Grasping forceps and suturing method

Abstract

This grasping forceps according to the present invention is provided with: a sheath extending in the longitudinal direction; a rod provided at the tip of the sheath and extending in the longitudinal direction; and a grasping part that has a first jaw connected to the base side of the rod and opening and closing toward the tip side of the rod, and a second jaw connected to the base side of the rod on the opposite side of the rod from the first jaw and opening and closing toward the tip side of the rod. The rod has a tip part provided with a first convex portion that protrudes toward the first jaw on a first protruding side.

Description

Technical Field

[0001] The present invention relates to grasping forceps and a suturing method.

Background Art

[0002] In recent years, a medical stapler is known as a treatment tool for suturing the digestive tract and the like. By using an appropriate medical stapler, the operation of suturing the digestive tract and the like can be facilitated, and the operation time can be significantly shortened. The medical stapler is used together with an endoscope. For example, while grasping the treatment target with forceps, suturing is performed.

[0003] As forceps for grasping the treatment target, the forceps described in Patent Document 1 are known. This grasping forceps has a grasping part on the tip side, which includes a rod and two forceps pieces (jaws). By an operator operating two operation parts (handles), the two forceps pieces can be opened and closed to ligate an excision part or the like after treatment.

[0004] By the way, in the stomach (inside the stomach), after the gastric wall (tissue) having a mucosal layer and a muscular layer formed on the peritoneal side (outside the stomach) rather than the mucosal layer is completely resected, the edges of the excised defect are drawn into the stomach and suturing is performed. In the stomach, when complete resection is performed, the air in the stomach escapes to the peritoneal side, so the shape of the stomach shrinks. Therefore, the approach direction of the medical stapler to the defect in this state of the stomach is likely to be limited to a direction close to parallel to the surface of the gastric wall.

Prior Art Documents

Patent Documents

[0005]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0006] However, with the forceps described in Patent Document 1, when grasping the edge of the defect after treatment and pulling it towards the medical stapler, it was difficult to reliably grasp the mucosal layer and the muscular layer when the approach direction of the medical stapler was nearly parallel to the surface of the stomach wall (tissue). Therefore, with the forceps described in Patent Document 1, suturing of the defect with the medical stapler was insufficient.

[0007] This invention has been made in consideration of these circumstances, and aims to provide a grasping forceps capable of reliably grasping the mucosal and muscular layers around the periphery of an excision hole, and a suturing method for suturing an excision hole using the grasping forceps. [Means for solving the problem]

[0008] To solve the above problems, this invention proposes the following means. A gripping forceps according to a first aspect of the present invention comprises a gripping portion having a sheath extending in the longitudinal direction, a rod provided at the tip of the sheath and extending in the longitudinal direction, a first jaw connected to the base end of the rod and opening and closing toward the tip of the rod, and a second jaw connected to the base end of the rod on the opposite side of the first jaw and opening and closing toward the tip of the rod, wherein the rod has a tip portion having a first protrusion that projects toward the first jaw in a first projection direction. [Effects of the Invention]

[0009] According to the grasping forceps and suturing method of the present invention, the mucosal layer and muscle layer around the periphery of the excision hole can be reliably grasped, and the excision hole can be sutured using the grasping forceps. [Brief explanation of the drawing]

[0010] [Figure 1] This figure shows the overall configuration of a medical system used in a gripping forceps and suturing method according to the first embodiment of the present invention. [Figure 2] This is a perspective view of the medical stapler in the medical system. [Figure 3]This is a front view of the cap of the medical stapler. [Figure 4] This is a perspective view of the medical stapler with the staple gripping section in the closed position. [Figure 5] This is a front view of the medical stapler, showing the stapler gripping section in the closed position. [Figure 6] This is a perspective view of the medical stapler with the staple gripping section in the open position. [Figure 7] This is a front view of the medical stapler, showing the stapler gripping section in the open position. [Figure 8] This is a side view of the medical stapler with the staple gripping section in the closed position. [Figure 9] This is a side view of the medical stapler, showing the stapler gripping section in the open position. [Figure 10] This is a cross-sectional view of the gripping section, including the staple release section. [Figure 11] This is a cross-sectional view of the gripping section where the release wire was pulled. [Figure 12] This is an overall view showing the grasping forceps used in the endoscope of the medical system. [Figure 13] This is a perspective view showing the endoscope with a medical stapler and grasping forceps attached. [Figure 14] This is a side view showing the first and second forceps pieces of the gripping forceps in an open position relative to the rod. [Figure 15] A side view showing a modified example of the rod of the same gripping forceps. [Figure 16] This is a side view showing the state in which the second forceps of the gripping forceps is open relative to the rod, and the first forceps is closed. [Figure 17] This is a side view showing the state in which the first forceps of the gripping forceps is open relative to the rod, and the second forceps is closed. [Figure 18] This is a side view showing the first and second forceps pieces of the gripping forceps in a closed position relative to the rod. [Figure 19] This is a diagram showing the state in which the endoscope is brought close to the lesion in the suturing method using the grasping forceps according to the first embodiment of the present invention. [Figure 20] This is a diagram for explaining the placement step in the suturing method. [Figure 21] This is a diagram for explaining the insertion step in the suturing method. [Figure 22] This is a diagram for explaining the first opening / closing step in the suturing method. [Figure 23] This is a diagram for explaining the insertion step in the suturing method. [Figure 24] This is a diagram for explaining the pulling step in the suturing method. [Figure 25] This is a diagram for explaining the first grasping step in the suturing method. [Figure 26] This is a diagram for explaining the second opening / closing step in the suturing method. [Figure 27] This is a diagram for explaining the second grasping step in the suturing method. [Figure 28] This is a diagram for explaining the pulling-in step in the suturing method. [Figure 29] This is a diagram for explaining the suturing step in the suturing method. [Figure 30] This is a diagram for explaining the suturing step in the suturing method. [Figure 31] This is a diagram for explaining the suturing step in the suturing method. [Figure 32] This is an enlarged view of the tip side of the grasping forceps according to the second embodiment of the present invention. [Figure 33] This is a side view showing the state in which the first forceps piece of the grasping forceps is in an open state and the second forceps piece is in a closed state. [Figure 34] This is an enlarged view of the tip side of the grasping forceps according to the third embodiment of the present invention. [Figure 35] This is a side view showing the state in which the first forceps piece and the second forceps piece of the forceps piece of the grasping forceps are in a closed state with respect to the rod. [Figure 36]This figure illustrates another modification of the gripping forceps according to the present invention. [Figure 37] This figure illustrates another modification of the gripping forceps according to the present invention. [Figure 38] This figure illustrates another modification of the gripping forceps according to the present invention. [Modes for carrying out the invention]

[0011] (First Embodiment) A first embodiment of the present invention will be described with reference to Figures 1 to 31. Figure 1 shows the overall configuration of the grasping forceps (endoscopic treatment instrument) 400 and the medical system 300 used in the suturing method according to this embodiment. Note that the medical system used in the suturing method according to this embodiment is not limited to the medical system 300.

[0012] [Medical System 300] The medical system 300 is used for 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, and a wire sheath 280. The opening / closing operation unit 250 is an operation unit that operates the medical stapler 100 using an opening / closing operation wire 254. The discharge operation unit 270 is an operation unit that operates the medical stapler 100 using a discharge operation wire 274.

[0013] [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.

[0014] The insertion section 210 has a treatment instrument channel 230 through which the gripping forceps 400 are 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.

[0015] The tip 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 212 of the insertion portion 210.

[0016] 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 (not shown) can bend the insertion section 210 in the desired direction by operating the knob 223.

[0017] 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 the gripping forceps 400 into the treatment instrument channel 230 through the forceps insertion port 222.

[0018] 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.

[0019] [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 254. 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. The base end of the opening / closing operation wire 254 is connected to the opening / closing operation slider 253. The operator can move the opening / closing operation wire 254 forward and backward by moving the opening / closing operation slider 253 forward and backward in the longitudinal axis direction relative to the opening / closing operation unit body 252.

[0020] [Discharge operation section 270] The discharge operation unit 270 is an operation unit that discharges (ejects) staples S from the medical stapler 100 by operating the discharge operation wire 274. As shown in Figure 1, the discharge operation unit 270 has a discharge operation unit body 272 and a discharge operation slider 273. The base end of the discharge operation wire 274 is connected to the discharge operation slider 273. The operator can move the discharge operation wire 274 forward and backward by moving the discharge operation slider 273 forward and backward in the longitudinal axis direction relative to the discharge operation unit body 272.

[0021] [Wire sheath 280] The wire sheath 280 is a sheath through which the opening / closing operation wire 254 and the discharge operation wire 274 are inserted. As shown in Figure 1, the tip end of the wire sheath 280 is connected to the insertion section 210 of the endoscope 200 by a band 281.

[0022] [Medical stapler 100] Figure 2 is a perspective view of the medical stapler 100. The medical stapler 100 comprises a cap (mounting member) 1, a staple gripping part 2, a staple discharge part 3, a staple receiving part 4, an opening / closing operation wire 254, and a discharge operation wire (power transmission member) 274. The medical stapler 100 is detachable from the tip 211 of the insertion part 210 shown in Figure 1.

[0023] Figure 3 is a front view of the cap 1 of the medical stapler 100. In Figure 3, the stapler gripping part 2 is shown transparently. The cap (attachment member) 1 is a member that can be attached to 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 the axial direction A (Figure 2) of the medical stapler 100, and a second through hole 12 that penetrates the axial direction A.

[0024] The first through-hole 11 is the hole into which the tip 211 of the insertion section 210 shown in Figure 1 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.

[0025] 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 3. The direction in which the central axis O1 is eccentric with respect to the central axis O is referred to as "upper side B1".

