Medical stapler

Abstract

The medical stapler is provided at the tip of an endoscope, and includes a staple ejection section having a wire extending in the axial direction of the endoscope, a cartridge capable of accommodating staples, and an ejection mechanism connected to the tip of the wire and capable of ejecting the staples from the cartridge, the cartridge being detachably provided on the staple ejection section, and the ejection mechanism being connected to the wire. is manipulated The cartridge is movable between a first position which is an initial position and a second position where the staples are fired, and is positioned at the second position when the cartridge is removed from the staple discharge portion, and is moved from the second position to the first position when the cartridge is attached to the staple discharge portion.

Description

Technical Field

[0001] The present invention relates to a medical stapler.

Background Art

[0002] In recent years, in surgeries enabling suturing within a lumen, a flexible stapler in which a suturing mechanism is supported by a flexible endoscope has been used. When using the flexible stapler, after loading needles (hereinafter referred to as staples) into the suturing mechanism, it is inserted into the lumen, and the affected area is sutured by firing the staples while accessing the affected area.

[0003] When firing a plurality of staples for a suturing procedure, it is necessary to load the staples multiple times. Therefore, after firing the staples, it is necessary to perform the operation of pulling them out of the body once, loading the staples, and then inserting them back into the body multiple times.

[0004] Also, in order to reload and fire the staples again, it is necessary to return the suturing mechanism to the initial position. As a method of returning the suturing mechanism to the initial position, a method in which an operator performs an operation to return it to the initial position and a method using a mechanism that automatically returns to the initial position can be considered.

[0005] As a conventional medical stapler, for example, there is a surgical stapling device described in Patent Document 1. The surgical stapling device described in Patent Document 1 includes a firing trigger that an operator operates when firing the staples, and a spring that returns the firing trigger to the initial position after the staples are fired.

Prior Art Documents

Patent Documents

[0006]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0007] However, when using a mechanism that automatically returns to the initial position, such as the surgical staple fastening device described in Patent Document 1, there are concerns about an increase in the number of components and the size of the components due to the complexity of the mechanism. In addition, there is a risk that it may be difficult for the operator to recognize whether or not the device has automatically returned to the initial position. On the other hand, if the operator has to manually return the device to the initial position, there are concerns that the number of steps in the operation will increase, and that the operator may forget to do so, resulting in the device not being returned to the initial position.

[0008] Based on the above circumstances, the present invention aims to provide a medical stapler that allows the suturing mechanism to be easily returned to its initial position and that makes it easy for the operator to recognize that the suturing mechanism has been returned to its initial position. [Means for solving the problem]

[0009] To solve the above problems, this invention proposes the following means. The medical stapler of the present invention is a medical stapler provided at the tip of an endoscope, and comprises a staple discharge section having a wire extending in the axial direction of the endoscope, a cartridge capable of housing staples, and an ejection mechanism connected to the tip of the wire and capable of ejecting the staples from the cartridge, wherein the cartridge is detachably provided at the staple discharge section, and the ejection mechanism is movable from a first position, which is an initial position, to a second position for ejecting the staples by the advancement and retraction of the wire, and when the cartridge is removed from the staple discharge section it is in the second position, and when the cartridge is attached to the staple discharge section it moves from the second position to the first position. [Effects of the Invention]

[0010] The present invention provides a medical stapler that allows the suturing mechanism to be easily returned to its initial position, and that makes it easy for the operator to recognize that the suturing mechanism has been returned to its initial position. [Brief explanation of the drawing]

[0011] [Figure 1] It is a diagram showing the overall configuration of a medical system including a medical stapler according to the present invention. [Figure 2] It is a perspective view of a wire sheath operation unit provided in the medical stapler. [Figure 3] It is a perspective view of the medical stapler. [Figure 4] It is a front view of a cap provided in the medical stapler. [Figure 5] It is a perspective view of the medical stapler with the gripping part in the closed state. [Figure 6] It is a front view of the medical stapler with the gripping part in the closed state. [Figure 7] It is a perspective view of the medical stapler with the gripping part in the open state. [Figure 8] It is a front view of the medical stapler with the gripping part in the open state. [Figure 9] It is a side view of the medical stapler with the gripping part in the closed state. [Figure 10] It is a side view of the medical stapler with the gripping part in the open state. [Figure 11] It is a perspective view showing the connection between the first gripping member and the cap. [Figure 12] It is a cross-sectional view of the gripping part including the staple discharge part. [Figure 13] It is a cross-sectional view of the gripping part after the discharge operation wire is pulled. [Figure 14] It is a cross-sectional view of the advanced gripping part and the cap. [Figure 15] It is a flowchart showing the surgical procedure using the medical stapler by the operator. [Figure 16] It is a diagram showing the operation of the protruding step by the medical stapler. [Figure 17] It is a diagram showing the operations of the advancing step, gripping step, and retracting step by the medical stapler. [Figure 18] It is a diagram showing the operation of the suturing step by the medical stapler. [Figure 19]It is a diagram showing the operation of the removal step by a medical stapler. [Figure 20] It is a perspective view showing the configuration of a medical stapler. [Figure 21] It is a perspective view showing the configuration of a cartridge. [Figure 22] It is a front view showing the configuration of the first member of a cartridge. [Figure 23] It is a front view showing the configuration of the second member of a cartridge. [Figure 24] It is an exploded perspective view showing the configuration of a cartridge. [Figure 25] It is an exploded perspective view showing the configuration of a cartridge. [Figure 26A] It is a cross-sectional view showing the operation in the reload step of a medical stapler. [Figure 26B] It is a cross-sectional view showing the operation following FIG. 26A in the reload step of a medical stapler. [Figure 26C] It is a cross-sectional view showing the operation following FIG. 26B in the reload step of a medical stapler. [Figure 26D] It is a cross-sectional view showing the operation following FIG. 26C in the reload step of a medical stapler. [Figure 27A] It is a cross-sectional view showing the operation following FIG. 26D in the reload step of a medical stapler. [Figure 27B] It is a cross-sectional view showing the operation following FIG. 27A in the reload step of a medical stapler. [Figure 27C] It is a cross-sectional view showing the operation following FIG. 27B in the reload step of a medical stapler. [Figure 28] It is a front view showing a staple having a marking member.

Mode for Carrying Out the Invention

[0012] The medical stapler 100 according to this embodiment will be described with reference to the drawings. FIG. 1 is a diagram showing the overall configuration of a medical system 300 including the medical stapler 100.

[0013] Medical system 300 is used in surgeries such as suturing the digestive tract. The medical system 300 comprises a medical stapler 100, an endoscope 200, an opening / closing operation unit 250, a discharge operation unit 270, a wire sheath 280, a resin sheath (long section) 290, and a wire sheath operation unit 260.

[0014] The opening / closing operation unit 250 is an operation unit that operates the medical stapler 100 using the opening / closing operation wire 5.

[0015] The discharge operation unit 270 is an operation unit that operates the medical stapler 100 using a discharge operation wire (wire) 6.

[0016] [Endoscope 200] The endoscope 200 is a known flexible endoscope and comprises a long insertion section 210 that is inserted into the body from its tip, an operating section 220 provided at the base end of the insertion section 210, and a universal cord 240.

[0017] The insertion section 210 has a treatment instrument channel 230 through which an endoscopic treatment instrument is inserted. The tip 212 of the insertion section 210 is provided with a forceps channel 214, which is the tip opening of the treatment instrument channel 230. The treatment instrument channel 230 extends from the tip 212 of the insertion section 210 to the operating section 220.

