knot pusher 66 advances toward the distal end of the ligation device 10 while pushing the second suture loop LP2, the distal end surface of the knot pusher 66 pushes the suture holder portion 102b of the suture holder 102 toward the distal end of the ligation device 10, as shown in Figure 35. This causes the suture holder 102 to rotate about the fourth rotation axis C4, as shown in Figure 36, and the suture L2 in the thread groove 100 (see Figures 7 and 9) is released from the suture holder portion 102b. Figure 37 shows this state.

[0056] When the knot pusher 66 is operated to advance further toward the distal end of the ligation device 10, the second loop LP2, of the first and second loops LP1 and LP2, which is farther from the object to be ligated 30, is moved toward the object to be ligated 30 and brought into contact with the first loop LP. As a result, a knot M of the ligated suture L is formed in a state in which the first portion L1 of the suture L that passes through the object to be ligated 30, which is closer to the first jaw 12 than the object to be ligated 30, and the second portion L2 of the suture L that is closer to the second jaw 28 than the object to be ligated 30, are grasped by the suture hooks 62, 68, as shown in FIG. 38. FIGS. 34 to 38 show the second suture loop moving step. Figure 39 shows an enlarged view of the knot M in Figure 38, and Figure 40 shows the knot M in the form of a man's knot, which is further tightened by applying equal tension to the first part L1 of the thread L and the second part L2 of the thread L.

[0057] Once the knot M is formed as described above, the second jaw 28 is rotated away from the first jaw 12, as shown in Figure 41. This causes the second cutter 54, which is fixed to the base of the second jaw 28, to cut the first portion L1 of the thread L and the second portion L2 of the thread L, and the ligation target 30 is released from the ligation device 10. Figure 41 shows the ligation target releasing step, in which the ligation target 30, which has been ligated with the thread, is released from the ligation device 10.

[0058] 42, the second jaw 28 is moved toward the first jaw 12 until it is parallel to the first jaw 12 and the first gripping surface 12b and the second gripping surface 28b are spaced a small distance apart. Next, the second suture hook 68 is operated to move toward the distal end of the ligation device 10 so that the distal end of the second suture hook 68 approaches the end of the suture L.

[0059] Next, the operating wire 68b is operated toward the distal end of the ligation device 10, so that the wire loop 68c protruding from the distal end of the second suture hook 68 is placed on the first gripping surface 12b of the first jaw 12 in a state in which it is spread to a width greater than the width of the slot 50. In this state, the second jaw 28 is rotated so that the first gripping surface 12b and the second gripping surface 28b approach each other until they are approximately adjusted. As a result, the new end of the suture L, which is connected to the bobbin 88 and protruding from the second gripping surface 28b, is placed into the wire loop 68c protruding from the distal end of the second suture hook 68. Figure 43 shows this state.

[0060] Next, the operating wire 68b is operated toward the proximal end of the ligation device 10, and the wire loop 68c is pulled into the outer tube 68a. As a result, the end of the suture L protruding from the second gripping surface 28b of the second jaw 28 is gripped by the tip of the second suture hook 68, as shown in Figure 44. Figures 42 to 44 show the second suture hook gripping step in which the second suture hook 68 grips the end of the suture L protruding from the second gripping surface 28b.

[0061] When the second suture hook 68 is operated toward the base end of the ligation device 10, a new end of the suture L that has passed through the needle eye 38 of the curved needle 34 housed in the needle housing hole 32 is placed in the thread groove 100, as shown in Figure 45. In this operating section, the suture L is supplied from the bobbin 88. This state is the same as the initial state shown in Figure 27 with respect to the suture L, and when the second jaw 28 moves away from the first jaw 12, the state shown in Figure 26 is reached, making continuous ligation possible. Figure 45 shows the ligation completion step, which marks the end of one ligation operation.

[0062] As described above, according to the ligation device 10 of this embodiment, the first thread hook 62 moves inside the first thread loop LP1 and the second thread loop LP2 while the first thread loop LP1 and the second thread loop LP2 are formed and fixed by the loop forming unit 71. Furthermore, the first thread hook 62 grasps the thread L while the needle eye (thread hooking portion) 38 around which the thread L is hooked is positioned at a specific position protruding from the ligation target body 30. The thread L grasped by the first thread hook 62 then passes inside the first thread loop LP1 and the second thread loop LP2, thereby ligating the thread L. Because the first thread loop LP1 and the second thread loop LP2 are formed in a fixed state by the loop forming unit 71, the first thread loop LP1 and the second thread loop LP2 are reliably formed without being affected by, for example, the surface tension or the attached weight of bodily fluids. Furthermore, the reliably forming the first thread loop LP1 and the second thread loop LP2 also ensures the ligation of the thread L.