[0026] The second through-hole 12 is a hole through which the wire sheath 280, through which the opening / closing operation wire 254 and the discharge operation wire 274 shown in Figure 1 are inserted, is inserted. The inner diameter of the second through-hole 12 is approximately the same as the outer diameter of the wire sheath 280. The tip of the wire sheath 280 is inserted into and fixed in the second through-hole 12. The opening / closing operation wire 254 and the discharge operation wire 274, which are inserted into the wire sheath 280, extend through the second through-hole 12 to the tip side.

[0027] 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 3. 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 (upper side B1). The direction in which the central axis O2 is eccentric with respect to the central axis O is referred to as "lower side B2". In this embodiment, the upper side B1 and lower side B2 are oriented along the vertical direction B.

[0028] Figure 4 is a perspective view of the medical stapler 100 with the stapler gripping section 2 in the closed position. Figure 5 is a front view of the medical stapler 100 with the stapler gripping section 2 in the closed position. 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 4 and 5. The operator can observe the object to be treated with the objective lens 215, even when the medical stapler 100 is attached to the tip 211 of the endoscope 200.

[0029] Figure 6 is a perspective view of the medical stapler 100 with the stapler gripping section 2 in the open position. Figure 7 is a front view of the medical stapler 100 with the stapler gripping section 2 in the open position. Furthermore, Figure 8 is a side view of the medical stapler 100 with the stapler gripping section 2 in the closed position. Figure 9 is a side view of the medical stapler 100 with the stapler gripping section 2 in the open position. As shown in Figure 6, the staple gripping section 2 includes a first staple gripping member 21, a second staple gripping member 22, an opening / closing rotating shaft 23, and a movable pin 27.

[0030] As shown in Figure 6, the first staple gripping member 21 and the second staple gripping member 22 are connected so as to be openable and closable by an opening / closing rotating shaft 23. The opening / closing rotating shaft 23 is located on the tip side of the cap 1. The axial direction C of the opening / closing rotating shaft 23 is perpendicular to the axial direction A and vertical direction B of the cap 1. As shown in Figure 7, the staple gripping portion 2 is formed symmetrically with respect to the central axis O3 in the vertical direction B.

[0031] The first staple gripping member 21 is fixed to the tip side of the cap 1 in a non-rotatable manner. The first staple gripping member 21 is fixed to the cap 1 at a point B2 below the central axis O of the cap 1. As shown in Figure 3, the first staple gripping member 21 is positioned so as to overlap with the second through-hole 12 of the cap 1 in a front view. On the other hand, as shown in Figure 7, the first staple 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.

[0032] As shown in Figure 6, the first staple gripping member 21 has a first tip portion 21a and a first body portion 21b, and is formed in a substantially T-shape in plan view. The first tip portion 21a is positioned towards the tip side of the first body portion 21b.

[0033] 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 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 (upper surface 21e) of the first tip portion 21a is provided with an opening 31a for the staple discharge portion 3.

[0034] 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 cap 1 with the wire sheath 280 in between. The first main body portion 21b has a contact pin 21c and a first engagement groove 21d (Figure 8).

[0035] The contact pin 21c is provided at the base end of the first main body 21b and contacts the second staple gripping member 22 in the closed state, thereby restricting the range of motion of the second staple gripping member 22.

[0036] As shown in Figure 8, 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.

[0037] The second staple gripping member 22 is rotatably attached to the first staple gripping member 21 in the opening / closing direction R by an opening / closing rotation shaft 23. As shown in Figures 6 and 7, the second staple 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.

[0038] The U-shaped member 22a is formed in a substantially U-shape, and both ends are connected to the second main body 22b. When closed, the central part of the U-shaped member 22a is positioned towards the tip side of the first stapler gripping member 21. The central part has a second tip 22c. The second tip 22c is formed in a substantially rectangular parallelepiped shape. The second tip 22c extends in the axial direction C of the opening / closing rotation shaft 23. A staple receiving portion 4 is provided on the second tip 22c.

[0039] The second main body portion 22b is rotatably attached to the first main body portion 21b of the first stapler 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. A pair of side plate portions 22g that face each other in the axial direction C with the guide groove 22d of the second main body portion 22b in between each have a second engagement groove 22e formed therein.

[0040] The second engagement groove 22e is a groove that penetrates in the axial direction C. As shown in Figure 7, the second engagement groove 22e is formed symmetrically with respect to the central axis O3 of the second stapler gripping member 22. As shown in Figure 8, in a side view when the second engagement groove 22e is closed, it is inclined downward B2 from the tip side to the base side in the axial direction A.

[0041] As shown in Figure 6, the second staple gripping member 22 has a field of view space (through 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.

[0042] As shown in Figure 8, the movable pin 27 is engaged 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 254 is attached to the movable pin 27. By operating the opening / closing operation wire 254, the movable pin 27 moves back and forth in the axial direction A, and in conjunction with this, the second stapler gripping member 22 opens and closes as shown in Figures 8 and 9.

[0043] As the opening / closing operation wire 254 moves forward towards the tip, the movable pin 27 rotates the second staple gripping member 22 in the opening direction (R1) around the opening / closing rotation axis 23, as shown in Figure 9, and the staple gripping part 2 opens. As the opening / closing operation wire 254 moves backward towards the base end, the movable pin 27 rotates the second staple gripping member 22 in the closing direction (R2) around the opening / closing rotation axis 23, as shown in Figure 8, and the staple gripping part 2 closes.

[0044] When the staple gripping section 2 is in the closed position, as shown in Figure 8, the staple discharge section 3 and the staple receiving section 4 face each other in the vertical direction B. When the staple gripping section 2 is in the closed position, a small gap P is formed between the staple discharge section 3 and the staple receiving section 4. When the staple gripping section 2 is in the closed position, the optical axis A10 of the objective lens 215 passes outside (upper side B1 side) of the first staple gripping member 21 and the second staple gripping member 22. Also, when the staple gripping section 2 is in the closed position, the central axis A20 of the forceps channel 214 does not overlap with the first staple gripping member 21 in a front view, but it is in a position that overlaps with the second staple gripping member 22.

[0045] When the staple gripping section 2 is in the open position, the staple receiving section 4 is positioned on the base end side of the opening / closing rotation axis 23, as shown in Figure 9. When the staple gripping section 2 is in the open position, the staple receiving section 4 is positioned on the base end side of the staple dispensing section 3. When the staple gripping section 2 is in the open position, the optical axis A10 of the objective lens 215 passes through the field of view space 25. Also, when the staple gripping section 2 is in the open position, the central axis A20 of the forceps channel 214 passes through the field of view space 25.

[0046] Figure 10 is a cross-sectional view of the stapler gripping section 2, including the staple release section 3. Figure 10 shows the situation before the release wire 274 is pulled. The staple discharge section 3 is provided at the first tip 21a of the first staple 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 32, and a rotating member 33.

[0047] The staple storage section 31 is a space for storing staples S provided at the first tip 21a of the first stapler gripping member 21. As shown in Figures 6 and 7, the first stapler gripping member 21 has two staple storage sections 31 formed side by side in the axial direction C, and can store two U-shaped staples S.

[0048] The staple storage section 31 has an opening 31a provided on the upper surface 21e of the first tip section 21a, which opens in the vertical direction B. 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.

[0049] In a plan view, the staple storage section 31 is formed in a rectangular shape with its short side extending in the axial direction A and its long side extending in the axial direction C. The staples S stored in the staple storage section 31 have their needle tips S1 at both ends arranged in the axial direction C.

[0050] The straight-moving member 32 is a member housed at the bottom of 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 on its upper side B1 that supports staples S. Staples S stored in the staple storage section 31 are fitted into the recess 32a.

[0051] The first pulley 34 and the second pulley 36, which serve as the rotating members 33, are rotatably mounted inside the first stapler gripping member 21, and their rotation moves the linear member 32 in the vertical direction B. The first rotation axis 35 of the first pulley 34 and the second rotation axis 37 of the second pulley 36 extend in the axial direction C and are substantially parallel to the opening and closing rotation axis 23 of the gripping portion 2.

[0052] The first pulley 34 is rotatable around the first rotation axis 35. The tip of the release operation wire 274 is connected to the first pulley 34, and the first pulley 34 rotates when the release operation wire 274 is pulled. The first pulley 34 has a protrusion (contact portion) 38 on its tip side that supports the straight-moving member 32 from below B2.

[0053] The second pulley 36 is rotatable around the second rotation axis 37. The second pulley 36 is positioned closer to the base end than the first pulley 34 and is a bend pulley that changes the direction of travel of the discharge operation wire 274.

[0054] The tip of the discharge control wire 274 is connected to the first pulley 34 above the first rotating shaft 35, at point B1. The discharge control wire 274 extends from the first pulley 34 through the second pulley 36 and the second through hole 12 to the discharge control section 270.

[0055] Figure 11 is a cross-sectional view of the stapler gripping section 2 to which the release wire 274 is pulled. As the release wire 274 is pulled, the upper B1 of the first pulley 34 rotates toward the base end, and the lower B2 of the first pulley 34 rotates toward the tip end. As a result, the protrusion 38 of the first pulley 34 pushes the straight member 32 upward toward the upper B1, and the stored staple S is released from the opening 31a toward the upper B1.

[0056] The staple receiving section 4 is provided on the lower surface of the second tip portion 22c of the second staple gripping member 22. The staple receiving section 4 is provided with a plurality of pockets 41 capable of receiving staples S (Figure 10) released from the staple discharge section 3. In this embodiment, two U-shaped staples are released from the staple discharge section 3. For this reason, the staple receiving section 4 is provided with four pockets 41 (Figure 7). When the staple gripping section 2 is in the closed state, the opening 31a from which the staples S (Figure 10) are released and the pockets 41 of the staple discharge section 3 face each other in the vertical direction B.

[0057] [Gripping forceps (endoscopic treatment instrument) 400] Figure 12 is an overall view showing the grasping forceps (endoscopic treatment instrument) 400 used with the endoscope 200 of the medical system 300. Figure 13 is a perspective view showing the endoscope 200 with the medical stapler 100 (see Figure 1) and the grasping forceps 400 attached.