[0018] The tip portion 211 of the insertion portion 210 is equipped with an imaging unit (not shown) having a CCD or the like. The 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 has a hard portion 211a (see Figure 14) on the tip side.

[0019] The base end of the operating section 220 is provided with a knob 223 for operating the insertion section 210 and a switch 224 for operating the imaging unit, etc. The operator can bend the insertion section 210 in the desired direction by operating the knob 223.

[0020] The tip of the operating section 220 is provided with a forceps insertion port 222 that communicates with the treatment instrument channel 230. The operator can insert an endoscopic treatment instrument into the treatment instrument channel 230 through the forceps insertion port 222.

[0021] The universal code 240 connects the control unit 220 to external peripheral devices. For example, the universal code 240 outputs images captured by the imaging unit to external devices. The images captured by the imaging unit are displayed on a display device such as a liquid crystal display via an image processing device.

[0022] [Opening / closing operation unit 250] The opening / closing operation unit 250 is an operation unit that opens and closes the medical stapler 100 by operating the opening / closing operation wire 5. As shown in Figure 1, the opening / closing operation unit 250 has an opening / closing operation unit body 252 and an opening / closing operation slider 253.

[0023] The base end of the opening / closing operation wire 5 is connected to the opening / closing operation slider 253. The operator can move the opening / closing operation wire 5 forward and backward by moving the opening / closing operation slider 253 forward and backward in the longitudinal direction relative to the opening / closing operation unit body 252.

[0024] [Discharge operation section 270] The discharge operation unit 270 is an operation unit that discharges staples S (see Figure 12) from the medical stapler 100 by operating the discharge operation wire 6. As shown in Figure 1, the discharge operation unit 270 has a discharge operation unit body 272 and a discharge operation slider 273.

[0025] The base end of the discharge wire 6 is connected to the discharge slider 273. The operator can move the discharge wire 6 forward and backward by moving the discharge slider 273 in the longitudinal direction relative to the discharge unit body 272.

[0026] [Wire sheath 280] The wire sheath 280 is a sheath through which the opening / closing operation wire 5 and the discharge operation wire 6 are inserted. The wire sheath 280 is a metal coil sheath. However, the wire sheath 280 is not limited to a metal coil sheath and may be a sheath of other form.

[0027] Two inner sheaths 282 (see Figure 14) are inserted through the wire sheath 280. The opening / closing operation wire 5 and the discharge operation wire 6 are inserted into the two inner sheaths 282, respectively. The two inner sheaths 282 may be multi-lumen tubes having two lumens each.

[0028] [Resin Sheath 290] The resin sheath 290 is a sheath through which the wire sheath 280 is inserted so as to be able to move forward and backward. The resin sheath 290 is made of resin material. As shown in Figure 1, the tip of the resin sheath 290 is connected to the insertion section 210 of the endoscope 200 by a band 291. The tip of the resin sheath 290 is fixed to the cap 1 of the medical stapler 100. The base end of the resin sheath 290 is fixed to the wire sheath operating section 260.

[0029] [Wire sheath operating section 260] Figure 2 is a perspective view of the wire sheath operating section 260. The wire sheath operating section 260 is an operating section that moves the wire sheath 280 forward and backward relative to the resin sheath 290. The wire sheath operating section 260 has an operating section body 261 and a band attachment section 264.

[0030] The operating unit body 261 is formed in a cylindrical shape and has a tip opening 262 and a base opening 263. The base end of the resin sheath 290 is fixed to the tip opening 262.

[0031] A wire sheath 280 extends from the proximal opening 263. The operator can move the wire sheath 280 forward and backward relative to the operating unit body 261, thereby moving the wire sheath 280 forward and backward relative to the resin sheath 290.

[0032] The band attachment portion 264 is a component attached to the operating unit body 261 and has a band insertion hole 265. By attaching a band (not shown) that passes through the band insertion hole 265 to the endoscope 200, the operating unit body 261 can be easily fixed to the endoscope 200.

[0033] By fixing the control unit body 261 to the endoscope 200, the operator can advance and retract the wire sheath 280 relative to the resin sheath 290 without having to hold the control unit body 261 by hand.

[0034] A rubber stopper 266 is provided at the base end opening 263 from which the wire sheath 280 extends, and which contacts the wire sheath 280. The frictional force generated between the wire sheath 280 and the rubber stopper 266 can suppress unintended forward and backward movement of the wire sheath 280 during treatment.

[0035] [Medical stapler 100] Figure 3 is a perspective view of the medical stapler 100. The medical stapler 100 is a suturing mechanism used for suturing procedures. The medical stapler 100 comprises a cap 1, a gripping part (suture part) 2, a staple dispensing part 3, a staple receiving part 4, an opening / closing operating wire 5, and a dispensing operating wire 6. The medical stapler 100 is detachable from the tip 211 of the insertion part 210.

[0036] Figure 4 is a front view of the cap 1. In Figure 4, the gripping portion 2 is shown transparently. The cap (detachable part) 1 is a component that can be attached to and detached from the tip 211 of the endoscope 200. The cap 1 is formed in a substantially cylindrical shape and has a first through hole 11 that penetrates in the axial direction A, a second through hole 12 that penetrates in the axial direction A, a third through hole 14 that penetrates in the axial direction A, and a fourth through hole 15 that penetrates in the axial direction A.

[0037] The first through-hole 11 is a hole into which the tip 211 of the insertion section 210 is inserted. The shape of the first through-hole 11 is formed to conform to the outer shape of the tip 211 of the insertion section 210. Therefore, by inserting the tip 211 of the endoscope 200 into the first through-hole 11, the cap 1 can be attached to the tip 211 of the endoscope 200.

[0038] The central axis O1 of the first through hole 11 in the axial direction A is eccentric with respect to the central axis O of the cap 1 in the axial direction A, as shown in Figure 4. Here, the direction in which the central axis O1 is eccentric with respect to the central axis O is defined as "upward B1" in the "vertical direction B".

[0039] The second through-hole 12 is the 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 through the second through-hole 12 and fixed in place.

[0040] The wire sheath 280, which passes through the resin sheath 290, the opening / closing operation wire 5, and the discharge operation wire 6 extend to the tip side through the second through hole 12.

[0041] The central axis O2 of the second through-hole 12 in the axial direction A is eccentric with respect to the central axis O of the cap 1 in the axial direction A, as shown in Figure 4. The direction in which the central axis O2 is eccentric with respect to the central axis O is opposite to the direction in which the central axis O1 is eccentric with respect to the central axis O (upward B1). The direction in which the central axis O2 is eccentric with respect to the central axis O is defined as "downward B2" in the vertical direction B. In this embodiment, upward B1 and downward B2 are directions along the vertical direction B.

[0042] The third through-hole 14 and the fourth through-hole 15 are formed on either side of the second through-hole 12 when viewed from a front view along the axial direction A.

[0043] Figure 5 is a perspective view of the medical stapler 100 with the gripping section 2 in the closed position. Figure 6 is a front view of the medical stapler 100 with the gripping section 2 in the closed position.

[0044] When the cap 1 is attached to the tip 211 of the endoscope 200, the objective lens 215 and the forceps channel 214 are exposed from the tip-side opening 13 of the first through-hole 11 of the cap 1, as shown in Figures 5 and 6. Therefore, even with the medical stapler 100 attached to the tip 211 of the endoscope 200, the operator can observe the object to be treated using the objective lens 215.

[0045] Figure 7 is a perspective view of the medical stapler 100 with the gripping part 2 in the open position. Figure 8 is a front view of the medical stapler 100 with the gripping part 2 in the open position.