[0063] Furthermore, according to the ligation device 10 of this embodiment, the placement unit places the needle hole (thread hook) 38 at the specific position so as to position at least a portion of the ligation target 30 within the imaginary first planar space SP1. The first planar space SP1 is formed by the thread L placed between the needle hole (thread hook) 38 and the position of the thread loop via the ligation target 30, and an imaginary line connecting the needle hole (thread hook) 38 and the position of the thread loop. The first thread hook 62 grasps the thread L so as not to position the ligation target 30 within the imaginary second planar space SP2. The second planar space SP2 is formed by connecting the needle hole (thread hook) 38, the position of the thread loop, and a gripping position where the first thread hook 62 grasps the thread L, respectively, with imaginary lines. The thread L is then ligated in a state in which the thread L is placed around at least a portion of the ligation target 30. This allows the thread L to be ligated to the object 30 more reliably.

[0064] Furthermore, according to the ligation device 10 of this embodiment, the second suture hook 68 and the first cutter 51 are provided in the ligation device 10. The second suture hook 68 holds an end of the suture L. The first end is the end of the suture L that has passed through the needle eye (thread hooking portion) 38. With the first end of the suture L held by the second suture hook 68, the first cutter 51 cuts the suture L into two sutures L after the needle eye (thread hooking portion) 38 is positioned at a specific position protruding from the ligation target 30. One of the sutures L separated by the cutting by the first cutter 51 is held by each of the suture hooks 62, 68, and the suture L is ligated. More specifically, with one end of the suture L held by the first suture hook 62 and the other end of the suture L held by the second suture hook 68, the suture L is ligated. After one thread L has been ligated, the second thread hook 68 grips the end of the other thread L of the threads L separated by cutting with the first cutter 51, in place of the other end of the one thread L. The end of the other thread L continues to be hooked on the needle eye (thread hooking portion) 38, and is a new end that protrudes from the second gripping surface 28b through the needle eye 38. This eliminates the need for the user to manually perform preparatory work for the next suturing or ligating, such as rearranging the thread L, after suturing or ligating is completed, and allows the next suturing and ligating to be performed consecutively.

[0065] Furthermore, according to the ligation device 10 of this embodiment, the second suture hook 68 has a wire loop that grips the new end of the suture L protruding through the needle eye 38. This makes it easier to grip the suture L more reliably, and makes it easier to prepare for the next suturing or ligation, such as by repositioning the suture L.

[0066] Furthermore, according to the ligation device 10 of this embodiment, the loop forming unit 71 has a thread groove, a hook groove, and a rotation shaft. The thread groove is a groove for passing the thread L. The hook groove is a groove for passing the first thread hook 62 and is formed in a direction perpendicular to the thread groove. The rotation shaft has a rotation axis extending in a direction intersecting the longitudinal direction of the first thread hook 62. Then, with the thread L passed through the thread groove, the loop forming unit 71 rotates around the rotation axis, forming a loop in the thread with the thread L wound around the outer peripheral surface of the rotation shaft. This allows for more stable formation of the thread loop. Furthermore, stable formation of the loop also allows for stable ligation of the thread.

[0067] Furthermore, according to the ligation device 10 of this embodiment, a plurality of loop forming units 71 are provided. The rotation axes of the plurality of loop forming units 71 are parallel to one another. Furthermore, the rotation direction of any one of the plurality of loop forming units 71 is opposite to the rotation direction of the other loop forming units. This makes it possible to further strengthen the knot M of the suture L that ligates the object to be ligated 30.

[0068] Furthermore, according to the ligation device 10 of this embodiment, the loop forming part 71 moves in the direction of the rotation axis while rotating around the rotation axis, which allows the loop of the suture L to have a three-dimensional shape, making it easier to pass the suture L inside the loop.

[0069] Furthermore, according to the ligation device 10 of this embodiment, a plurality of loop forming units 71 are provided, and a thread presser 102 is provided between adjacent loop forming units 71. The thread presser 102 presses the thread that is stretched between the loop forming units 71 at a rotational axis direction position before the loop forming unit 71 moves toward the loop formation side in the rotational axis direction. Furthermore, the thread presser 102 maintains the rotational axis direction position of the thread L regardless of the movement of the loop forming unit 71 toward the loop formation side in the rotational axis direction. This prevents the thread L from falling out of the thread groove, allowing for more reliable formation of a loop of the thread L.

