Grasping forceps and suture 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

Grasping forceps and suturing method

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

[0002] In recent years, medical staplers have become known as treatment tools for suturing the digestive tract, etc. Using an appropriate medical stapler can facilitate surgery for suturing the digestive tract, etc., and significantly reduce the time required for the surgery. Medical staplers are used in conjunction with endoscopes, and for example, the treatment target is grasped with forceps and sutured.

[0003] Known forceps for grasping a treatment target include the forceps described in Patent Document 1. This grasping forceps has a gripping portion at the tip end that includes a rod and two forceps pieces (jaws), and the surgeon can open and close the two forceps pieces by manipulating two operating portions (handles), thereby ligating the excised portion or the like after treatment.

[0004] Incidentally, a medical stapler performs a full-thickness resection of the stomach wall (tissue) inside the stomach (inside the stomach), which includes the mucosal layer and the muscular layer formed on the abdominal cavity side of the mucosal layer (outside the stomach), and then retracts the edges of the resected defect into the stomach and sutures them. When a full-thickness resection is performed inside the stomach, the air inside the stomach escapes into the abdominal cavity, causing the stomach to shrink. 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 nearly parallel to the surface of the stomach wall.

[0005] U.S. Pat. No. 9,603,614

[0006] However, with the forceps described in Patent Document 1, when grasping the edges of the defect after treatment and pulling them toward the medical stapler, if the approach direction of the medical stapler is nearly parallel to the surface of the stomach wall (tissue), it is difficult to reliably grasp the mucosal layer and the muscular layer. As a result, with the forceps described in Patent Document 1, the suturing of the defect by the medical stapler is insufficient.

[0007] The present invention has been made in consideration of the above circumstances, and aims to provide a grasping forceps that can reliably grasp the mucosal layer and muscle layer around the resection hole, and a suturing method for suturing the resection hole using the grasping forceps.

[0008] In order to solve the above problems, the present invention proposes the following means: A grasping forceps according to a first aspect of the present invention includes a sheath extending in a longitudinal direction, a rod provided at a distal end of the sheath and extending in the longitudinal direction, a gripping portion having: a first jaw connected to a proximal end of the rod and opening and closing toward the distal end of the rod, and a second jaw connected to the proximal end of the rod on the opposite side of the first jaw with the rod therebetween and opening and closing toward the distal end of the rod, wherein the rod has a distal end portion including a first convex portion that protrudes on a first protruding side toward the first jaw.

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

[0010] FIG. 1 is a diagram showing the overall configuration of a medical system used in the grasping forceps and suturing method according to a first embodiment of the present invention. FIG. 2 is a diagram showing the overall configuration of a medical stapler of the medical system. FIG. 3 is a front view of a cap of the medical stapler. FIG. 4 is a perspective view of the medical stapler with the stapler gripping portion of the medical stapler in a closed state. FIG. 5 is a front view of the medical stapler with the stapler gripping portion of the medical stapler in a closed state. FIG. 6 is a perspective view of the medical stapler with the stapler gripping portion of the medical stapler in an open state. FIG. 7 is a front view of the medical stapler with the stapler gripping portion of the medical stapler in an open state. FIG. 8 is a side view of the medical stapler with the stapler gripping portion of the medical stapler in a closed state. FIG. 9 is a side view of the medical stapler with the stapler gripping portion of the medical stapler in an open state. FIG. 10 is a cross-sectional view of a gripping portion including a staple discharge portion. FIG. 11 is a cross-sectional view of a gripping portion with a discharge operation wire pulled. FIG. 12 is an overall view showing grasping forceps used in an endoscope of the medical system. FIG. 13 is a perspective view showing a state in which the medical stapler and grasping forceps are attached to the endoscope. FIG. 1 is a side view showing a state in which a first forceps blade and a second forceps blade of the forceps grasping forceps are in an open state relative to the rod. FIG. 2 is a side view showing a modified example of the rod of the grasping forceps. FIG. 3 is a side view showing a state in which a second forceps blade of the forceps grasping forceps is in an open state relative to the rod, and the first forceps blade is in a closed state. FIG. 4 is a side view showing a state in which a first forceps blade of the forceps grasping forceps is in an open state relative to the rod, and the second forceps blade is in a closed state. FIG. 5 is a side view showing a state in which a first forceps blade and a second forceps blade of the forceps grasping forceps are in a closed state relative to the rod. FIG. 6 is a view showing a state in which an endoscope is brought close to a lesion in a suturing method using the grasping forceps according to a first embodiment of the present invention. FIG. 7 is a view illustrating a positioning step in the suturing method. FIG. 8 is a view illustrating an insertion step in the suturing method. FIG. 9 is a view illustrating a first opening and closing step in the suturing method. FIG. 10 is a view illustrating an insertion step in the suturing method. FIG. 11 is a view illustrating a pulling-in step in the suturing method. FIG. 12 is a view illustrating a first grasping step in the suturing method. FIG. 13 is a view illustrating a second opening and closing step in the suturing method. 10A to 10C are diagrams illustrating a second gripping step in the suturing method, a drawing step in the suturing method, and a suturing step in the suturing method.1 is a diagram illustrating a suturing step in the suturing method. FIG. 2 is a diagram illustrating a suturing step in the suturing method. FIG. 3 is an enlarged view of the tip side of grasping forceps according to a second embodiment of the present invention. FIG. 4 is a side view showing a state in which the first forceps piece and the second forceps piece of the grasping forceps are in an open state. FIG. 5 is an enlarged view of the tip side of grasping forceps according to a third embodiment of the present invention. FIG. 6 is a side view showing a state in which the first forceps piece and the second forceps piece of the grasping forceps are in a closed state relative to the rod. FIG. 7 is a diagram illustrating another modified example of grasping forceps according to the present invention. FIG. 8 is a diagram illustrating another modified example of grasping forceps according to the present invention.