[0046] Figure 9 is a side view of the medical stapler 100 with the gripping part 2 in the closed position. Figure 10 is a side view of the medical stapler 100 with the gripping part 2 in the open position.

[0047] The gripping portion 2 is provided on the tip side of the cap 1 and can suture the gripped target tissue with staples S. The gripping portion 2 includes a first gripping member 21, a second gripping member 22, an opening / closing rotating shaft 23, and a movable pin 27.

[0048] The first gripping member 21 and the second gripping member 22 are connected by an opening / closing rotation shaft 23 so as to be openable and closable. The first gripping member 21 and the second gripping member 22 rotate relative to each other to grip the target tissue.

[0049] The opening / closing rotation shaft 23 is located on the tip side of the cap 1. The axial direction (width direction C) of the opening / closing rotation shaft 23 is perpendicular to the axial direction A and vertical direction B of the cap 1. As shown in Figure 8, the gripping portion 2 is formed symmetrically with respect to the central axis of the vertical direction B, which passes through the central axis O of the cap 1.

[0050] Figure 11 is a perspective view showing the connection between the first gripping member 21 and the cap 1. The first gripping member 21 is connected to the tip side of the cap 1 so as to be able to move back and forth. The first gripping member 21 is connected to the cap 1 at a point B2 below the central axis O of the cap 1. Two support members 26 are attached to the first gripping member 21, extending towards the base end in the axial direction A.

[0051] The two support members 26 are rigid, elongated members that support the first gripping member 21 so that it can move forward and backward relative to the cap 1. The two support members 26 are inserted into the third through hole 14 and the fourth through hole 15, respectively, so that they can move forward and backward in the axial direction A. In other words, the two support members 26, the third through hole 14, and the fourth through hole 15 constitute the forward and backward movement mechanism of the first gripping member 21.

[0052] The first gripping member 21 is supported by two support members 26 arranged in the width direction C, and therefore does not rotate around the axial direction A as the axis of rotation. Furthermore, the two support members 26 have the effect of suppressing the deflection of the wire sheath 280 when the tissue is pulled in during the retraction step S16 described later, and supporting the first gripping member 21 of the gripping section 2 so that it does not move relative to the central axis O2. Note that if the rigidity of the support member 26 is sufficient, one support member 26 may be used.

[0053] As shown in Figure 11, the tip of the wire sheath 280 through which the opening / closing operation wire 5 and the discharge operation wire 6 are inserted is fixed to the first gripping member 21. When the wire sheath 280 moves forward and backward relative to the resin sheath 290, the first gripping member 21 connected to the wire sheath 280 moves forward and backward relative to the cap 1.

[0054] As shown in Figure 4, the first gripping member 21 is positioned so as to overlap with the second through-hole 12 in a front view. Also, as shown in Figure 8, the first gripping member 21 is positioned so as not to overlap with the objective lens 215 and forceps channel 214 of the endoscope 200 in a front view.

[0055] As shown in Figure 7, the first gripping member 21 has a first tip portion 21a and a first main body portion 21b, and is formed in a substantially T-shape in plan view. The first tip portion 21a is positioned towards the tip of the first main body portion 21b.

[0056] The first tip portion 21a is formed in a substantially rectangular parallelepiped shape. In a plan view, the first tip portion 21a is formed in a rectangular shape extending in the axial direction (width direction C) of the opening / closing rotation axis 23. The first tip portion 21a is provided with a staple discharge portion 3. The upper surface B1 (top surface 21e) of the first tip portion 21a is provided with an opening 31a for the staple discharge portion 3.

[0057] The first main body portion 21b is an elongated member extending in the axial direction A. The tip of the first main body portion 21b is fixed to the first tip portion 21a. The base end of the first main body portion 21b is fixed to the support member 26. The first main body portion 21b has a contact pin 21c and a first engagement groove 21d.

[0058] The contact pin 21c is provided at the base end of the first main body portion 21b and contacts the second gripping member 22 in the closed state, thereby restricting the range of motion of the second gripping member 22.

[0059] As shown in Figure 9, the first engagement groove 21d is a groove that penetrates the first main body portion 21b in the axial direction C of the opening / closing rotation shaft 23. The first engagement groove 21d extends in the axial direction A.

[0060] The second gripping member 22 is rotatably attached to the first gripping member 21 by an opening / closing rotation shaft 23. 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.

[0061] The U-shaped member 22a is formed in a substantially U-shape, with both ends connected to the second main body 22b, and the central part positioned towards the tip. The central part has a second tip 22c. The second tip 22c is formed in a substantially rectangular parallelepiped shape. The second tip 22c is provided with a staple receiving portion 4.

[0062] The second main body portion 22b is rotatably attached to the first main body portion 21b of the first gripping member 21 by an opening / closing rotation shaft 23. The second main body portion 22b has a guide groove 22d into which the first main body portion 21b is inserted. Second engagement grooves 22e are formed on both sides of the guide groove 22d of the second main body portion 22b.

[0063] The second engagement groove 22e is a groove formed in the second main body portion 22b. The second engagement groove 22e is a groove that penetrates in the axial direction C. In a side view, the second engagement groove 22e is formed on the side opposite to the staple receiving portion 4, with the opening / closing rotation shaft 23 in between. In the second gripping member 22, the second engagement groove 22e is formed symmetrically with respect to the central axis B in the vertical direction passing through the central axis O.

[0064] As shown in Figure 7, the second gripping member 22 has a field of view space 25 that penetrates in the opening / closing direction R between the staple receiving portion 4 at the tip end and the opening / closing rotation shaft 23 at the base end. In this embodiment, the field of view space 25 is the space surrounded by the sides of the U-shaped member 22a, which is formed in a substantially U shape.

[0065] The movable pin 27 engages with the first engagement groove 21d and the second engagement groove 22e, and moves back and forth in the axial direction A along the first engagement groove 21d. The tip of the opening / closing operation wire 5 is attached to the movable pin 27. As the opening / closing operation wire 5 moves forward toward the tip, the movable pin 27 rotates the second gripping member 22 around the opening / closing rotation axis 23, as shown in Figure 10, and the gripping portion 2 opens.

[0066] As the opening / closing operation wire 5 moves backward toward the base end, the movable pin 27 rotates the second gripping member 22 around the opening / closing rotation axis 23, as shown in Figure 9, and the gripping part 2 closes. In other words, the opening / closing operation wire 5 is a component that rotates the first gripping member 21 and the second gripping member 22 relative to each other, transmitting power to the gripping part 2 to grip the target tissue.

[0067] When the gripping portion 2 is in the closed position, the staple discharge portion 3 and the staple receiving portion 4 face each other in the vertical direction B, as shown in Figure 6. When the gripping portion 2 is in the closed position, a small gap is formed between the staple discharge portion 3 and the staple receiving portion 4.

[0068] When the gripping portion 2 is in the closed position, as shown in Figures 5, 6, and 9, the optical axis X1 of the objective lens 215 passes outside the first gripping member 21 and the second gripping member 22. Also, when the gripping portion 2 is in the closed position, the central axis X2 of the forceps channel 214 does not overlap with the first gripping member 21 in a front view, but it is in a position that overlaps with the second gripping member 22.

[0069] When the gripping portion 2 is in the open position, as shown in Figure 10, the staple receiving portion 4 is positioned on the base end side of the opening / closing rotation axis 23. When the gripping portion 2 is in the open position, as shown in Figures 7, 8, and 10, the staple ejection portion 3 and the staple receiving portion 4 are positioned on either side of the optical axis X1 of the objective lens 215.