[0070] Furthermore, according to the ligation device 10 of this embodiment, a knot pusher 66 is provided in the ligation device 10. The knot pusher 66 moves the loop of the suture L formed by the loop forming unit 71 in a direction from the loop forming unit 71 toward the ligation target body 30. The knot pusher 66 has a guide groove 66c that captures the suture L. This allows the ligation position of the suture L to be moved to a position adjacent to the ligation target body 30.

[0071] Furthermore, according to the ligation device 10 of this embodiment, the suture holder 102 rotates in association with the movement of the knot pusher 66. This releases the suture L that was held by the suture holder 102, making it easier to move the ligation position of the suture L to a position adjacent to the object 30 to be ligated.

[0072] Furthermore, according to the ligation device 10 of this embodiment, the knot pusher 66 captures the loop and pushes it toward the ligation target 30 while tension is applied to the suture L passing through the inside of the loop. This makes it possible to more reliably move the ligation position of the suture L to a position adjacent to the ligation target 30.

[0073] Furthermore, according to the ligation device 10 of this embodiment, multiple loops of the thread L are formed, and when the first thread hook 62 pulls the thread L, the loop closest to the ligation body 30 among the multiple loops is moved to a position adjacent to the ligation body 30, and the loops other than the loop closest to the ligation body 30 are moved to positions adjacent to the ligation body 30 by the knot pusher 66.

[0074] Furthermore, according to the ligation device 10 of this embodiment, the holding portion is a curved needle 34 bent into an arc shape that punctures the ligation target body 30 together with the thread L in order to suture the ligation target body 30. This allows the ligation target body 30 to be sutured as well.

[0075] Furthermore, according to the ligation device 10 of this embodiment, the distal end portion of the holding portion is formed with a recess 40. This makes it possible to avoid interference between the holding portion and the first suture hook 62.

[0076] Furthermore, the ligation device 10 of this embodiment is provided with a main body 14, a first jaw 12, and a second jaw 28. The main body 14 houses the loop forming portion 71. The first jaw 12 and the second jaw 28 have a longitudinal shape and protrude from the main body 14. The second jaw 28 is provided so as to be rotatable relative to the main body 14 and to be able to move toward and away from the first jaw 12. The first jaw 12 and the second jaw 28 each have gripping protrusions (first gripping protrusion 12a and second gripping protrusion 28a) that protrude from their distal ends in directions toward each other and grip the object to be ligated 30. When the first jaw 12 and the second jaw 28 are closed, the respective gripping protrusions (first gripping protrusion 12a and second gripping protrusion 28a) are able to come into contact with each other. This allows the thread L to be ligated or sutured to the object 30 more reliably.

[0077] Furthermore, according to the ligation device 10 of this embodiment, the ligation device 10 is provided with a main body 14 that houses the loop forming portion 71. The main body 14 has a bearing hole. The loop forming portion 71 is held within the bearing hole so as to be rotatable about the rotation axis. The loop forming portion 71 includes a driving rotor, a rotation shaft, and a cam follower. The driving rotor is provided so as to be rotatable about the rotation axis but immovable in the direction of the rotation axis. The rotation shaft is fitted into the driving rotor so as to be imrotatable relative to the driving rotor but movable in the direction of the rotation axis. The cam follower protrudes radially from the rotation shaft and engages with a spiral cam groove formed on the inner surface of the bearing hole.

[0078] Furthermore, the ligation device 10 of this embodiment is provided with a main body 14, a first jaw 12, a second jaw 28, and a first cutter 51. The main body 14 houses a loop forming part 71. The first jaw 12 and the second jaw 28 have a longitudinal shape protruding from the main body 14. The second jaw 28 is rotatable relative to the main body 14 and is movable toward and away from the first jaw 12. The first cutter 51 is disposed within the first jaw 12 and cuts the suture L. The holding part is disposed within the second jaw 28 and is movable toward and away from the first jaw 12. When the first jaw 12 and the second jaw 28 are closed, the holding part is moved toward the first jaw 12, causing the first cutter 51 to cut the suture L hooked on the suture hook. This allows the portion of the suture L that is not required for ligation to be cut off from the object to be ligated 30 simply by operating the holding portion.