[0058] As shown in Figure 12, the gripping forceps 400 (also called the treatment instrument 400) comprises a forceps gripping section 5, a forceps sheath (sheath) 6, a forceps operating wire 7, and a forceps operating section 8.

[0059] In this embodiment, the longitudinal direction of the grasping forceps 400 is the same as the axial direction A. In the following description, the axial direction A will also be referred to as the longitudinal direction A of the grasping forceps 400. Furthermore, in the longitudinal direction A, the side inserted into the patient's body will be referred to as the "tip side A1", and the side with the forceps operating section 8 will be referred to as the "proximal end side A2". In the grasping forceps 400, the forceps gripping section 5, the forceps sheath 6 and forceps operating wire 7, and the forceps operating section 8 are arranged in this order from the tip side A1 to the proximal end side A2 of the grasping forceps 400. The grasping forceps 400 is inserted into the treatment instrument channel 230 from the forceps insertion port 222 provided on the tip side of the operating section 220 of the endoscope 200 shown in Figure 1. The grasping forceps 400, inserted through the forceps insertion port 222, pass through the instrument channel 230 and protrude from the tip of the grasping forceps 400 into the forceps port 214, which is the tip opening of the instrument channel 230. The term "patient" as used herein includes all living organisms, including the term "subject." The patient may be a human or an animal.

[0060] [Force gripping part 5] The forceps gripping section 5 is a forceps useful for patient treatment procedures such as preventing tissue bleeding, closing perforations and hemostasis, suturing and contracting internal wounds, traction on lesions (mucosal protrusions), and other surgical procedures. The forceps gripping section 5 is rotatable about its longitudinal axis in the longitudinal direction A. The surgeon can easily rotate the entire gripping forceps 400 by operating the forceps manipulation section 8, for example. The forceps gripping section 5 comprises a rod 50, forceps jaws 51, and a connecting pin 54.

[0061] Here, the forceps piece 51 has a first forceps piece (first jaw) 52 and a second forceps piece (second jaw) 53 that open and close relative to the rod 50. The first forceps piece 52 and the second forceps piece 53 are provided on both sides of the rod 50, sandwiched between the rod 50 by a connecting pin 54, in the vertical direction D of the gripping forceps 400 which is perpendicular to the longitudinal direction A, and they open and close independently of each other. The vertical direction D is the opening and closing direction of the first forceps piece 52 and the second forceps piece 53. Therefore, the vertical direction D is also called the opening and closing direction D. As shown in Figure 13, in the vertical direction (opening and closing direction) D, the side of the rod 50 on which the second forceps piece 53 is provided is the upper side D1, and the side of the rod 50 on which the first forceps piece 52 is provided is the lower side D2. The direction perpendicular to the longitudinal direction A and the vertical direction (opening and closing direction) D is the width direction E.

[0062] [Rod 50] Figure 14 is a side view showing the state in which the first forceps piece 52 and the second forceps piece 53 of the forceps piece 51 of the gripping forceps 400 are open relative to the rod 50. As shown in Figures 13 and 14, the rod 50 is a rod-shaped member that extends in the longitudinal direction (axial direction) A and is provided between the first forceps piece 52 and the second forceps piece 53, which are provided on both sides in the vertical direction (opening / closing direction) D. The rod 50 is provided at the tip 6a of the forceps sheath 6. The rod 50 has a load portion 500 formed at the tip side A1 and a connecting portion 503 formed at the base end side A2.

[0063] The load portion 500 is, for example, a roughly round rod-shaped member made of a biocompatible material. The entire outer surface of the load portion 500 is exposed and can come into contact with tissue. The load portion 500 comprises a tip portion 501 and a rod-shaped portion 502.

[0064] The tip portion 501 is provided at the tip of the rod-shaped portion 502. As shown in Figure 13, the tip portion 501 is formed with its length in the vertical direction D so that it is substantially rhombic when viewed from the base end side in the longitudinal direction A. The tip portion 501 is formed asymmetrically with respect to the central axis O4 in the longitudinal direction A of the rod-shaped portion 502. Compared to the rod-shaped portion 502, the length of the tip portion 501 in the vertical direction D is greater than the length of the rod-shaped portion 502. The tip portion 501 comprises a first protrusion 501a and a second protrusion 501b.

[0065] As shown in Figure 14, the first protrusion 501a is a projection that protrudes toward the first forceps piece (first jaw) 52 provided on the lower side (first protruding side) D2 of the load portion 500 in the vertical direction (protruding direction) D.

[0066] As shown in Figure 14, the second protrusion 501b is a projection that protrudes toward the second forceps piece (second jaw) 53 provided on the upper side (second protruding side) D1 of the load portion 500 in the vertical direction (protruding direction) D.

[0067] The tip portion 501 can be manipulated and positioned by the surgeon to catch on biological tissue, thereby locking the rod 50 into the biological tissue. Here, the protruding length of the first protrusion 501a that protrudes downward D2 in the vertical direction D is longer than the protruding length of the second protrusion 501b that protrudes upward D1 in the vertical direction D.

[0068] The rod-shaped portion 502 is a substantially round rod-shaped member, and is provided with a tip portion 501 at its end. Here, the rod 50 may be provided in the forceps sheath 6 with its central axis in the longitudinal direction A eccentrically offset from the central axis O3 of the forceps sheath 6. In this embodiment, as shown in Figure 14, the central axis O4 in the longitudinal direction A of the rod-shaped portion 502 provided in the rod 50 is eccentrically offset to the upper side D1, which is the second protruding side, from the central axis O3 of the forceps sheath 6.

[0069] As shown in Figure 14, the rod-shaped portion 502 has a first projection 502a on the lower side D2 facing the first forceps piece 52 in the opening / closing direction (up / down direction) D. The rod-shaped portion 502 also has a second projection 502b on the upper side D1 facing the second forceps piece 53 in the opening / closing direction D.

[0070] The first projection 502a and the second projection 502b are multiple projections provided on the rod-shaped portion 502, as shown in Figure 14. The first projection 502a protrudes from the rod-shaped portion 502 toward the first forceps piece 52, which is located on the lower side D2 in the opening / closing direction D. The second projection 502b protrudes from the rod-shaped portion 502 toward the second forceps piece 53, which is located on the upper side D1 in the opening / closing direction D.

[0071] Preferably, the first projection 502a and the second projection 502b are formed to a size that does not interfere with the first forceps piece 52 and the second forceps piece 53 in the opening and closing direction D. In this embodiment, the central axis O4 in the longitudinal direction A of the rod-shaped portion 502 is eccentrically positioned D1 above the central axis O3 of the forceps sheath 6. Therefore, as shown in Figure 14, the first projection 502a is longer and larger than the second projection 502b in the opening and closing direction D. The number of first projections 502a and second projections 502b is not particularly limited. Also, the rod-shaped portion 502 does not necessarily have to have first projections 502a and second projections 502b.

[0072] The connecting portion 503 is connected to the base end of the load portion 500. The diameter of the connecting portion 503 is larger than that of the rod-shaped portion 502 of the load portion 500. (abbreviated) It is formed in a cylindrical shape. Both ends of the connecting portion 503 in the longitudinal direction A are open so that the first operating wire 71 and the second operating wire 72 can be inserted through them. The base end of the connecting portion 503 is connected to the forceps sheath 6. The tip of the connecting portion 503 has grooves 503h on both sides in the vertical direction D.

[0073] As shown in Figure 13, the groove 503h is formed in a U-shape from the tip of the connecting portion 503 toward the base end A2 in the longitudinal direction A.

[0074] Note that the rod 50 does not necessarily have to have the second protrusion 501b. For example, as shown in Figure 15, the rod 50F does not have the second protrusion 501b at the tip 501F of the load portion 500F, compared to Figure 14.

[0075] [Forceps jaw 51] Figure 16 is a side view showing the gripping forceps 400 with the second forceps piece 53 of the forceps piece 51 open relative to the rod 50 and the first forceps piece 52 closed. Figure 17 is a side view showing the gripping forceps 400 with the first forceps piece 52 of the forceps piece 51 open relative to the rod 50 and the second forceps piece 53 closed. Figure 18 is a side view showing the gripping forceps 400 with the first forceps piece 52 and the second forceps piece 53 of the forceps piece 51 closed relative to the rod 50.

[0076] The forceps jaws 51 are components for grasping biological tissue. The forceps jaws 51 are made of a metal material such as stainless steel. As shown in Figures 14 to 18, the forceps jaws 51 comprises a first forceps jaw 52 and a second forceps jaw 53. The first forceps jaw 52 and the second forceps jaw 53 can be opened and closed independently with respect to the rod 50. The first forceps jaw 52 and the second forceps jaw 53 are supported so as to be rotatable in the opening and closing direction (up and down direction) D with a connecting pin 54 as the center of rotation. Furthermore, the first forceps jaw 52 and the second forceps jaw 53 are arranged symmetrically with respect to the central axis of the forceps jaw 51 in the longitudinal direction A. Here, the central axis of the forceps jaw 51 in the longitudinal direction A approximately coincides with the central axis O3 of the forceps sheath 6 in the longitudinal direction A.

[0077] [First forceps piece (first jaw) 52] The first forceps piece (first jaw) 52 is provided to open and close on the lower side D2 of the rod 50 in the opening and closing direction D. The first forceps piece 52 extends longitudinally A relative to the rod 50 when closed. The first forceps piece 52 is rotatably attached by a connecting pin 54 so as to open away from the rod 50 on the lower side D2. The first forceps piece 52 comprises a first arm portion 520 and a first connecting portion 522.