[0070] When the gripping portion 2 is open, the optical axis X1 of the objective lens 215 passes through the field of view 25. Also, when the gripping portion 2 is open, the central axis X2 of the forceps channel 214 passes through the field of view 25.

[0071] Figure 12 is a cross-sectional view of the gripping section 2, including the staple release section 3. The staple discharge section 3 is provided at the first tip 21a of the first gripping member 21 and can store and discharge staples S. The staple discharge section 3 includes a staple storage section 31, a straight-moving member (support member) 32, and a rotating member (extrusion member) 33.

[0072] The staple storage section 31 is a space for storing staples S provided at the first tip 21a of the first gripping member 21. As shown in Figure 7, the first gripping member 21 has two staple storage sections 31 arranged side by side in the width direction C, and can store two U-shaped staples S.

[0073] The staple storage section 31 has an opening 31a provided on the upper surface 21e of the first tip section 21a, which opens upward B1. Staples S are stored in the staple storage section 31 through the opening 31a. Staples S are stored in the staple storage section 31 with the needle tip S1 of the staple S facing upward B1.

[0074] In a plan view, the staple storage section 31 is formed in a substantially rectangular shape with its shorter side extending in the axial direction A and its longer side extending in the width direction C. The staples S stored in the staple storage section 31 have their needle tips S1 at both ends arranged in the width direction C.

[0075] The straight-moving member (support member) 32 is a member housed in the staple storage section 31 and is movable in the vertical direction B within the internal space of the staple storage section 31. The straight-moving member 32 has a recess 32a that supports the staple S from below B2. The staple S stored in the staple storage section 31 is fitted into the recess 32a.

[0076] The first pulley (first member) 34 and the second pulley 36, which are included in the rotating member 33, are rotatably mounted inside the first gripping member 21, and their rotation moves the linear member 32 in the vertical direction B. The tip of the release operation wire 6 is connected to the first pulley 34. The first pulley 34 can be rotated by pulling the release operation wire 6.

[0077] The second pulley 36 is rotatably mounted inside the first gripping member 21, and the first pulley 34 is positioned further forward than the second pulley 36. The rotation axis 35 of the first pulley 34 and the rotation axis 37 of the second pulley 36 extend in the width direction C and are substantially parallel to the opening / closing rotation axis 23 of the gripping part 2. The first pulley 34 has a protrusion (contact portion) 38 on its tip side that supports the straight-moving member 32 from below B2.

[0078] The tip of the discharge control wire 6 is connected to the first pulley 34 above the rotating shaft 35 at point B1. The discharge control wire 6 extends from the first pulley 34 through the second pulley 36 and through the second through hole 12 to the discharge control section 270.

[0079] The reason for providing the second pulley 36 is to adjust its position to smoothly guide the release operation wire 6 into the second through hole 12 and to reduce frictional resistance when guiding the release operation wire 6 into the second through hole 12. Therefore, the same effect can be obtained by using only the first pulley 34 as the rotating member 33 and providing a friction-reducing member with a smooth sliding surface and an R-shape instead of the second pulley 36.

[0080] Figure 13 is a cross-sectional view of the gripping section 2 after the release wire 6 has been pulled. When the release operation wire 6 is pulled, the upper part B1 of the first pulley 34 rotates towards the base end with the rotation axis 35 as the center of rotation, and the lower part B2 of the first pulley 34 rotates towards the tip end. As a result, the protrusion 38 of the first pulley 34 pushes the straight member 32 upward B1, and the stored staple S is released upward B1 from the opening 31a. In other words, the release operation wire 6 is a member that transmits power to the gripping part 2 to release the staple S. The rotating member 33 is an injection mechanism capable of ejecting the staple S.

[0081] The staple receiving section 4 is provided on the lower surface 22f of the second tip portion 22c of the second gripping member 22. The staple receiving section 4 is provided with a plurality of pockets 41 capable of receiving staples S released from the staple discharge section 3. In this embodiment, since two U-shaped staples are released from the staple discharge section 3, the staple receiving section 4 is provided with four pockets. When the gripping section 2 is in the closed state, as shown in Figure 12, the opening 31a from which the staples S are released and the pockets 41 of the staple receiving section 4 are opposite each other in the vertical direction B.

[0082] Figure 14 is a cross-sectional view of the advanced gripping portion 2 and cap 1. Even when the gripping section 2 is in its forward position, it remains connected to the opening / closing wire 5 and the discharge wire 6 that pass through the wire sheath 280. The operator can move the opening / closing wire 5 and the discharge wire 6 forward and backward even when the gripping section 2 is in its forward position.

[0083] The gripping portion 2 shown in Figure 14 is positioned as far forward as possible relative to the cap 1. In the wire sheath 280, the length Y1 of the tip portion 285 that can protrude toward the tip from the second through hole 12 of the cap 1 is less than or equal to the length Y2 of the rigid portion 211a at the tip portion 211 of the endoscope 200.

[0084] [Operation of Medical Stapler 100] Next, we will explain an example of how the medical stapler 100 operates. Figure 15 is a flowchart showing the procedure performed by the operator using the medical stapler 100. Figures 16 to 19 are diagrams illustrating the operation of the medical stapler 100.

[0085] The operator first begins the procedure using the medical stapler 100 (step S10). Next, the operator performs the attachment step S11. In the attachment step S11, the operator attaches the medical stapler 100 to the tip 211 of the endoscope 200.

[0086] Next, the surgeon performs insertion step S12. In insertion step S12, the surgeon inserts the medical stapler 100 and the endoscope 200 into the body.

[0087] Furthermore, the operator brings the tip 211 of the endoscope 200, which is fitted with a medical stapler 100, close to the target T (an example of target tissue). The operator opens the gripping section 2 by operating the opening / closing operation section 250 to advance the opening / closing operation wire 5. Since the optical axis X1 of the objective lens 215 passes through the field of view space 25, the operator can observe the target T through the imaging unit of the endoscope 200.

[0088] Figure 16 shows the operation of the protruding step S13 by the medical stapler 100. The surgeon performs the protrusion step S13, extending the grasping forceps (treatment instrument) G from the forceps channel 214. During the protrusion step S13, the central axis X2 of the forceps channel 214 passes through the field of view 25, so the surgeon can extend the grasping forceps G from the forceps channel 214, as shown in Figures 11 and 16.

[0089] Figure 17 shows the operation of the medical stapler 100 in the forward step S14, gripping step S15, and retraction step S16.

[0090] If the target of treatment T is in a location that makes it difficult for the endoscope 200 to approach, the operator performs the advancement step S14 and advances the gripping section 2 by advancing the wire sheath 280, as shown in Figure 17.

[0091] Furthermore, the surgeon performs the grasping step S15, extending the grasping forceps G from the field of view (penetration space) 25 of the advanced grasping part 2 to grasp the object to be treated T.

[0092] Next, the surgeon performs the retraction step S16, and as shown in Figure 17, while grasping the object to be treated T with the grasping forceps G, retracts the grasping forceps G. The surgeon retracts the grasping forceps G until the tip of the grasping forceps G passes through the field of view (penetration space) 25, thereby retracting the object to be treated T until it passes through the field of view (penetration space) 25.

[0093] As a result, the object to be treated T is positioned on the proximal side of the staple release section 3. The operator may also pull in the object to be treated T by advancing the gripping section 2 relative to the gripping forceps G. That is, the object to be treated T is pulled in by relatively retracting the gripping forceps G relative to the gripping section 2.

[0094] Here, as shown in Figure 17, the first gripping member 21 is pressing down on the area surrounding the object to be treated T, making it easier for the surgeon to pull the object to be treated T in with the gripping forceps G.