[0079] Furthermore, according to the ligation device 10 of this embodiment, the first cutter 51 is positioned so that the length of the suture L after cutting is longer than the distance between the thread hooking portion of the holding portion and the tip of the holding portion, and shorter than the open distance between the first jaw 12 and the second jaw 28. This allows the first cutter 51 to cut the suture L more reliably.

[0080] Furthermore, the ligation device 10 of this embodiment is provided with a main body 14, a first jaw 12, a second jaw 28, and a second cutter 54. The main body 14 houses the loop forming part 71. The first jaw 12 and the second jaw 28 have a longitudinal shape that protrudes from the main body 14. The second jaw 28 is provided so as to be rotatable relative to the main body 14 and so as to be able to move toward and away from the first jaw 12. The second cutter 54 is provided within the main body 14. The second cutter 54 cuts the suture L by opening the second jaw 28 in a direction away from the first jaw 12. This releases the ligation target 30 from the first jaw 12 and the second jaw 28, and simultaneously cuts off the excess portion of the suture L used for ligation and separates it from the ligation target 30.

[0081] Furthermore, according to the ligation device 10 of this embodiment, the first suture hook 62 can be switched between a semi-gripping state that allows sliding of the suture L and a full-gripping state that prevents sliding of the suture L. This allows the length of the suture L required for ligation to be freely adjusted.

[0082] Furthermore, according to the ligation device 10 of this embodiment, after grasping the suture L, the first suture hook 62 grasps the suture L in a semi-grasping state until the suture L is passed through the loop, and then grasps the suture L in a complete grasping state after the suture L is passed through the loop. This allows the suture L to be more reliably ligated to the ligation target 30.

[0083] Furthermore, according to the ligation device 10 of this embodiment, a bobbin (thread supply unit) 88 is provided in the ligation device 10. The bobbin 88 supplies the thread L to the thread hooking unit. The bobbin 88 also has a resistance member 92 that applies resistance to the supplied thread L. This makes it possible to perform ligation and suturing on the ligated body 30 multiple times in succession.

[0084] The ligation device 10 of this embodiment also includes a needle 34, a loop forming unit 71, and a first suture hook 62. The needle 34 has a thread hooking unit 38 at its tip for hooking the suture L, and is inserted into the ligation target body 30. The loop forming unit 71 forms a loop of the suture L in a fixed state. The first suture hook 62 moves inside the loop of the suture L while the loop is formed, and grasps the suture L that has penetrated the ligation target body 30 while the ligation target body 30 is being punctured by the needle 34. The suture L grasped by the first suture hook 62 then passes inside the loop, thereby ligating the suture L. As a result, the suture L that has penetrated the ligation target body 30 is susceptible to the surface tension and adhering weight of bodily fluids, but the loop forming unit 71 can form a loop in the suture L at a portion different from the portion that has penetrated the ligation target body 30. Therefore, the loop is formed stably and the ligation of the suture is also performed stably.

[0085] The ligation device 10 of this embodiment also includes a needle 34, a loop forming unit 71, and a first suture hook 62. The needle 34 has a distal end through which the suture L is inserted and pierced into the ligation target body 30. The loop forming unit 71 has a rotation shaft, and as the rotation shaft rotates, a loop of the suture L is formed. The first suture hook 62 moves toward the needle 34 inside the loop formed by the loop forming unit 71 and grasps the suture L that has penetrated the ligation target body 30. The first suture hook 62, while grasping the suture L, moves inside the loop and returns to its initial position, thereby ligating the suture L. As a result, the suture L that has penetrated the ligation target body 30 is susceptible to the surface tension and adhering weight of bodily fluids, but the loop forming unit 71 can form a loop in a portion of the suture L different from the portion that has penetrated the ligation target body 30. This ensures stable loop formation and stable ligation of the suture.

[0086] The ligation device 10 of this embodiment also includes a holding section that holds the suture L, a loop forming section 71 that forms a loop in the suture L, a main body 14 that houses the loop forming section 71, and a first jaw 12 and a second jaw 28 that protrude from the main body 14. The holding section is provided within the second jaw 28. The loop forming section 71 forms a loop in the suture L within the main body 14 while the holding section is holding the suture L. The second jaw 28 is rotatably provided on the main body 14 and can move toward and away from the first jaw 12. The second jaw 28 also grips the object 30 to be ligated between itself and the first jaw 12. This allows a suture loop to be stably formed without being affected by, for example, the surface tension or attached weight of a bodily fluid. Furthermore, stably forming the loop also allows for stable ligation of the suture.