[0078] The first arm portion 520 is provided on the tip side A1 of the first forceps piece 52. The first arm portion 520 is a single flat plate made of, for example, resin or metal. As shown in Figures 16 and 18, when the first arm portion 520 is closed relative to the rod 50, the front surface faces the upper side D1 and the back surface faces the lower side D2. Here, the front surface of the first arm portion 520 is the inner surface that contacts the biological tissue and faces the rod 50 in the opening and closing direction D. Also, when the first forceps piece 52 is closed relative to the rod 50, the first arm portion 520 is parallel to the rod 50 in the longitudinal direction A. The first arm portion 520 may be formed in a substantially cup shape with the back surface as the bottom when closed relative to the rod 50. The first arm portion 520 is provided with an engaging portion 521 on the tip side A1.

[0079] The engaging portion 521 is provided on the tip side A1 of the first arm portion 520. As shown in Figures 16 and 18, the engaging portion 521 is formed by bending the tip of the first arm portion 520 so that the tip of the engaging portion 521 faces upward D1 when the first forceps piece 52 is closed against the rod 50. With this configuration, the engaging portion 521 This reduces the number of parts required and simplifies the manufacturing process.

[0080] The engaging portion 521 is formed in a claw shape with two divided tips and engages with the first protrusion 501a of the tip portion 501 provided at the end of the rod-shaped portion 502 of the rod 50. With this configuration, the first forceps piece 52 can reliably grasp biological tissue when closed against the rod 50.

[0081] The first connecting portion 522 is provided on the proximal end side A2 of the first forceps piece 52. The first connecting portion 522 is formed in a substantially plate shape with a surface in the width direction E. The first connecting portion 522 is connected to the proximal end of the first arm portion 520. The first connecting portion 522 has a first through hole 522a that penetrates in the width direction E. As shown in Figure 14 or Figure 17, when the first forceps piece 52 is open relative to the rod 50, the first connecting portion 522 is inserted into a groove 503h provided at the tip of the connecting portion 503 of the rod 50 such that the first through hole 522a is positioned above the connecting portion 503 D1 when viewed from the width direction E, without overlapping with the connecting portion 503 of the rod 50.

[0082] The first forceps piece 52 may have a marker that can be visually distinguished from the second forceps piece 53, for example. The marker is not particularly limited, but it is acceptable as long as it can be distinguished from the second forceps piece 53 by its color, pattern, shape, etc.

[0083] [Second forceps piece (second jaw) 53] The second forceps piece (second jaw) 53 is provided to be openable and closable on the upper side D1 opposite to the first forceps piece 52, sandwiching the rod 50 in the opening and closing direction D. The second forceps piece 53 extends longitudinally A relative to the rod 50 when closed. The second forceps piece 53 is rotatably attached by a connecting pin 54 so as to open away from the rod 50 on the upper side D1. The second forceps piece 53 comprises a second arm portion 530 and a second connecting portion 532.

[0084] The second arm portion 530 is provided on the tip side A1 of the second forceps piece 53. The second arm portion 530 is a single flat plate made of, for example, resin or metal. As shown in Figures 17 and 18, when the second arm portion 530 is closed relative to the rod 50, the front surface faces downward D2 and the back surface faces upward D1. Here, the front surface of the second arm portion 530 is the inner surface that contacts the biological tissue and faces the rod 50 in the opening and closing direction D. Also, when the second forceps piece 53 is closed relative to the rod 50, the second arm portion 530 is parallel to the rod 50 in the longitudinal direction A. The second arm portion 530 may be formed in a substantially cup shape with the back surface as the bottom when closed relative to the rod 50. The second arm portion 530 is provided with an engaging portion 531 on the tip side A1.

[0085] The engaging portion 531 is provided on the tip side A1 of the second arm portion 530. As shown in Figures 17 and 18, the engaging portion 531 is formed by bending the tip of the second arm portion 530 so that the tip of the engaging portion 531 faces downward D2 when the second forceps piece 53 is closed against the rod 50. This configuration reduces the number of parts required for the engaging portion 531 and simplifies the manufacturing process.

[0086] The engaging portion 531 is formed in a claw shape with two protruding tips and engages with the second protrusion 501b of the tip portion 501 provided at the end of the rod-shaped portion 502 of the rod 50. With this configuration, the second forceps piece 53 can reliably grasp biological tissue when closed against the rod 50.

[0087] The second connecting portion 532 is provided on the proximal end side A2 of the second forceps piece 53. The second connecting portion 532 is formed in a substantially plate shape with a surface in the width direction E. The second connecting portion 532 is connected to the proximal end of the second arm portion 530. The second connecting portion 532 has a second through hole 532a that penetrates in the width direction E. As shown in Figure 14 or Figure 16, when the second forceps piece 53 is open relative to the rod 50, the second connecting portion 532 is inserted into a groove 503h provided at the tip of the connecting portion 503 of the rod 50 such that the second through hole 532a does not overlap with the connecting portion 503 of the rod 50 when viewed from the width direction E, and is positioned below the connecting portion 503 D2.

[0088] The opening and closing angles of the first forceps piece 52 and the second forceps piece 53 with respect to the rod 50 are not particularly limited, but it is preferable to set them to 90 degrees or more so that biological tissue can be easily grasped even when the longitudinal direction A of the grasping forceps 400 is nearly parallel to the surface of the stomach wall.

[0089] [Connecting pin 54] As shown in Figures 14 to 18, the connecting pin 54 is attached to the tip side A1 of the connecting portion 503 of the rod 50. In the width direction E, the connecting pin 54 connects the first connecting portion 522 of the first forceps piece 52 and the second connecting portion 532 of the second forceps piece 53 to the connecting portion 503 of the rod 50. Specifically, when the first forceps piece 52 is closed relative to the rod 50, the connecting pin 54 is attached to the first connecting portion 522 at the tip side A1 beyond the first through hole 522a. Also, when the second forceps piece 53 is closed relative to the rod 50, the connecting pin 54 is attached to the second connecting portion 532 at the tip side A1 beyond the second through hole 532a. The first forceps piece 52 and the second forceps piece 53 open and close independently in the opening and closing direction D with the connecting pin 54 as the center of rotation.

[0090] [Forceps sheath 6] The forceps sheath 6 has a central axis O3 (see Figure 14) and is a long member extending from the tip 6a to the base 6b. The forceps sheath 6 is flexible and can easily change shape to conform to the curved shape of the lumen tissue within the lumen. The forceps sheath 6 has an outer diameter that allows it to be inserted into the instrument channel 230 of the endoscope 200. When inserted into the instrument channel 230, the tip 6a of the forceps sheath 6 can protrude from the forceps port 214, which is the tip opening of the instrument channel 230. The tip 6a of the forceps sheath 6 is connected to the rod 50. The forceps sheath 6 is made of an insulating material, such as a fluororesin such as PTFE (polytetrafluoroethylene) or a resin material such as HDPE (high-density polyethylene). The first operating wire 71 and the second operating wire 72 of the forceps operating wire 7 are inserted through the forceps sheath 6.

[0091] [Forceps manipulation wire 7] As shown in Figures 12 to 18, the forceps operating wire 7 comprises a first operating wire 71 and a second operating wire 72. The first operating wire 71 and the second operating wire 72 are inserted through an internal space (not shown) of the forceps sheath 6.

[0092] The first operating wire 71 is inserted into the forceps sheath 6 so as to be able to move forward and backward in the longitudinal direction A. As shown in Figures 14 and 17, the tip of the first operating wire 71 is connected to the first through hole 522a of the first connecting portion 522 of the first forceps piece 52. When the first operating wire 71 moves forward towards the tip side A1 in the longitudinal direction A, the tip of the first operating wire 71 protrudes upward D1 from the groove 503h provided in the connecting portion 503 of the rod 50 provided at the tip 6a of the forceps sheath 6, causing the first connecting portion 522 to rotate. As a result, the first arm portion 520 of the first forceps piece 52 rotates downward D2 around the connecting pin 54. The base end of the first operating wire 71 is fixed to the first slider 82 of the forceps operating portion 8. The first operating wire 71 may be made of, for example, a single or stranded metal wire. Furthermore, the outer surface of the first operating wire 71 may be covered with a non-conductive material or the like. The first operating wire 71 is fixed to the first through hole 522a of the first connecting portion 522 by various known methods, such as bonding or welding.

[0093] The second operating wire 72 is inserted into the forceps sheath 6 so as to be able to move forward and backward in the longitudinal direction A. As shown in Figures 14 and 16, the tip of the second operating wire 72 is connected to the second through hole 532a of the second connecting portion 532 of the second forceps piece 53. When the second operating wire 72 moves forward towards the tip side A1 in the longitudinal direction A, the tip of the second operating wire 72 protrudes downward D2 from the groove 503h provided in the connecting portion 503 of the rod 50 provided at the tip 6a of the forceps sheath 6, causing the second connecting portion 532 to rotate. As a result, the second arm portion 530 of the second forceps piece 53 rotates upward D1 around the connecting pin 54. The base end of the second operating wire 72 is fixed to the second slider 83 of the forceps operating portion 8. The second operating wire 72 may be made of, for example, a single or stranded metal wire. Furthermore, the outer surface of the second operating wire 72 may be covered with a non-conductive material or the like. The second operating wire 72 is fixed to the second through hole 532a of the second connecting portion 532 by various known methods, such as bonding or welding.

[0094] With the above configuration, the first forceps piece 52 and the second forceps piece 53 are opened and closed by the first operating wire 71 and the second operating wire 72 moving back and forth in the longitudinal direction A.

[0095] [Forceps operating section (handle) 8] As shown in Figure 12, the forceps operating section 8 is provided on the proximal end side A2 of the forceps sheath 6. The forceps operating section 8 operates the forceps gripping section 5 by sandwiching the first operating wire 71 and the second operating wire 72 between them. The forceps operating section 8 comprises a forceps operating section body 81, a first slider 82, a second slider 83, a simultaneous opening and closing assist section (butt section) 84, a forceps rotating section 85, and a finger rest 86.