[0095] The forward step S14 may be performed before the gripping step S15 or before the retraction step S16. In either case, the first gripping member 21 can press down on the peripheral area of ​​the object to be treated T during the retraction step S16.

[0096] Figure 18 shows the operation of the suturing step S17 using the medical stapler 100.

[0097] The surgeon performs the suturing step S17 and, as shown in Figure 18, operates the opening / closing operation unit 250 to retract the opening / closing operation wire 5 and close the gripping unit 2. The object to be treated T is held between the staple discharge unit 3 of the first gripping member 21 and the staple receiving unit 4 of the second gripping member 22.

[0098] When the gripping portion 2 is in the closed position, a portion of the object to be treated T, which is gripped by the gripping forceps G, can be placed in the space (field of view 25) formed by the U-shaped member 22a and the second main body portion 22b of the second gripping member 22, making it easier to fix the object to be treated T, which is held between the staple discharge portion 3 and the staple receiving portion 4.

[0099] When the gripping section 2 is in the closed position, as shown in Figure 9, the optical axis X1 of the objective lens 215 passes outside the first gripping member 21 and the second gripping member 22. Therefore, even when the gripping section 2 is in the closed position, the operator can observe the treatment target T through the imaging unit of the endoscope 200.

[0100] As shown in Figure 18, the surgeon holds the object to be treated T between the staple release section 3 and the staple receiving section 4, and operates the release operation section 270 to pull the release operation wire 6, releasing the stored staple S toward the staple receiving section 4. The needle tip S1 of the staple S penetrates the object to be treated T and bends upon contact with the pocket 41 of the staple receiving section 4. As a result, the object to be treated T is sutured by the staple S.

[0101] Figure 19 shows the operation of the removal step S18 using the medical stapler 100.

[0102] The surgeon performs the removal step S18 and, as shown in Figure 19, operates the opening / closing mechanism 250 to open the gripping mechanism 2 again. The surgeon removes the gripping forceps G from the object T to be treated and completes the suturing procedure. The surgeon removes the medical stapler 100 and the endoscope 200 from the body.

[0103] In addition, during the insertion step S12 and the removal step S18, the surgeon positions the gripping part 2 in its most retracted position to facilitate the passage of the medical stapler 100 into the body.

[0104] Next, the surgeon decides whether or not to terminate the procedure (step S19). If the procedure is not terminated, the surgeon performs the reloading step S20. For example, if the entire target T has not been sutured in the suturing step S17, the surgeon does not terminate the procedure and performs the reloading step S20. In the reloading step S20, the surgeon reloads the staples S into the medical stapler 100 that has been removed from the body. At this time, the surgeon reloads the cartridge 30 having the staple storage section 31.

[0105] Now, let's describe cartridge 30. The operation in reloading step S20 will be described later.

[0106] Figure 20 is a perspective view showing the configuration of the medical stapler 100. Figure 21 is a perspective view showing the configuration of the cartridge 30. Figure 22 is a front view showing the configuration of the first component 131 of the cartridge 30. Figure 23 is a front view showing the configuration of the second component 132 of the cartridge 30. Figures 24 and 25 are exploded perspective views showing the configuration of the cartridge 30.

[0107] As shown in Figure 20, the staple discharge unit 3 has a cartridge 30 having a staple storage unit 31. The cartridge 30 is a separate component from the first gripping member 21 and is detachably attached to the first tip portion 21a of the first gripping member 21.

[0108] The cartridge 30 is inserted from above B1 into a recess 21g formed in the first tip portion 21a of the first gripping member 21. The cartridge 30 has a pair of staple storage portions 31 in the width direction C, into which staples S are inserted.

[0109] As shown in Figure 21, the cartridge 30 is composed of a first member 131 and a second member 132.

[0110] As shown in Figure 21, the first member 131 has a pair of snap-fit ​​portions 133 and a pair of through holes 134, respectively, at positions corresponding to the pair of staple storage portions 31.

[0111] The snap-fit ​​portion 133 has a snap-fit ​​133a that is located inside the pair of through holes 134 in the width direction C. The snap-fit ​​133a has a slender rod shape extending in the vertical direction B, and a locking portion 133b is formed on the lower B2 side, projecting outward in the width direction C.

[0112] The locking portion 133b has a triangular shape when viewed from the axial direction A, and the apex q that protrudes most in the width direction C is not sharp. Both outer surfaces of the locking portion 133b in the width direction C are chamfered, forming a smooth curved connecting surface 133e that connects the outer surface 133c and the lower end surface 133d.

[0113] The through-hole 134 penetrates the first member 131 in the thickness direction. The through-hole 134 has a first through-hole 134a formed on the outside in the width direction C of the first member 131 relative to the snap fit 133a, a second through-hole 134b formed on the inside in the width direction C of the snap fit 133a, and a third through-hole 134c formed below B2 of the snap fit 133a.

[0114] The first through-hole 134a is formed to be longer than the second through-hole 134b along the vertical direction B. The upper end of the first through-hole 134a does not reach the upper surface of the cartridge 30. The lower end of the first through-hole 134a communicates with the third through-hole 134c.

[0115] The second through-hole 134b is connected to the inside of the first through-hole 134a and the third through-hole 134c in the width direction C, below B2 of the snap-fit ​​133a. The third through-hole 134c, which communicates with the first through-hole 134a in the vertical direction B, opens to the lower surface of the first member 131.

[0116] The first through-hole 134a and the third through-hole 134c are guide holes that guide the inserted straight-moving member 32 in the vertical direction B. The combined length of the first through-hole 134a and the third through-hole 134c in the vertical direction B is the same as or slightly longer than the range of movement of the straight-moving member 32 in the vertical direction B.

[0117] The second through-hole 134b is a through-hole that forms a gap to allow displacement C in the width direction of the snap-fit ​​133a. The length B in the vertical direction of the second through-hole 134b is shorter than that of the first through-hole 134a. The width of the second through-hole 134b in the width direction C is approximately equal to or slightly smaller than the width of the snap-fit ​​133a.

[0118] The width of the second through-hole 134b is preferably such that, when the straight-moving member 32 passes through the locking portion 133b of the snap-fit ​​133a in the vertical direction B, the snap-fit ​​133a, which has been displaced in the width direction C, does not come into contact with the inner surface 134d of the second through-hole 134b.

[0119] As shown in Figures 21 and 24, the protruding portion 32c of the straight-moving member 32 is inserted into the third through-hole 134c. The protruding portion 32c is a prismatic convex portion of the straight-moving member 32 that protrudes forward A1 in the axial direction A, and abuts against the lower end of the snap-fit ​​133a from the lower B2 side.

[0120] The protruding portion 32c of the straight member 32 is approximately rectangular when viewed from the front A1 side, and the pair of corners on the upper B1 side are rounded off. The rounded surface 32d of the protruding portion 32c abuts against the locking portion 133b of the snap fit 133a located at the upper B1 side from the lower B2 side.

[0121] The projection length of the protruding portion 32c along the axial direction A is approximately equal to the plate thickness of the snap-fit ​​133a. However, the projection length of the protruding portion 32c along the axial direction A and the plate thickness of the snap-fit ​​133a may be different dimensions, as long as the rigidity of both is ensured.

[0122] As shown in Figure 23, the second member 132 has a pair of through holes 135 (slits) and a positioning hole 136 formed between these through holes 135, at positions corresponding to the pair of staple storage sections 31. Also, as shown in Figures 24 and 25, the second member 132 is positioned on the rear A2 side in the axial direction A of the first member 131.