[0087] Furthermore, according to the ligation device 10 of this embodiment, the loop forming unit 71 includes a first thread loop shaft 72 and a second thread loop shaft 74. The first thread loop shaft 72 rotates about a first rotation axis C1 and forms a first thread loop LP1 in the thread L within the main body 14. The second thread loop shaft 74 rotates in the opposite direction to the first thread loop shaft 72 about a second rotation axis C2 that is parallel to the first rotation axis C1 and forms a second thread loop LP2 in the thread L within the main body 14. This makes it possible to further strengthen the knot M of the thread L that ligates the ligated object 30.

[0088] Furthermore, according to the ligation device 10 of this embodiment, a first suture hook 62 is provided in the ligation device 10. The first hook 62 passes inside the loop formed by the loop forming portion 71 and is movable toward the tips of the first jaw 12 and the second jaw 28, which are gripping the object to be ligated 30. The first hook 62 grips the suture L held by the holding portion and pulls it into the main body 14. This allows the base of the knot M of the suture L to be stably formed without being affected by, for example, the surface tension or attached weight of bodily fluids. [Example]

[0089] Next, another embodiment of the present invention will be described. In the following description, parts common to the above embodiment will be designated by the same reference numerals and description thereof will be omitted.

[0090] Figure 46 shows a curved needle 134 of another embodiment that can be used in place of the curved needle 34 of the previously described embodiment. The curved needle 134 of this embodiment is similar to the curved needle 34 of the previously described embodiment, except that it has an engagement groove 136 cut longitudinally from the needle tip, instead of the needle hole 38 of the curved needle 34 of the previously described embodiment. Like the curved needle 34 of the previously described embodiment, when the curved needle 134 of this embodiment is punctured into the body to be ligated 30, the suture L hooked in the engagement groove 136, which functions as a suture hook, is allowed to pass through the body to be ligated 30 together with the needle tip of the curved needle 134. [Example]

[0091] 47 shows a curved needle 144 of another embodiment that can be used in place of the curved needle 34 of the previously described embodiment. The curved needle 144 of this embodiment has a needle hole 146 formed at the needle tip in a direction parallel to the center line of curvature of the curved needle 144, instead of the needle hole 38 formed in the curved needle 34 of the previously described embodiment that penetrates in the direction of the radius of curvature. Furthermore, instead of the recess 40 formed on the inner periphery of the needle tip of the curved needle 34 of the previously described embodiment, a recess 148 is formed on the side of the needle tip. Like the curved needle 34 of the previously described embodiment, when the curved needle 144 of this embodiment is punctured into the body to be ligated 30, the suture L threaded through the needle hole 146, which functions as a thread threading portion, is passed through the body to be ligated 30 together with the needle tip of the curved needle 144. The needle storage hole 32 shown in Figure 11 of the previous embodiment is formed in a plane including the longitudinal direction x and the height direction z, whereas the needle storage hole that stores the curved needle 144 in this embodiment is formed in a plane including the width direction y and the height direction z. [Example]

[0092] 48 shows a knot pusher 166 of another embodiment that can be used in place of the knot pusher 66 of the previously described embodiment. The knot pusher 166 of this embodiment is composed of a tubular member through which the second portion L2 of the suture L and a second suture hook 68 that grips the second portion L2 are passed and which is guided by a second guide hole 70 (see FIGS. 6 and 7). Like the previously described knot pusher 66, the knot pusher 166 of this embodiment can feed the second suture loop LP2 toward the distal end of the ligation device 10.

[0093] Although one embodiment of the present invention has been described above with reference to the drawings, the present invention can also be applied to other embodiments.

[0094] For example, a ligatable, flexible wire is used for the thread L in the above-described embodiment. The thread L is preferably a natural thread twisted from natural plant or animal fibers, a synthetic resin thread made of single or twisted synthetic fibers, a metal thread made of single or twisted metal wires, or a composite thread made of natural and synthetic fibers.

[0095] Furthermore, the ligation device 10 in the above-described embodiment has a rectangular cross section, that is, a prismatic shape, but may have a circular cross section in the shape of a cylinder.

[0096] Furthermore, in the ligation device 10 of the above-described embodiment, the arc-shaped curved needle 34 is used as an example of the needle, but a straight needle may also be used.