[0096] The forceps operating section body 81 is formed in a rod shape extending in the longitudinal direction A. The forceps operating section body 81 includes a sheath fixing section 811 and a through hole 812.

[0097] The sheath fixing portion 811 is provided on the tip side A1 of the forceps operating portion body 81. The proximal end 6b of the forceps sheath 6 can be attached to the inside of the sheath fixing portion 811 by a conventionally known method. The sheath fixing portion 811 connects the forceps sheath 6 and the forceps operating portion body 81.

[0098] As shown in Figure 12, the through-hole 812 is an elongated hole that extends along the shape of the forceps operating section body 81. The through-hole 812 penetrates the forceps operating section body 81 in the width direction E. By providing the through-hole 812, the forceps operating section body 81 forms a first side portion 813 on the upper side D1 in the vertical direction D, through which the first slider 82 can slide in the longitudinal direction A, and a second side portion 814 on the lower side D2 in the vertical direction D, through which the second slider 83 can slide in the longitudinal direction A. The first operating wire 71 and the second operating wire 72, through which the forceps sheath 6 is inserted, extend in the longitudinal direction A through the through-space 812s of the through-hole 812.

[0099] The first slider 82 is slidably attached to the first side portion 813 of the forceps operating unit body 81 along the longitudinal direction A. The first slider 82 may be attached by inserting it through the first side portion 813, or it may be attached by assembling multiple parts onto the first side portion 813 of the forceps operating unit body 81. The first slider 82 is formed in a substantially ring shape above the center D1 of the forceps operating unit body 81, making it easy for the operator's finger to grip. The proximal end of the first operating wire 71 is fixed to the first slider 82. The operator moves the first operating wire 71 forward and backward by moving the first slider 82 relative to the forceps operating unit body 81. Specifically, when the first slider 82 is advanced along the forceps operating unit body 81 toward the tip side A1 in the longitudinal direction A, the first operating wire 71 moves forward toward the tip side A1 in the longitudinal direction A in conjunction with it. As a result, the first forceps piece 52, which is fixed to the tip of the first operating wire 71, rotates downward D2 around the connecting pin 54. With this configuration, when the first slider 82 is slid in the longitudinal direction A on the forceps operating unit body 81, the first forceps piece 52 is driven to open and close in the opening and closing direction D.

[0100] The second slider 83 is slidably attached to the second side portion 814 of the forceps operating unit body 81 along the longitudinal direction A. The second slider 83 may be attached by inserting it through the second side portion 814, or it may be attached by assembling multiple parts onto the second side portion 814 of the forceps operating unit body 81. The second slider 83 is formed in a roughly ring shape below the center D2 of the forceps operating unit body 81, making it easy for the operator's finger to grip. The proximal end of the second operating wire 72 is fixed to the second slider 83. The operator moves the second operating wire 72 forward and backward by moving the second slider 83 relative to the forceps operating unit body 81. Specifically, when the second slider 83 is advanced along the forceps operating unit body 81 toward the tip side A1 in the longitudinal direction A, the second operating wire 72 moves forward toward the tip side A1 in the longitudinal direction A in conjunction with it. As a result, the second forceps piece 53, which is fixed to the tip of the second operating wire 72, rotates upward D1 around the connecting pin 54. With this configuration, when the second slider 83 is slid in the longitudinal direction A on the forceps operating unit body 81, the second forceps piece 53 is driven to open and close in the opening and closing direction D. The first slider 82 and the second slider 83 slide independently in the longitudinal direction A on the forceps operating unit body 81.

[0101] The simultaneous opening and closing assist part (buttock part) 84 is attached to the forceps operating unit body 81, spanning the first side part 813 and the second side part 814. The simultaneous opening and closing assist part 84 can contact the base end of the first slider 82 and the base end of the second slider 83. When the simultaneous opening and closing assist part 84 is moved to the tip side A1 in the longitudinal direction A on the forceps operating unit body 81, it contacts the base end of the first slider 82 and the base end of the second slider 83 simultaneously, causing the first slider 82 and the second slider 83 to slide simultaneously toward the tip side A1 in the longitudinal direction A. As a result, the simultaneous opening and closing assist part 84 can sandwich the first slider 82 and the second slider 83 between it and open the first forceps piece 52 and the second forceps piece 53 simultaneously.

[0102] The forceps rotating part 85 is attached to the forceps operating unit body 81. The surgeon can easily rotate the gripping forceps 400 by using one hand to operate the first slider 82 and the second slider 83, while using the other hand to rotate the forceps rotating part 85 in the axial direction of the gripping forceps 400. The location where the forceps rotating part 85 is attached is not particularly limited, but it is preferable that the forceps rotating part 85 be attached to the forceps operating unit body 81 in a position that does not interfere with the sliding first slider 82 and the second slider 83.

[0103] The finger rest portion 86 is a roughly ring-shaped finger rest portion formed on the proximal end A2 of the forceps operating body 81. The operator can hold the finger rest portion 86 and pull the grasping forceps 400 toward the proximal end A2, thereby retracting the grasping forceps 400 toward the proximal end A2.

[0104] [How to use the medical stapler 100 with gripping forceps 400] Next, referring to Figures 19 to 31, the method of using the medical stapler 100 with the grasping forceps 400 will be explained. Specifically, the method of suturing the defect (resection opening) G formed after a lesion formed in the stomach has been fully resected by endoscopic treatment will be explained.

[0105] <Marking Step> Figure 19 shows the endoscope 200 in a position close to the lesion. The operator or assistant (hereinafter simply referred to as "operator") inserts the insertion section 210 of the endoscope 200, which is fitted with a medical stapler 100, through the natural opening, and brings the tip 211 closer to the treatment target T located below B2 of the endoscope 200. The operator inserts a marking instrument, such as a high-frequency knife, into the treatment instrument channel 230 using a conventionally known method and marks the area around the lesion on the treatment target T. The marking instrument may be a high-frequency forceps, a high-frequency snare, a heating element such as a heat probe, an ultrasonic device, etc. The operator presses the knife of the high-frequency knife against the surrounding tissue surrounding the lesion on the treatment target T and cauterizes it, thereby forming a pair of markings on the surrounding tissue on both sides of the lesion.

[0106] <Full-thickness resection steps> The surgeon uses a marking instrument to perform a full-thickness resection of the stomach wall (tissue) M, which includes the mucosal layer M1 and the muscular layer M2 formed on the abdominal side (muscular layer side) P1 relative to the mucosal layer M1. As a result, air from inside the stomach escapes to the abdominal side P1 through the defect (resection opening) G formed in the stomach wall M by the full-thickness resection, causing the stomach to collapse and deform (contract) as shown in Figure 19.

[0107] <Placement Steps> Figure 20 shows the placement steps. The surgeon positions the medical stapler 100, located at the tip of the endoscope 200, in the approach direction toward the defect G of the target T. Here, the approach direction is the same as the axial direction (longitudinal direction) A of the medical stapler 100. During the full-thickness resection step, the stomach contracts, so the approach direction is along the tangential direction H, which is nearly parallel to the surface of the stomach wall M. The abdominal side (muscular layer side) P1 is in the same direction as the lower side B2 of the vertical direction B when the medical stapler 100 is facing the approach direction. The defect G has a first end Ta at its periphery, which is the end of the proximal H1 in the tangential direction H. The defect G also has a second end Tb at its periphery, which is the end of the distal H2 in the tangential direction H.

[0108] Next, with the medical stapler 100 attached to the tip 211 of the endoscope 200, the surgeon tilts the insertion section 210 so that the tip 211 of the insertion section 210 faces the defect G, in order to observe the target T with the objective lens 215. When the stapler gripping section 2 is open, the optical axis A10 of the objective lens 215 passes through the field of view 25, allowing the surgeon to observe the target T with the imaging unit of the endoscope 200 in between. However, when the stomach is contracted, it is difficult for the surgeon to align the approach direction with a direction that makes it easy to observe the target T perpendicular to the tangential direction H. Therefore, the approach direction remains along the tangential direction H. At the periphery of the defect G, the muscular layer M2 exposed at the first end Ta of the proximal H1 located on the proximal side H1 in the tangential direction H is hidden by the mucosal layer M1. Therefore, it becomes difficult for the surgeon to accurately visualize the first end Ta. In this state, the operator operates the opening / closing control unit 250 of the endoscope 200 to advance the opening / closing control wire 254 and open the stapler gripping unit 2.

[0109] <Insertion Step> Figure 21 shows the insertion step of the gripping forceps 400. The surgeon inserts the grasping forceps 400 into the treatment instrument channel 230 as a retraction instrument. Specifically, the surgeon inserts the grasping forceps 400 towards the treatment instrument channel 230 from the forceps insertion port 222 located at the tip of the operating section 220 of the endoscope 200. The grasping forceps 400 inserted from the forceps insertion port 222 passes through the treatment instrument channel 230 and protrudes from the tip of the grasping forceps 400 through the forceps port 214, which is the tip opening of the treatment instrument channel 230. As shown in Figure 21, the grasping forceps 400 is positioned in the approach direction near the center of the defect G.

[0110] <Steps for positioning the gripping forceps> In the positioning step, the surgeon rotates the forceps gripping portion 5 around the longitudinal axis in the longitudinal direction A to position it. The surgeon can easily rotate the forceps gripping portion 5 of the gripping forceps 400 by, for example, operating the forceps rotation portion 85 provided on the forceps operating portion 8. In this embodiment, the first forceps piece 52, which is provided on the lower side D2 relative to the rod 50 in the forceps gripping portion 5, is positioned on the lower side B2 in the vertical direction B of the cap 1, as shown in Figures 21 to 29. At this time, the opening and closing direction D is in the same direction as the vertical direction B. The first forceps piece 52 is positioned on the abdominal side (muscular side) P1, which is in the same direction as the lower side B2 in the vertical direction B. When the opening and closing direction D is in the same direction as the vertical direction B, the axial direction E is in the same direction as the axial direction C. Furthermore, if the first forceps piece 52 has a marker that is visible and distinguishable from the second forceps piece 53, the operator can easily position the first forceps piece 52 on the abdominal side P1 by placing the imaging unit of the endoscope 200 between them.