[0123] The through-hole 135 is formed at a position opposite the through-hole 134 of the first member 131 in the axial direction A. The through-hole 135 penetrates the second member 132 in the thickness direction. The through-hole 135 is formed to be long in the vertical direction B, and is approximately equal to the combined length of the first through-hole 134a and the third through-hole 134c of the first member 131. The through-hole 135 opens to the lower surface of the second member 132. As shown in Figure 25, a projection 32g that protrudes from the straight member 32 toward the rear A2 is inserted into the through-hole 135.

[0124] As shown in Figure 23, the positioning hole 136 is an elongated hole formed in the vertical direction B, which is narrower and shorter than the through hole 135. The positioning hole 136 is formed approximately in the center of the second member 132 in all directions (up, down, left, and right).

[0125] A positioning projection 131a, formed on the inner surface of the first member 131 (the rear A2 side surface facing the second member 132), is inserted into the positioning hole 136. The positioning hole 136 is formed to be slightly larger than the positioning projection 131a.

[0126] Furthermore, at the lower end of the through-hole 135 that opens downward B2, indentation portions 139 are provided on both sides of the through-hole 135 in the width direction C. The indentation portions 139 protrude downward B2 from the lower surface of the second member 132 and have a roughly L-shape, bending in the width direction C toward the through-hole 135. As shown in Figure 23, the dimension of the through-hole 135 in the width direction C is narrowed in the portion sandwiched between the indentation portions 139 in the width direction C.

[0127] The lower surface (downward B2 surface) 139a of the indentation portion 139 is a plane extending in the axial direction A and the width direction C. Furthermore, at the tip of the indentation portion 139 which is bent in an L shape in the width direction C, the upper corner B1 is chamfered, forming a beveled surface 139b. As a result, the dimensions of the through hole 135 in the portion sandwiched by the beveled surface 139b in the width direction C become narrower as it goes downward B2. Also, the dimensions of the through hole 135 in the portion sandwiched by the beveled surface 139b in the width direction C are smaller than the dimensions of the protrusion 38 of the first pulley 34 in the width direction C.

[0128] Furthermore, the cartridge 30 is detachably fixed to the first tip portion 21a of the first gripping member 21 via a connecting member 39 that is inserted through a pair of insertion holes 137 formed on the lower end side of the first member 131 and a pair of insertion holes 138 formed on the lower end side of the second member 132. The method of fixing the cartridge 30 to the first gripping member 21 is not limited to this, and for example, it may be detachably provided on the first gripping member 21 using a snap-fit ​​structure.

[0129] The operation in the reloading step S20 of the medical stapler 100 will be explained using Figures 26A to 26D and Figures 27A to 27C. First, the operation of removing the cartridge 30 from the staple discharge section 3 will be explained using Figures 26A to 26D.

[0130] Figure 26A is a cross-sectional view showing the operation of the medical stapler 100 in the reloading step S20. The medical stapler 100 shown in Figure 26A is in the state after the removal step S18, and therefore after the staples S have been ejected in the suturing step S17. The medical stapler 100 is also in the state after being removed from the body in the removal step S18.

[0131] In Figure 26A, the medical stapler 100 is in a state where the release operation wire 6 is pulled, causing the first pulley 34 to rotate, and the straight member 32 moves upward to B1 due to the protrusion 38 of the first pulley 34. At this time, the protrusion 38 of the first pulley 34 is inserted through the through hole 135 of the second member 132.

[0132] Figure 26B is a cross-sectional view showing the operation following Figure 26A in the reloading step S20 of the medical stapler 100. In the reloading step S20, the operator first removes the cartridge 30 from the first gripping member 21. At this time, if the cartridge 30 is fixed to the first gripping member 21 via a connecting member 39, the operator removes the connecting member 39 from the first gripping member 21 and the cartridge 30, thereby releasing the cartridge 30 from the first gripping member 21.

[0133] As shown in Figure 26B, the surgeon moves the cartridge 30 upward B1 relative to the first gripping member 21. At this time, the protrusion 38 of the first pulley 34 moves the through hole 135 downward B2 relative to the cartridge 30. The surgeon may move the cartridge 30 by grasping it with their hand, or they may move the cartridge 30 using a jig or other tool.

[0134] As shown in Figure 26B, when the cartridge 30 is moved upward B1 relative to the first gripping member 21, the push-in portion 139 of the second member 132 contacts the convex portion 38, which is rotated by the pulling of the discharge operation wire 6, from below B2.

[0135] When the operator moves the cartridge 30 further upward to B1 from the state shown in Figure 26B, the protrusions 38 are pressed against each of the inclined surfaces 139b of the pair of indentation portions 139 of the second member 132 from above B1. As the protrusions 38 are pressed against the inclined surfaces 139b from above B1, the pair of indentation portions 139 move in the width direction C away from the protrusions 38. At this time, for example, the indentation portions 139 move in the width direction C due to the elasticity of the material.

[0136] When the protrusion 38 is pressed against the pair of indentation portions 139, they are separated from each other in the width direction C, and the protrusion 38 passes through the through hole 135 (slit) between the pair of indentation portions 139 from above B1 to below B2. That is, the gap between the pair of indentation portions 139 in the width direction C is widened to the right C1 and left C2 in the width direction C by the protrusion 38, and the protrusion 38 passes downward B2 while widening the gap between the pair of indentation portions 139.

[0137] After the protrusion 38 passes between the pair of indentations 139, the pair of indentations 139 return to their original positions due to the elasticity of the material. That is, in the width direction C, the pair of indentations 139 move closer to each other and return to the position shown in Figure 23.

[0138] Figure 26C is a cross-sectional view showing the operation of the medical stapler 100 following Figure 26B in the reloading step S20. After the protrusion 38 passes between the pair of indentation portions 139, the cartridge 30 is positioned above the protrusion 38 at B1, as shown in Figure 26C.

[0139] As shown in Figures 26B and 26C, the indentation portion 139 moves from below B2 to above B1 of the protrusion 38 as the protrusion 38 passes through the through hole 135.

[0140] Figure 26D is a cross-sectional view showing the operation of the medical stapler 100 following Figure 26C in the reloading step S20. 6D As shown, the operator can pull the cartridge 30 upward B1 from the first gripping member 21 and remove it from the staple discharge section 3.

[0141] Next, using Figures 27A to 27C, we will explain the operation of removing the cartridge 30 from the staple discharge unit 3 and then reloading the cartridge 30 into the staple discharge unit 3.

[0142] Figure 27A is a cross-sectional view showing the operation following Figure 26D in the reloading step S20 of the medical stapler. The operation shown in Figure 27A is the operation of reloading the cartridge 30 into the staple discharge section 3, which has the cartridge 30 removed.

[0143] Here, the cartridge 30 to be reloaded contains staples S, but the staples S are omitted in the cross-sectional view shown in Figures 27A to 27C. The cartridge 30 to be reloaded may be, for example, the cartridge 30 removed in Figures 26A to 26D into which the operator has placed staples S, or it may be a different cartridge 30 from the one removed.

[0144] As shown in Figure 27A, the surgeon inserts the cartridge 30 to be reloaded into the recess 21g of the first gripping member 21 from above B1. At this time, since staples S are housed in the staple storage section 31 of the cartridge 30, the straight-moving member 32 is in a state where it is moved downward B2 relative to the staple storage section 31.

[0145] When reloading the cartridge 30, as shown in Figure 27A, the lower surface 139a of the push-in portion 139 of the second member 132 contacts the protrusion 38 from above B1. Therefore, when the cartridge 30 is moved downward B2 relative to the first gripping member 21, the protrusion 38 is pushed downward B2 by the push-in portion 139, causing the first pulley 34 to rotate. At this time, the operator is not operating the discharge wire 6.