[0097] Furthermore, in the ligation device 10 of the above-described embodiment, two loops for ligation are formed in the suture L, but three or more loops may be formed for ligation. That is, the loop forming unit 71 of the ligation device 10 of the above-described embodiment includes two first suture loop shafts 72 and two second suture loop forming shafts 74, but it may include three or more suture loop shafts.

[0098] Furthermore, in the ligation device 10 of the above-described embodiment, the first thread loop shaft 72 rotates counterclockwise toward the first cover member 18, and the second thread loop forming shaft 74 rotates clockwise toward the first cover member 18, but they may also rotate in the opposite directions. In short, the pair of first thread loop shaft 72 and second thread loop forming shaft 74 may rotate in opposite directions.

[0099] Furthermore, the ligation device 10 of the above-described embodiment was provided with two first thread loop shafts 72 and two second thread loop forming shafts 74, but it may also be provided with three or more thread loop shafts.

[0100] Furthermore, in the ligation device 10 of the above-described embodiment, the opening / closing operating rod 60 that opens and closes the second jaw 28, the needle operating member 36 that protrudes and operates the curved needle 34 from the second gripping surface 28b, the gripping operation of the first suture hook 52, and the gripping operation of the second suture hook 68 may be performed manually or remotely using an electrically driven and controlled actuator.

[0101] 28, after the needle piercing step in which the tip of the curved needle 34 is passed through the inside of the second thread loop LP2 and the first thread loop LP1 to the vicinity of the curved needle 34 and the thread L is performed, a first thread hook gripping step in which the first thread hook 62 passes through the inside of the second thread loop LP2 and the first thread loop LP1 to the vicinity of the curved needle 34 and grips the thread L engaged at the tip of the curved needle 34, and a first thread hook retracting step in which the first thread hook pulls out the thread L through the inside of the first thread loop LP1 and the second thread loop LP2 are performed. In contrast to this, after the loop forming step, the first thread hook 62 may be moved through the inside of the second thread loop LP2 and the first thread loop LP1 to the vicinity of the curved needle 34, and after the needle piercing step is performed, a first thread hook gripping step in which the first thread hook pulls out the thread L through the inside of the first thread loop LP1 and the second thread loop LP2 is performed.

[0102] Furthermore, in the above-described embodiment, the first jaw 12 is fixedly provided so as to protrude longitudinally from the main body 14, but the first jaw 12 may be provided so as to be rotatable with respect to the main body 14, similar to the second jaw 22. In this case, the first thread hook 62 may be made of a flexible member, and a first guide hole 64 for guiding the first thread hook 62 may be formed not only in the main body 14 but also in the first jaw 12, so that the first thread hook 62 can be moved to the vicinity of the curved needle 34 through the inside of the second thread loop LP2 and the first thread loop LP1.

[0103] Furthermore, in the above-described embodiment, a curved needle 34 was used to puncture the ligation target 30 in order to wrap the thread L around a portion of the ligation target 30, but if the ligation target 30 is a blood vessel of a living body or the like, it is not necessary to use a curved needle 34 in order to wrap the thread L around the entire ligation target 30. In this case, for example, a protrusion is formed on a portion of the second gripping surface 28b of the second jaw 28 that is located on the distal side of the ligation device 10 and in the center in the width direction y, together with the thread groove 98, so that it can be fitted into the slot 50 formed in the first jaw 12. With the object to be ligated 30 held between the proximal end side of the second gripping surface 28b of the ligation device 10 where no protrusion is formed and the first gripping surface 12b, as shown in FIG. 29, the first thread hook 62 grips the portion of the thread L that is located on the protrusion side of the object to be ligated 30, and thereby the thread L that has been wound around the entire object to be ligated 30 can be ligated, as shown in FIGS. 30 to 38 described above.