[0111] <First opening / closing step> Figure 22 shows the first opening and closing step of the gripping forceps 400. As shown in Figure 22, the surgeon opens and closes the first forceps piece 52, which is close to the first end Ta of the defect G that will be treated T. More specifically, the surgeon slides the first slider 82 of the forceps operating unit 8 toward the tip side A1 in the longitudinal direction A on the forceps operating unit body 81. As a result, the first operating wire 71, which is fixed to the first slider 82, moves toward the tip side A1 in the longitudinal direction A within the forceps sheath 6. The tip of the first operating wire 71 is connected to the first through hole 522a of the first connecting unit 522. The tip of the first operating wire 71 protrudes upward D1 from the groove 503h provided in the connecting unit 503 of the rod 50, and rotates the first connecting unit 522. As a result, the first forceps piece 52 rotates downward D2 around the connecting pin 54 as the center of rotation. The first forceps piece 52 rotates downward D2 in the opening and closing direction D so as to move away from the tip side A1 of the rod 50. As a result, the first forceps piece 52 opens relative to the rod 50.

[0112] <Insertion Step> Figure 23 shows the insertion step of the gripping forceps 400. As shown in Figure 23, the surgeon inserts the rod 50, which is located at the tip 6a of the forceps sheath 6 and positioned longitudinally (approach direction) A, into the defect (resection hole) G with the first forceps piece 52 in an open position relative to the rod 50. In this state, the surgeon moves the open first forceps piece 52 and rod 50 toward the first end Ta of the defect G to be grasped, positioning the first end Ta between the first forceps piece 52 and the rod 50. At this time, the surgeon positions the tip 501 of the rod 50 toward the abdominal cavity P1 relative to the muscle layer M2 exposed at the first end Ta.

[0113] <Hook step> The tip 501 of the rod 50 has a first protrusion 501a on its lower side D2 in the vertical direction D. The surgeon hooks the first protrusion 501a of the tip 501 onto the muscle layer M2 formed on the abdominal side P1 of the mucosal layer M1, thereby locking the rod 50 onto the stomach wall M of the stomach. The surgeon may rotate the forceps gripping part 5 during the hooking step.

[0114] <Pulling Step> Figure 24 shows the pulling step of the gripping forceps 400. As shown in Figure 24, the surgeon hooks the first protrusion 501a of the tip 501 of the rod 50 onto the muscle layer M2 of the first end Ta and pulls it from the abdominal side P1 to the gastric side (mucosal layer side) P2 opposite to the abdominal side P1.

[0115] Here, the projection length of the first protrusion 501a that protrudes downward D2 in the vertical direction D is longer than the projection length of the second protrusion 501b that protrudes upward D1 in the vertical direction D. Therefore, even if the surgeon cannot accurately visualize the first end Ta of the proximal H1 of the defect G, they can easily pull the first end Ta together with the muscle layer M2.

[0116] <First gripping step> Figure 25 shows the first gripping step of the gripping forceps 400. Once the surgeon confirms that the first end Ta, which has been pulled in by the first protrusion 501a of the tip 501 of the rod 50, is positioned between the first forceps piece 52 and the rod 50, the surgeon slides the first slider 82 of the forceps operating unit 8 toward the proximal end A2 in the longitudinal direction A on the forceps operating unit body 81. As a result, the first operating wire 71, which is fixed to the first slider 82, moves toward the proximal end A2 in the longitudinal direction A within the forceps sheath 6. The tip of the first operating wire 71 rotates so as to pull the first connecting part 522 into the groove 503h provided in the connecting part 503. As a result, the first forceps piece 52 rotates toward the upper side D1 in the opening / closing direction D so as to approach the tip side A1 of the rod 50. As a result, the first forceps piece 52 closes to the rod 50, and the rod 50 and the first forceps piece 52 grasp the first end Ta of the defect G. At this time, both the muscular layer M2 and the mucosal layer M1 of the first end Ta of the defect G are grasped by the first forceps piece 52 and the rod 50. The surgeon may rotate the forceps gripping part 5 during the first gripping step. The surgeon can easily rotate the forceps rotation part 85 in the axial direction of the gripping forceps 400 using the other hand, while operating the first slider 82 and the second slider 83 with one hand. Therefore, even if the stomach wall M of the stomach is in a direction that makes it difficult to grasp with the gripping forceps 400, the surgeon can rotate the forceps gripping part 5 to adjust it for easier grasping.

[0117] <Re-grasp step> Furthermore, after performing the first grasping step, the surgeon can, in the re-grasping step, rotate the first forceps piece 52 by operating the forceps operating section 8 again, thereby opening the first forceps piece 52 relative to the rod 50 and re-grasping the first end Ta of the defect G.

[0118] <Towing Step> While maintaining the state in which the first end Ta of the defect G is grasped by the first forceps piece 52 and the rod 50, the surgeon advances the entire grasping forceps 400 and endoscope 200 to the vicinity of the second end Tb of the distal H2, which is the distal end of H2 in the tangential direction H, at the periphery of the defect G. During this process, the surgeon maintains the closed state of the first forceps piece 52 and the rod 50.

[0119] <Second opening / closing step> Figure 26 shows the second opening and closing step of the gripping forceps 400. As shown in Figure 26, the surgeon opens and closes the second forceps piece 53 near the second end Tb. More specifically, the surgeon slides the second slider 83 of the forceps operating section 8 toward the tip side A1 in the longitudinal direction A on the forceps operating section body 81. As a result, the second operating wire 72 fixed to the second slider 83 moves toward the tip side A1 in the longitudinal direction A within the forceps sheath 6. The tip of the second operating wire 72 is connected to the second through hole 532a of the second connecting section 532. The tip of the second operating wire 72 protrudes downward D2 from the groove 503h provided in the connecting section 503 of the rod 50, rotating the second connecting section 532. As a result, the second forceps piece 53 rotates upward D1 around the connecting pin 54 as the center of rotation. The second forceps piece 53 rotates upward D1 in the opening and closing direction D so as to move away from the tip side A1 of the rod 50. As a result, the second forceps piece 53 opens relative to the rod 50. With the second forceps piece 53 in the open position relative to the rod 50, the surgeon positions the second end Tb between the second forceps piece 53 and the rod 50.

[0120] <Lifting step> Here, the second end Tb of the defect G is positioned in a location that allows for easy observation with the imaging unit of the endoscope 200 in between. Therefore, the operator can easily position the tip 501 of the rod 50 on the abdominal side P1 of the muscular layer M2 exposed at the second end Tb. With the first end Ta grasped by the rod 50 and the first forceps piece 52, the operator can lift the muscular layer M2 of the second end Tb of the defect G from the abdominal side P1 to the gastric side P2 using the rod 50. The second end Tb of the defect G may also be pulled from the abdominal side P1 to the gastric side P2 by the second convex portion 501b of the tip 501 of the rod 50, similar to the first end Ta. Both the muscular layer M2 and the mucosal layer M1 of the second end Tb of the defect G are grasped by the second forceps piece 53 and the rod 50.

[0121] <Second gripping step> Figure 27 shows the second gripping step of the gripping forceps 400. Once the surgeon confirms that the second end Tb is positioned between the second forceps piece 53 and the rod 50, the surgeon slides the second slider 83 of the forceps operating unit 8 toward the proximal end A2 in the longitudinal direction A on the forceps operating unit body 81. This causes the second operating wire 72, fixed to the second slider 83, to move toward the proximal end A2 in the longitudinal direction A within the forceps sheath 6. The tip of the second operating wire 72 rotates the second connecting portion 532 into the groove 503h provided in the connecting portion 503. This causes the second forceps piece 53 to rotate downward D2 around the connecting pin 54 as the center of rotation. The second forceps piece 53 rotates downward D2 in the opening / closing direction D so as to approach the tip A1 of the rod 50. As a result, the second forceps piece 53 closes to the rod 50, and the rod 50 and the second forceps piece 53 grasp the second end Tb of the defect G.

[0122] Furthermore, similar to the first grasping step, the operator may perform a re-gripping step after executing the second grasping step. This re-gripping step allows the operator to perform the first and second grasping steps multiple times. The operator may also rotate the forceps gripping part 5 during the second grasping step.

[0123] <Simultaneous opening and closing steps> Alternatively, the operator may perform the first opening / closing step and the second opening / closing step simultaneously. The operator moves the simultaneous opening / closing assist part (buttock part) 84 provided on the forceps operating part 8 to the tip side A1 in the longitudinal direction A. The simultaneous opening / closing assist part 84 simultaneously contacts the base end of the first slider 82 and the base end of the second slider 83, allowing the first slider 82 and the second slider 83 to slide simultaneously toward the tip side A1 in the longitudinal direction A. With this configuration, the simultaneous opening / closing assist part 84 can sandwich the first slider 82 and the second slider 83 between them and open the first forceps piece 52 and the second forceps piece 53 simultaneously.

[0124] <Retractable Step> Figure 28 shows the retraction step. The surgeon holds the finger rest 86 of the forceps handling section 8 and pulls the gripping forceps 400 towards the proximal end. The first forceps piece 52 and the second forceps piece 53 are pulled towards the proximal end while gripping the first end Ta and second end Tb of the defect (excision hole) G. The surgeon retracts the gripping forceps 400 so that the tip of the gripping forceps 400 is positioned proximal to the staple release section 3.