[0146] Figure 27B is a cross-sectional view showing the operation following Figure 27A in the reloading step S20 of the medical stapler. As shown in Figure 27B, when the cartridge 30 is moved further down B2 from the state shown in Figure 27A, the protrusion 38 of the first pulley 34 is pushed by the push-in part 139 and rotates further, moving down B2.

[0147] Figure 27C is a cross-sectional view showing the operation following Figure 27B in the reloading step S20 of the medical stapler. As shown in Figure 27C, when the cartridge 30 is moved further down B2 from the state shown in Figure 27B, the protrusion 38 of the first pulley 34 is pushed by the push-in part 139 and rotates further, moving toward the base end side of the push-in part 139.

[0148] Since the protrusion 38 is located closer to the base end than the push-in portion 139, the push-in portion 139 can move downward B2 relative to the protrusion 38. Therefore, the cartridge 30 can be fully inserted into the first gripping member 21 and attached to the staple discharge portion 3. At this time, the protrusion 38 and the straight-moving member 32 are not in contact.

[0149] When fixing the cartridge 30 to the staple discharge section 3 via the connecting member 39, in the state shown in Figure 27C, the connecting member 39 is inserted into the insertion hole 137 of the first member 131 and the insertion hole 138 of the second member 132, thereby fixing the cartridge 30 to the staple discharge section 3.

[0150] Here, the position of the first pulley 34 (rotating member 33) shown in Figure 27C is referred to as the "first position." The first position is the initial position of the rotating member 33. That is, in the reloading step S20, the operator can return the rotating member 33 to its initial position by attaching the cartridge 30 to the staple discharge section 3.

[0151] After reloading the cartridge 30 containing the staples S into the staple discharge unit 3 in the reloading step S20, the surgeon returns to the insertion step S12 and repeats the subsequent steps. For example, if all the suturing of the target T was not completed in the first suturing step S17, the surgeon uses the staples S contained in the cartridge 30 reloaded in the reloading step S20 to perform the suturing procedure again.

[0152] If the insertion step S12 and subsequent steps are to be repeated after the reloading step S20, in the suturing step S17, the surgeon operates the discharge wire 6 to rotate the rotating member 33.

[0153] At this point, the rotating member 33 is positioned in the first position by the reloading step S20, so the operator pulls the discharge operation wire 6 to bring the protrusion 38 and the straight member 32 into contact, resulting in the state shown in Figure 12.

[0154] The surgeon further pulls the release wire 6 to eject the staple S from the staple release section 3 and performs the suturing procedure again. At this time, as described above, the rotating member 33 is rotated to the position shown in Figure 26A. Here, the position of the rotating member 33 shown in Figure 26A is referred to as the "second position". That is, in the rotating member 33, the second position is the position when the staple S is ejected from the staple release section 3.

[0155] The rotating member 33 is the release operation wire 6 towing operation This allows the rotating member 33 to rotate from its initial first position to a second position where staples S are ejected. In the reloading step S20, the rotating member 33 is in the second position when the cartridge 30 is removed from the staple ejection unit 3. When the cartridge 30 is attached to the staple ejection unit 3, the rotating member 33 rotates from the second position back to the first position and returns to its initial position.

[0156] Furthermore, in the reloading step S20, when the cartridge 30 is removed from the staple discharge unit 3, the push-in portion 139 of the cartridge 30 moves from below B2 to above B1 of the rotating member 33, which is located in the second position. Also, when the cartridge 30 is attached to the staple discharge unit 3, the push-in portion 139 rotates the rotating member 33, which is located in the second position, back to the first position by pushing it from above B1 to below B2, returning it to its initial position.

[0157] In this way, after the suturing step S17, the surgeon can reload the staples S into the medical stapler 100 by removing the cartridge 30 from the staple dispensing unit 3 and attaching the cartridge 30 containing the staples S back to the staple dispensing unit 3, thereby allowing the suturing procedure to continue. Furthermore, since the rotating member 33 returns to its initial position (first position) by the action of attaching the cartridge 30 to the staple dispensing unit 3, the surgeon (operator) can easily return the rotating member 33 to its initial position and easily recognize that the rotating member 33 has been returned to its initial position.

[0158] After completing all suturing procedures, the surgeon removes the medical stapler 100 from the body in removal step S18, thus concluding the procedure (step S21).

[0159] When suturing is performed multiple times by carrying out the reloading step S20, there is a risk that the surgeon may have difficulty visually identifying the staples S used for suturing at the already sutured site. Therefore, it is preferable to provide a marking member on the staples S used in the medical stapler 100 to improve visibility.

[0160] Figure 28 is a front view showing a staple S having a marking member M. The marking member M is connected to the lower part B2 of the staple S housed in the medical stapler 100. Therefore, even when the staple S has been ejected from the staple discharge section 3 in the suturing step S17 and the needle tip S1 has penetrated the treatment target T, the surgeon can still see the marking member M through the imaging unit of the endoscope 200.

[0161] The marking member M is made of a material that appears enhanced by image enhancement light such as NBI or AFI. Here, NBI is a technique (method) that enhances the appearance of capillaries and mucosal micro-patterns on the mucosal surface by irradiating with two narrowband wavelengths of light that are easily absorbed by hemoglobin in the blood. In NBI, in order to observe blood vessels with high contrast, attention is paid to the use of light that has the characteristic of being strongly absorbed by blood and the characteristic of being strongly reflected and scattered by the mucosal surface. Blue narrowband light (390~445nm) is used for observing capillaries on the mucosal surface, and green narrowband light (530~550nm) is used to enhance the contrast between observing large blood vessels in the deeper parts and capillaries on the mucosal surface.

[0162] For example, when light strikes a solid, light of wavelengths specific to that solid is absorbed. Light of wavelengths not absorbed by the solid is reflected. The human eye receives the light of wavelengths not absorbed by the material, and therefore perceives the color of the material as the color of the reflected light. Thus, the color of a solid is the complementary color to the color of the light absorbed by the solid.

[0163] Therefore, by using a color that does not easily absorb the NBI light described above for the marking member M, the marking member M can be emphasized. Specifically, it can be emphasized by using violet or green. In addition, by using a color that is violet or green for the staples S, not only the marking member M but also the staples S can be emphasized.

[0164] The means of highlighting the staples S and marking members M are not limited to methods using NBI; for example, fluorescent materials such as ICG, which are excited when irradiated with near-infrared light, may be used in the staples S and marking members M to highlight them.

[0165] The dimensions of the marking member M only need to be such that the operator can see it through the imaging unit of the endoscope 200. For example, if it is made of a material that is enhanced by image enhancement light, it may be a member smaller in size than the staple S. Even if the marking member M is small, its visibility can be improved by enhancing it with image enhancement light. Preferably, the marking member M is made of a biocompatible material.

[0166] Furthermore, increasing the dimension of the portion of the marking member M that protrudes from the staple S can improve the visibility of the staple S. Therefore, it is preferable that the dimension of the portion of the marking member M that protrudes from the staple S is greater than the wire diameter of the staple S.

[0167] Furthermore, when the staple S to which the marking member M is fixed is housed in the cartridge 30, it is preferable that the cartridge 30 has a space (relief portion) to accommodate the marking member M. For example, by making the shape of the recess 32a of the straight member 32 a shape that accommodates the marking member M, the cartridge 30 can have a relief portion to accommodate the marking member M. It is preferable that the marking member M has dimensions (width) that fit into the relief portion of the cartridge 30.