[0104] Furthermore, in the loop forming unit 71 of the above-described embodiment, the pair of cam protrusions 72d of the first thread loop shaft 72 is fitted into the pair of spiral cam grooves 80a, thereby rotating about the first rotation center line C1 and moving in the direction of the first rotation center line C1, i.e., along the height direction z, and the pair of cam protrusions 74d of the second thread loop shaft 74 is fitted into the pair of spiral cam grooves 82a, thereby rotating about the second rotation center line C2 and moving in the direction of the second rotation center line C2, i.e., along the height direction z. However, the first thread loop shaft 72 and the second thread loop shaft 74 do not necessarily have to move in the direction of the first rotation center line C1 and the direction of the second rotation center line C2, i.e., along the height direction z, respectively. As shown in FIGS. 14 and 16 , the tip of the first thread hook 62 is cut obliquely. Therefore, by rotating the first thread hook 62 and pushing it toward the tip of the ligation device 10, the thread L wound around the outer peripheral surfaces of the second thread loop shaft 74 and the first thread loop shaft 72 are positioned above and below the first thread hook 62, and as a result, the first thread hook 62 is passed through the inside of the second thread loop LP2 and the first thread loop LP1.

[0105] Although not specifically illustrated, the present invention can be implemented in various forms with various modifications and improvements based on the knowledge of those skilled in the art. [Explanation of symbols]

[0106] 10: Ligation device 12: First jaw 14: Main body 18: First cover member 22: Second cover member 28: Second jaw 30: Ligated body 34, 134, 144: Curved needle (holding part, needle) 36: Needle operating member (arrangement part) 38, 146: Needle hole (thread guide) 62: First thread hook 68: Second thread hook 71: Loop forming part 72: First thread loop axis 74: Second thread loop axis 88: Bobbin (thread supply unit) 102: Thread presser LP1: 1st thread loop (thread loop) LP2: 2nd thread loop (thread loop) L: Thread L1: First part of thread L L2: The second part of the thread L SP1: 1st plane space SP2: 2nd plane space

Claims

1. a holding part having a thread hooking part at a tip part for hooking a thread, the holding part holding the thread by hooking the thread on the thread hooking part; a loop forming section for forming a loop of the thread in a fixed state; a placement unit that places the thread hooking unit, on which the thread is hooked, at a specific position; a first yarn hook that moves inside the loop when the loop is formed, and that grips the yarn when the yarn hooking portion to which the yarn is hooked is located at the specific position, The thread gripped by the first thread hook passes through the inside of the loop, thereby ligating the thread; the loop forming section has a thread groove for passing the thread, a hook groove for passing the first thread hook in a direction perpendicular to the thread groove, and a rotation shaft having a rotation axis extending in a direction intersecting the longitudinal direction of the first thread hook, and the ligation device rotates around the rotation axis with the thread passed through the thread groove, thereby forming the loop with the thread wound around the outer peripheral surface of the rotation shaft.

2. A ligation device as described in claim 1, wherein a plurality of the loop forming portions are provided, the rotation axes of each of the plurality of loop forming portions are parallel to each other, and the rotation direction of any one of the plurality of loop forming portions is opposite to the rotation direction of other loop forming portions of the plurality of loop forming portions.

3. The ligation device further comprises: a second yarn hook that grips the end of the yarn; a first cutter that cuts the yarn into two yarns after the yarn hooking portion is positioned at the specific position with the end of the yarn held by the second yarn hook; Equipped with one of the two sutures cut by the first cutter is ligated while being held by the first suture hook; 3. The ligation device according to claim 1, wherein after one of the threads is ligated, the second suture hook grasps, in place of the end portion, a new end portion of the other of the two threads that continues to be hooked on the thread hook portion.

4. The ligation device further comprises: a main body that houses the loop forming portion; a first elongated jaw portion protruding from the body; a second jaw portion having an elongated shape and rotatably provided on the main body and capable of moving toward and away from the first jaw portion; and gripping protrusions protruding from the distal end portions of the first jaw portion and the second jaw portion in directions approaching each other to grip a body to be ligated, The ligation device according to claim 1 , wherein the gripping protrusions of the first jaw portion and the second jaw portion are in contact with each other when the first jaw portion and the second jaw portion are in a closed state.

5. The ligation device further comprises: a main body that houses the loop forming portion; a first elongated jaw portion protruding from the body; a second jaw portion having an elongated shape and rotatably provided on the main body and capable of moving toward and away from the first jaw portion; a first cutter disposed within the first jaw for cutting the thread; the holding portion is disposed within the second jaw portion so as to be movable toward and away from the first jaw portion, 5. The ligation device according to claim 1, wherein the first jaw and the second jaw are closed and the holding portion is moved toward the first jaw, thereby causing the first cutter to cut the thread hooked on the thread hook.

6. A ligation device as described in Claim 5, wherein the first cutter is positioned at a position where the length of the thread after cutting is longer than the distance between the thread hooking portion of the holding portion and the tip of the holding portion and shorter than the maximum opening distance of the first jaw portion and the second jaw portion.