[0125] <Suture Steps> Figures 29 to 31 show the suturing steps. The surgeon operates the opening / closing operation unit 250 to retract the opening / closing operation wire 254, thereby closing the staple gripping unit 2. The surgeon then clamps the suture site, which is located outside the defect G in the surrounding tissue beyond the first end Ta and the second end Tb, with the staple release unit 3 of the first staple gripping member 21 and the staple receiving unit 4 of the second staple gripping member 22. The suture site may be marked or otherwise identified by the surgeon so that it can be visually identified.

[0126] When the staple gripping section 2 is in the closed position, as shown in Figure 29, the optical axis A10 of the objective lens 215 passes above the first staple gripping member 21 and the second staple gripping member 22, B1. Therefore, even when the staple gripping section 2 is in the closed position, the operator can observe the target of treatment T with the imaging unit of the endoscope 200 in between.

[0127] The surgeon, with the suture site sandwiched between the staple release section 3 and the staple receiving section 4, operates the release operation section 270 to pull the release operation wire 274, thereby ejecting the stored staple S toward the staple receiving section 4. The needle tip S1 of the staple S penetrates the suture site and bends upon contact with the pocket 41 of the staple receiving section 4. As a result, the suture site is sutured.

[0128] Furthermore, if the suturing of defect G is insufficient, the surgeon may perform suturing on other areas. Once all suturing is complete, the surgeon completes the suturing procedure using the grasping forceps 400 on defect G, which was formed after full-thickness resection.

[0129] According to the suturing method of this embodiment, even if the gastrointestinal tract, such as the stomach, is fully resected and air escapes from the gastrointestinal tract to the abdominal side P1, causing the gastrointestinal tract to collapse and deform, the surgeon can accurately grasp the gastric wall M of the stomach using grasping forceps 400 and perform the suturing procedure.

[0130] Furthermore, in this embodiment, the first forceps piece 52 and the second forceps piece 53 of the forceps piece 51 provided on the forceps gripping portion 5 of the gripping forceps 400 can be opened and closed independently. Therefore, the surgeon can easily grasp the defect G using the gripping forceps 400 and pull the tissue towards the proximal end A2 of the gripping forceps 400 for suturing.

[0131] Furthermore, in this embodiment, the rod 50 provided on the gripping portion 5 of the gripping forceps 400 has a tip portion 501. Therefore, the surgeon can insert the tip portion 501 into the defect G and hook it onto the periphery.

[0132] Furthermore, in this embodiment, the tip portion 501 is longer than the protruding length of the second protrusion 501b that protrudes upward D1 in the vertical direction D, and is equipped with a first protrusion 501a that protrudes downward D2. Therefore, even if the surgeon cannot accurately visualize the first end portion Ta on the proximal H1 of the defect G, they can easily hook and lock the first protrusion 501a onto the muscle layer M2 of the first end portion Ta from the abdominal side P1. In addition, with the first protrusion 501a hooked onto the muscle layer M2, the surgeon can pull the first end portion Ta, along with the muscle layer M2, towards the gastric side P2 opposite to the abdominal side P1.

[0133] Furthermore, in this embodiment, the central axis O4 in the longitudinal direction A of the rod-shaped portion 502 provided on the rod 50 is eccentric to the upper side D1, which is on the second protruding side, relative to the central axis O3 of the forceps sheath 6. Therefore, even if the protruding length of the first protrusion 501a is longer than the protruding length of the second protrusion 501b, the gripping forceps 400 can be manufactured without changing the overall length and size in the opening and closing direction D.

[0134] Furthermore, in this embodiment, the rod 50 is provided with a first projection 502a and a second projection 502b on the rod-shaped portion 502. Therefore, when the rod 50 grasps biological tissue with the forceps piece 51, the biological tissue can be hooked onto the first projection 502a and the second projection 502b. As a result, the grasping forceps 400 can prevent the tissue grasped by the forceps piece 51 and the rod 50 from slipping off.

[0135] Furthermore, in this embodiment, the surgeon moves the entire gripping forceps 400 and endoscope 200 to the vicinity of the second end Tb of the distal H2 while maintaining the state in which the first end Ta of the defect G is grasped by the first forceps piece 52 and rod 50. Therefore, even if the surgeon cannot accurately visualize the defect G, they can easily move the forceps gripping part 5 to grasp the distal H2 while grasping both the muscle layer M2 and the mucosal layer M1 of the first end Ta.

[0136] Although the first 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 are also included within the scope of the gist of the present invention. Furthermore, the components shown in the above-described embodiment and modified examples can be combined as appropriate.

[0137] (Second embodiment) Next, a second embodiment of the present invention will be described with reference to Figures 32 to 33. In the following description, components common to those already described will be denoted by the same reference numerals, and redundant descriptions will be omitted. Note that the following embodiments differ from the first embodiment in that the grasping forceps attached to the endoscope are different. Therefore, the following description will focus on the differences from the first embodiment.

[0138] Figure 32 is an enlarged view of the tip A1 of the gripping forceps. Figure 33 is a side view showing the state in which the first forceps piece 52A of the gripping forceps is open and the second forceps piece 53 is closed.

[0139] The gripping portion 5A of the gripping forceps (endoscopic treatment instrument) according to the second embodiment of the present invention comprises a rod 50A, a forceps jaw 51, and a connecting pin 54, as shown in Figure 32. The rod 50A also comprises a tip portion 501A (see Figure 33) of the load portion 500A and a rod-shaped portion 502 A It has a connecting portion 503. The forceps piece 51 comprises a first forceps piece 52A and a second forceps piece 53.

[0140] As shown in Figure 33, the tip portion 501A is formed symmetrically with respect to the central axis of the rod-shaped portion 502A in the longitudinal direction A, compared to the first embodiment. Furthermore, as shown in Figure 33, the tip portion 501A includes an anchor (first protrusion) 55 that extends from the tip portion 501A downward (first protruding side) B2 in the vertical direction (protruding direction) B when the first forceps piece 52A of the forceps piece 51 is open relative to the rod 50A. Note that the tip portion 501A may be formed asymmetrically with respect to the central axis of the rod-shaped portion 502, similar to the first embodiment.

[0141] The anchor (first protrusion) 55 is a rod-shaped member to which the fixed end of the anchor 55 is connected at the center of the tip portion 501A. As shown in Figure 32, the anchor 55 is equipped with a fixing pin (fixing portion) 55b at its fixed end. The anchor 55 is rotatable around the fixing pin 55b toward the base end A2 in the longitudinal direction A from the tip portion 501A. The anchor 55 is also equipped with a protruding wire 73A.

[0142] The protruding wire 73A is connected at one end to the movable end of the anchor 55, opposite to the fixed end of the anchor 55, from the fixing pin 55b. The other end of the protruding wire 73A is connected to the first operating wire (first wire) 71, which is connected to the first connecting portion 522 of the first forceps piece 52A. When the first operating wire 71 moves back and forth in the longitudinal direction A, the protruding wire 73A moves back and forth along the longitudinal direction A in conjunction with the first operating wire 71.

[0143] As shown in Figure 33, when the protruding wire 73A of the anchor 55 moves forward along the longitudinal direction A toward the tip side A1 in conjunction with the first operating wire 71, the anchor 55 rotates around the fixing pin 55b, causing the tip portion 55a to protrude below the tip portion 501A toward the lower side D2. When the first forceps piece 52A of the forceps piece 51 is open relative to the rod 50A, the anchor 55 protrudes from the tip portion 501A toward the first forceps piece 52A located below the vertical direction D2. At this time, the tip portion 501A of the rod 50A is longer than the protruding length of the second protrusion 501b that protrudes upward D1 in the vertical direction D, and is equipped with an anchor (first protrusion) 55 that protrudes downward D2.

[0144] Furthermore, as shown in Figure 32, when the convex wire 73A moves along the longitudinal direction A to the proximal end A2 in conjunction with the first operating wire 71, the anchor 55 rotates so that its tip portion 55a is pulled towards the proximal end A2. When the first forceps piece 52A of the forceps piece 51 is in a closed position relative to the rod 50A, the anchor 55 folds its tip portion 55a between the first forceps piece 52A and the rod 50A, with its tip portion 55a facing the proximal end A2.

[0145] The first forceps piece 52A has a marker that is visually distinguishable from the second forceps piece 53, compared to the first forceps piece 52 of the first embodiment. In this embodiment, the first forceps piece 52A has a different color from the second forceps piece 53. The first forceps piece 52A only needs to be visually distinguishable from the second forceps piece 53, and may have, for example, a pattern or a different shape.

[0146] In this embodiment, as with the first embodiment described above, the tip portion 501A of the rod 50A is equipped with an anchor (first protrusion) 55. Therefore, even if the surgeon cannot accurately visualize the first end portion Ta of the proximal H1 of the defect G, they can hook the anchor 55 from the abdominal side P1 of the muscle layer of the first end portion Ta and lock it in place, and pull the muscle layer M2 toward the gastric side P2.

[0147] Furthermore, in this embodiment, the anchor 55 is folded between the first forceps piece 52A and the rod 50A when the first forceps piece 52A of the forceps piece 51 is in a closed position relative to the rod 50A. Therefore, it does not interfere when the first forceps piece 52A closes relative to the rod 50A.

[0148] Furthermore, in this embodiment, the first forceps piece 52A has a marker that can be visually distinguished from the second forceps piece 53. Therefore, when the operator manipulates the grasping forceps with the imaging unit of the endoscope 200 in between, the operator can easily confirm the opening and closing of the first forceps piece 52A on the lower side D1 where the anchor 55 is located relative to the rod 50A.

[0149] Although a second 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 modifications and the like are also included within the scope of the gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0150] (Third embodiment) Next, a third embodiment of the present invention will be described with reference to Figures 34 and 35. This embodiment is , theCompared to one embodiment, the gripping portion of the gripping forceps is different. Therefore, the following description will focus on the differences from the first embodiment.

[0151] Figure 34 is an enlarged view of the tip side A1 of the gripping forceps. Figure 33 is a side view showing the state in which the first forceps piece 52 and the second forceps piece 53B of the gripping forceps are in the open position.