[0168] As described above, the visibility of the staple S can be improved by having a marking member M. The marking member M only needs to improve the visibility of the staple S, and can be made of resin, metal, tape, thread, or the like.

[0169] According to the medical stapler 100 of this embodiment, the discharge operation wire 6 towing operation The device comprises a staple discharge unit 3 having a rotating member 33 (injection mechanism) that can rotate (move) between a first position which is an initial position and a second position for ejecting staples S, and a cartridge 30 that is detachably provided on the staple discharge unit 3.

[0170] Furthermore, the rotating member 33 is positioned in the second position when the cartridge 30 is removed from the staple discharge unit 3, and rotates from the second position to the first position when the cartridge 30 is attached to the staple discharge unit 3.

[0171] As a result, in the medical stapler 100 (suturing mechanism), the rotating member 33 can be easily returned to its initial position (first position), and the operator (surgeon) can easily recognize that it has been returned to the initial position.

[0172] Furthermore, since the rotating member 33 returns to its initial position in conjunction with the operation of attaching the cartridge 30 to the staple discharge unit 3, it is possible to prevent forgetting to return it to its initial position.

[0173] Although one embodiment of the present invention has been described in detail above with reference to the drawings, the specific configuration is not limited to this embodiment, and design changes and the like that do not depart from the spirit of the present invention are also included. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0174] (Variation 1) In the above embodiment, the cartridge 30 rotates the rotating member 33 to the first position by being pushed in by the push-in portion 139, but the form of the cartridge is not limited thereto.

[0175] The cartridge may use the linear member 32 to push the rotating member 33 downward B2, thereby rotating the rotating member 33 to the first position. In this case, the cartridge does not have a push-in portion 139.

[0176] Furthermore, when the linear member 32 pushes the rotating member 33, there is a risk that the linear member 32 may move upward B1 due to the rotating member 33. When the linear member 32 pushes the rotating member 33, for example, by inserting a cover member that restricts the upward movement of the linear member 32 into the staple storage section 31 from above B1, the movement of the linear member 32 upward B1 due to the rotating member 33 can be suppressed.

[0177] In this case, when attaching the cartridge to the staple discharge section 3, the cover member is inserted into the staple storage section 31 of the cartridge from above B1 and secured. After attaching the cartridge to the staple discharge section 3 with the movement of the straight-moving member 32 upward B1 restricted by the cover member, the operator removes the cover member from the cartridge. By removing the cover member, the straight-moving member 32 can move upward B1, and staples S can be ejected.

[0178] (Modification 2) In the above embodiment, the staple S has sufficient visibility by being equipped with a marking member M, but the form of the staple is not limited thereto.

[0179] The visibility of staples may be improved by coating the surface of the staples with a material that appears enhanced by image-enhancing light. Alternatively, the visibility of staples may be improved by forming them from a material that appears enhanced by image-enhancing light.

[0180] (Variation 3) In the above embodiment, the recess 32a of the cartridge 30 is into which the staple S stored in the staple storage section 31 is fitted, and separates from the staple S when the staple S is ejected, but the shape of the recess is not limited to this.

[0181] The recess in the cartridge into which the staple S is inserted may be ejected from the staple discharge section 3 together with the staple S while connected to the staple S when the staple S is ejected. In suturing procedures, the staple S and the recess may be ejected while connected, and the object to be treated T can be sutured, thereby improving the visibility of the staple S due to the recess. At this time, the recess may be connected (joined) with the staple S when the staple S ejected from the staple discharge section 3 is pressed against the pocket 41 of the staple receiving section 4 and deforms.

[0182] Furthermore, it is preferable that the diameter of the groove shape (groove portion) of the recess be slightly smaller than the diameter of the staple S. Here, the groove shape of the recess is the portion that is recessed downward B2 and supports the staple S from downward B2. Note that it is not limited to the overall diameter of the groove shape of the recess, but it is sufficient if the diameter of a part of the groove shape of the recess is slightly smaller than the diameter of the staple S. Alternatively, a claw shape (claw portion) may be provided at the opening (entrance) above B1 of the groove shape of the recess, and the staple S and the recess may be connected by this claw shape. [Explanation of Symbols]

[0183] 300 healthcare systems 200 Endoscopes 210 Insertion section 250 Opening / closing operation unit 270 Discharge operation part 100 Medical Staplers 5. Opening / closing operation wire 6. Release operation wire (wire) 2 Gripping part (suture part) 21 First gripping member 22 Second gripping member 3. Staple discharge section 30 cartridges 32. Straight-line member (support member) 32a Recess 33. Rotating component (injection mechanism) 34 First pulley (first component) 36 Second Pulley 38. Convex part (contact part) 135 Through hole (slit) 139 Push-in part 4. Staple receiving section A-axis B Vertical direction B1 upper B2 Downward S staples M marking component

Claims

1. A medical stapler attached to the tip of an endoscope, The wire extending in the axial direction of the endoscope, A staple discharge unit having a cartridge capable of housing staples and an injection mechanism connected to the tip of the wire and capable of ejecting the staples from the cartridge, Equipped with, The cartridge is detachably provided in the staple discharge section. The injection mechanism is, The wire can be moved from the initial first position to the second position where the staple is fired by manipulating it. When the cartridge is removed from the staple discharge section, it is positioned in the second position. When the cartridge is attached to the staple discharge section, it moves from the second position to the first position. Medical stapler.

2. The cartridge has a support member that supports the staple from below and is movable in the vertical direction, When the aforementioned wire is pulled, The injection mechanism moves from the first position to the second position while moving the support member from below to above. The staple is launched upward from the staple discharge section by the support member. A medical stapler according to claim 1.

3. The cartridge has a push-in portion located below the support member, The aforementioned push-in portion is When the cartridge is removed from the staple discharge section, the ejection mechanism located in the second position moves from below to above, When the cartridge is attached to the staple discharge section, the ejection mechanism located in the second position is moved to the first position by pushing it from above downwards. A medical stapler according to claim 2.

4. The aforementioned push-in portion is Having a slit that opens downwards, When the cartridge is removed from the staple discharge section, the injection mechanism moves from below to above as it passes through the slit. A medical stapler according to claim 3.

5. The cartridge is attached to the staple discharge section with the staples contained within it. A medical stapler according to claim 1.

6. The injection mechanism is rotatable between the first position and the second position. A medical stapler according to claim 1.

7. The cartridge further includes a cover member that restricts the upward movement of the staple and is detachable from the cartridge. A medical stapler according to claim 1.

8. The cartridge is capable of accommodating the substantially U-shaped staples having an opening at the top, A marking member containing a material that is enhanced by image enhancement light is connected below the staple. A medical stapler according to claim 1.

9. The staple includes a material that is enhanced by image enhancement light. A medical stapler according to claim 8.

10. The cartridge has a support member that supports the staple from below and is movable in the vertical direction, The support member has a relief portion capable of accommodating the marking member. A medical stapler according to claim 8.

11. The marking member has dimensions that allow it to be accommodated in the relief portion. A medical stapler according to claim 10.

12. The marking member is fixed to the staple. A medical stapler according to claim 8.

13. The support member is connected to the staple when the injection mechanism moves from the first position to the second position, and is launched upward from the staple discharge section together with the staple. A medical stapler according to claim 2.

14. The support member has a recess formed with a groove shape that is concave downwards, which allows the staple to be supported from below. A medical stapler according to claim 13.

15. The support member has a recess formed in the lower part of the groove shape, which allows the staple to be supported from below. The recess has a claw portion capable of fixing the staple to the upper opening in the groove shape. A medical stapler according to claim 13.

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