7. A ligation device as described in any one of claims 1 to 6, wherein the first thread hook is switchable between a semi-gripping state that allows the thread to slide and a full-gripping state that prevents the thread from sliding.

8. A ligation device as described in Claim 7, wherein the first thread hook grasps the thread in the semi-gripping state after grasping the thread until the thread is passed through the loop, and grasps the thread in the full-gripping state after the thread is passed through the loop.

9. A holding part having a thread hooking part for hooking a thread at the tip part, the holding part holding the thread by hooking the thread on the thread hooking part; a loop forming section for forming a loop of the thread in a fixed state; a placement unit that places the thread hooking unit, on which the thread is hooked, at a specific position; a first yarn hook that moves inside the loop when the loop is formed, and that grips the yarn when the yarn hooking portion to which the yarn is hooked is located at the specific position, The thread gripped by the first thread hook passes through the inside of the loop, thereby ligating the thread; the positioning unit positions the thread hooking unit at the specific position so as to position at least a part of the object to be ligated within a virtual first planar space formed by the thread arranged between the thread hooking unit and the position of the loop and a virtual straight line connecting the thread hooking unit and the position of the loop; the first suture hook grasps the suture so that the object to be ligated is not positioned inside a virtual second planar space formed by connecting the suture hooking portion, the position of the loop, and a grasping position for grasping the suture with virtual straight lines, The thread is ligated in a state in which the thread is disposed around at least a portion of the object to be ligated.

10. A holding part having a thread hooking part for hooking a thread at the tip part, the holding part holding the thread by hooking the thread on the thread hooking part; a loop forming section for forming a loop of the thread in a fixed state; a placement unit that places the thread hooking unit, on which the thread is hooked, at a specific position; a first yarn hook that moves inside the loop when the loop is formed, and that grips the yarn when the yarn hooking portion to which the yarn is hooked is located at the specific position, The thread gripped by the first thread hook passes through the inside of the loop, thereby ligating the thread; The ligation device further comprises: A ligation device comprising a knot pusher having a groove for capturing the suture, which moves the loop formed by the loop forming portion in a direction from the loop forming portion toward the body to be ligated, and positions the ligation position adjacent to the body to be ligated.

11. A holding part having a thread hooking part for hooking a thread at a tip portion, the holding part holding the thread by hooking the thread on the thread hooking part; a loop forming section for forming a loop of the thread in a fixed state; a placement unit that places the thread hooking unit, on which the thread is hooked, at a specific position; a first yarn hook that moves inside the loop when the loop is formed, and that grips the yarn when the yarn hooking portion to which the yarn is hooked is located at the specific position, The thread gripped by the first thread hook passes through the inside of the loop, thereby ligating the thread; The holding portion is a curved needle bent into an arc shape that punctures the body to be ligated together with the thread in order to suture the body to be ligated.

12. A holding part having a thread hooking part for hooking a thread at a tip portion, the holding part holding the thread by hooking the thread on the thread hooking part; a loop forming section for forming a loop of the thread in a fixed state; a placement unit that places the thread hooking unit, on which the thread is hooked, at a specific position; a first yarn hook that moves inside the loop when the loop is formed, and that grips the yarn when the yarn hooking portion to which the yarn is hooked is located at the specific position, The thread gripped by the first thread hook passes through the inside of the loop, thereby ligating the thread; The ligation device further comprises: a main body that houses the loop forming portion; a first elongated jaw portion protruding from the body; a longitudinal second jaw portion rotatably provided on the main body and capable of approaching and moving away from the first jaw portion, A ligation device, wherein a second cutter is provided within the body, and cuts the suture when the second jaw portion opens in a direction away from the first jaw portion.

13. A holding part having a thread hooking part for hooking a thread at a tip part, the holding part holding the thread by hooking the thread on the thread hooking part; a loop forming section for forming a loop of the thread in a fixed state; a placement unit that places the thread hooking unit, on which the thread is hooked, at a specific position; a first yarn hook that moves inside the loop when the loop is formed, and that grips the yarn when the yarn hooking portion to which the yarn is hooked is located at the specific position, The thread gripped by the first thread hook passes through the inside of the loop, thereby ligating the thread; The ligation device further comprises: The ligating device includes a thread supply unit that supplies the thread to the thread hooking unit and has a resistance member that applies resistance to the thread being supplied.

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