[0152] This invention three As shown in Figure 34, the gripping portion 5B of the gripping forceps (endoscopic treatment instrument) according to this embodiment comprises a rod 50B, a forceps jaw 51B, and a connecting pin 54. The rod 50B also has a tip portion 501B and a rod-shaped portion 502B of the load portion 500B, and a connecting portion 503.

[0153] As shown in Figures 34 and 35, the tip portion 501B is formed in a substantially triangular shape, tapering towards the tip side A1 in the longitudinal direction A, compared to the first embodiment. The tip portion 501B also includes a second protrusion 501Bb that protrudes upward D1 in the vertical direction D, and a first protrusion 501Ba that is longer than the protrusion length of the second protrusion 501Bb and protrudes downward D2 in the vertical direction D.

[0154] The rod-shaped portion 502B has a first recess 502Bh at its tip end A1 in the longitudinal direction A, recessed to the upper side D1 in the vertical direction D. The depth of the first recess 502Bh in the vertical direction D is approximately the same as the length of the engaging portion 521 of the first forceps piece 52. Therefore, as shown in Figure 35, when the first forceps piece 52 of the forceps piece 51B is in a closed state relative to the rod 50B, the engaging portion 521 of the first forceps piece 52 fits into the first recess 502Bh. Furthermore, the rod-shaped portion 502B has a second recess 502Bg recessed along its longitudinal direction at its proximal end A2, recessed to the lower side D2 in the vertical direction D. The second recess 502Bg is formed by hollowing out a recess to approximately the same shape as the second forceps piece 53B of the forceps piece 51B. The rod-shaped portion 502B may further include a first projection 502a and a second projection 502b.

[0155] The second forceps piece 53B of the forceps piece 51B has a length in the longitudinal direction A that is shorter than the length of the first forceps piece 52. As shown in Figure 35, when the second forceps piece 53B is in a closed position relative to the rod 50B, it fits into the second recess 502Bg provided in the rod-shaped portion 502B.

[0156] In this embodiment, when the first forceps piece 52 of the forceps piece 51B is closed relative to the rod 50B, the engaging portion 521 fits into the first recess 502Bh. Similarly, when the second forceps piece 53B is closed relative to the rod 50A, it fits into the second recess 502Bg provided in the rod-shaped portion 502B. Therefore, the width and thickness of the gripping forceps in the vertical direction D and the width direction E can be made as small as possible, making it easier to perform suturing procedures even on small defects (excision holes) G.

[0157] Although a third 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 are also included within the scope of the gist of the present invention. Furthermore, the components shown in the above-described embodiment and the following modifications can be combined as appropriate.

[0158] (modified version) The tip portion provided on the rod of the gripping forceps according to the above embodiment may be formed with the tip facing toward the proximal end in the longitudinal direction. For example, as shown in Figure 36, the rod 50C of the forceps gripping portion 5C is provided with a tip portion 501C on the load portion 500C. The first protrusion 501Ca of the tip portion 501C is formed with the tip facing toward the proximal end A2 in the longitudinal direction A, compared to the first protrusion 501Ba of the third embodiment. This configuration makes it easier for the first protrusion 501Ca of the tip portion 501C to grip biological tissue.

[0159] Furthermore, the thickness of the forceps pieces of the gripping forceps according to the above embodiment is not particularly limited. For example, as shown in Figure 36, the thickness of the second forceps piece 53C in the short direction perpendicular to the longitudinal direction A is formed to be thinner than that of the first forceps piece 52C. With this configuration, when the forceps pieces are closed relative to the rod, the width and thickness of the gripping forceps in the vertical direction D and the width direction E can be made even smaller.

[0160] Furthermore, as shown in Figure 37, the rod 50D of the gripping forceps according to the above embodiment may have a recess 501Dh on the surface (hooking surface) provided on the proximal end side A2 in the longitudinal direction A of the first protrusion 501Da of the tip portion 501D provided on the load portion 500D, which is recessed toward the tip side A1 in the longitudinal direction A. With this configuration, the first protrusion 501Da can hook onto the muscle layer of the first end Ta, and then allow tissue to enter the recess 501Dh, making it difficult to detach from the first protrusion 501Da.

[0161] Furthermore, as shown in Figure 38, the other end of the convex wire 73E of the rod 50E of the gripping forceps according to the above embodiment may be connected to the first connecting portion 522 of the first forceps piece 52, compared to the convex wire 73E of the third embodiment. In this configuration as well, when the first operating wire 71 moves back and forth in the longitudinal direction A, the first connecting portion 522 rotates, and the convex wire 73E can move back and forth along the longitudinal direction A in conjunction with the first connecting portion 522.

[0162] Furthermore, the anchor 55 of the grasping forceps according to the second embodiment does not need to have a convex wire 73A, as it is made elastic when moving from a downwardly protruding state to an upward state. Even in this case, the surgeon can hook and lock the anchor 55 from the abdominal side of the muscle layer and pull the muscle layer together toward the inside of the stomach. In addition, the anchor 55 can be folded between the first forceps piece and the rod so that the anchor 55 is pushed upward when the first forceps piece of the forceps piece is displaced from an open state to a closed state relative to the rod.

[0163] In all of the above embodiments, the grasping forceps and suturing method of the present invention allow for secure grasping of the mucosal and muscular layers around the excision site, and the excision site can be sutured using the grasping forceps. [Explanation of symbols]

[0164] 1…Cap (mounting component) 2…Stapler gripping part 3… Staple discharge section 4… Staple receiving section 21...First stapler gripping member 22...Second staple gripping member 25…Visual space (penetration space) 100... Medical stapler 200… Endoscopy 211...Tip 212... Tip 214... Forceps channel 215…Objective lens 300… Healthcare system 400... Grasping forceps (endoscopic treatment instrument) 5(5A, 5B, 5C)...forceps gripping part 50 (50A, 50B, 50C, 50D, 50E, 50F)... Rod 500 (500A, 500B, 500C, 500D, 500F)... Load section 501 (501A, 501B, 501C, 501D, 501F)...Tip 501a (501Ba, 501Ca, 501Da)...First convex part 501b...Second protrusion 501Dh…recess 502 (502A, 502B)...rod-shaped part 51 (51B)... Forceps jaws 52 (52A, 52C)... First forceps section (first jaw) 53 (52B, 52C)... Second forceps section (second jaw) 55... Anchor (first protrusion) 55a... Fixing pin (fixing part) 6…Forceps sheath (sheath) 7… Forceps manipulation wire 71...First operating wire (first wire) 72...Second operating wire 73E…Recessed wire 8... Forceps operating section 82...First slider 83... Second slider 84... Simultaneous opening and closing assist part (butt stop part) S... staples T... Subject to treatment G... Missing part M…Stomach wall (tissue) M1…mucosal layer M2…muscular layer

Claims

1. A sheath that extends in the longitudinal direction, A gripping portion having a rod provided at the tip of the sheath and extending in the longitudinal direction, a first jaw connected to the base end of the rod and opening and closing toward the tip of the rod, and a second jaw connected to the base end of the rod on the opposite side of the first jaw and opening and closing toward the tip of the rod, Equipped with, The rod has a tip portion having a first protrusion that projects toward the first jaw toward the first projection side, The first protrusion has a fixing portion provided on the fixed end side of the first protrusion and connected to the rod, and is rotatable toward the base end in the longitudinal direction with respect to the fixing portion. Grasping forceps.

2. The longitudinal central axis of the rod is eccentric to the side opposite to the first protruding side compared to the longitudinal central axis of the sheath. The gripping forceps according to claim 1.

3. The first protrusion further comprises a protrusion wire, one end of which is connected to the movable end side opposite to the fixed end side of the fixed portion, and the other end of which is connected to the first jaw. The aforementioned protruding wire causes the first protrusion to rotate by linking it with the first jaw. The gripping forceps according to claim 1.

4. The first jaw is connected so as to be openable and closable, and a first wire moves back and forth in the longitudinal direction, In the first protrusion, one end is connected to the movable end side opposite to the fixed end side of the fixed portion, and the other end is connected to the first wire, and the protrusion wire is connected to the first wire, Furthermore, The aforementioned protruding wire rotates the first protruding portion by linking it with the first wire. The gripping forceps according to claim 1.

5. A sheath that extends in the longitudinal direction, A gripping portion having a rod provided at the tip of the sheath and extending in the longitudinal direction, a first jaw connected to the base end of the rod and opening and closing toward the tip of the rod, and a second jaw connected to the base end of the rod on the opposite side of the first jaw and opening and closing toward the tip of the rod, Equipped with, The rod has a first protrusion on its tip side that protrudes toward the first jaw toward the first projection side, The longitudinal central axis of the rod is eccentric to the second protruding side, opposite to the first protruding side, compared to the longitudinal central axis of the sheath. Grasping forceps.

6. The first jaw has a marker that can be visually distinguished from the second jaw. The gripping forceps according to claim 5.

7. The first protrusion has a fixing portion provided on the fixed end side of the first protrusion and connected to the rod, and is rotatable toward the base end in the longitudinal direction with respect to the fixing portion. The gripping forceps according to claim 5.

8. The first protrusion further comprises a protrusion wire, one end of which is connected to the movable end side opposite to the fixed end side of the fixed portion, and the other end of which is connected to the first jaw. The aforementioned protruding wire causes the first protrusion to rotate by linking it with the first jaw. The gripping forceps according to claim 7.

9. The first jaw is connected so as to be openable and closable, and a first wire moves back and forth in the longitudinal direction, In the first protrusion, one end is connected to the movable end side opposite to the fixed end side of the fixed portion, and the other end is connected to the first wire, and the protrusion wire is connected to the first wire, Furthermore, The aforementioned protruding wire rotates the first protruding portion by linking it with the first wire. The gripping forceps according to claim 7.

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