[0011] First Embodiment A first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 31. Fig. 1 is a diagram showing the overall configuration of a grasping forceps (endoscopic treatment tool) 400 and a medical system 300 used in a 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] Medical system 300 is used in surgery to suture the digestive tract, etc. Medical system 300 includes medical stapler 100, endoscope 200, opening / closing operation unit 250, discharge operation unit 270, and wire sheath 280. Opening / closing operation unit 250 is an operation unit that operates medical stapler 100 with opening / closing operation wire 254. Discharge operation unit 270 is an operation unit that operates medical stapler 100 with discharge operation wire 274.

[0013] [Endoscope 200] The endoscope 200 is a known flexible endoscope, and includes a long insertion section 210 that is inserted into the body from the tip, an operation section 220 provided at the base end of the insertion section 210, and a universal cord 240.

[0014] The insertion section 210 is formed with a treatment instrument channel 230 through which the grasping forceps 400 are inserted. A forceps port 214, which is a distal end opening of the treatment instrument channel 230, is provided at the distal end 212 of the insertion section 210. The treatment instrument channel 230 extends from the distal end 212 of the insertion section 210 to the operation section 220.

[0015] The distal end 211 of the insertion section 210 is provided with an imaging unit (not shown) having a CCD or the like. An objective lens 215 of the imaging unit is exposed at the distal end 212 of the insertion section 210.

[0016] A knob 223 for operating the insertion portion 210 and a switch 224 for operating the imaging unit, etc. are provided on the proximal end side of the operation portion 220. An operator (not shown) can bend the insertion portion 210 in a desired direction by operating the knob 223.

[0017] A forceps insertion port 222 that communicates with the treatment instrument channel 230 is provided on the distal end side of the operation section 220. The surgeon can insert the grasping forceps 400 into the treatment instrument channel 230 through the forceps insertion port 222.

[0018] The universal cord 240 connects the operation unit 220 to external peripheral devices. For example, the universal cord 240 outputs an image captured by the imaging unit to the external device. The image captured by the imaging unit is displayed on a display device such as a liquid crystal display via an image processing device.

[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 an opening / closing operation wire 254. As shown in Fig. 1 , the opening / closing operation unit 250 has an opening / closing operation unit main 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 surgeon can advance and retract the opening / closing operation wire 254 by advancing and retracting the opening / closing operation slider 253 in the longitudinal axis direction relative to the opening / closing operation unit main body 252.

[0020] [Ejection Operation Unit 270] The ejection operation unit 270 is an operation unit that ejects (fires) staples S from the medical stapler 100 by operating a ejection operation wire 274. As shown in FIG. 1 , the ejection operation unit 270 has an ejection operation unit main body 272 and an ejection operation slider 273. The base end of the ejection operation wire 274 is connected to the ejection operation slider 273. The surgeon can advance and retract the ejection operation wire 274 by advancing and retracting the ejection operation slider 273 in the longitudinal axis direction relative to the ejection operation unit main body 272.

[0021] [Wire Sheath 280] The wire sheath 280 is a sheath through which the opening / closing operation wire 254 and the releasing operation wire 274 are inserted. As shown in FIG.

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

[0023] Figure 3 is a front view of the cap 1 of the medical stapler 100. The stapler gripping portion 2 is shown in perspective in Figure 3. The cap (attachment member) 1 is a member that can be attached to the distal end portion 211 of the endoscope 200. The cap 1 is formed in a substantially cylindrical shape and has a first through-hole 11 that penetrates in the axial direction A (Figure 2) of the medical stapler 100, and a second through-hole 12 that penetrates in the axial direction A.

[0024] 1 is inserted into the first through hole 11. The shape of the first through hole 11 is formed to fit the outer shape of the tip portion 211 of the insertion portion 210. Therefore, by inserting the tip portion 211 of the endoscope 200 into the first through hole 11, the cap 1 can be attached to the tip portion 211 of the endoscope 200.

[0025] 3, 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 axial direction A of the cap 1. The direction in which the central axis O1 is eccentric with respect to the central axis O is referred to as the "upper side B1."

[0026] The second through-hole 12 is a hole into which a wire sheath 280, through which the opening / closing operation wire 254 and the ejection operation wire 274 shown in Fig. 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 end of the wire sheath 280 is inserted and fixed in the second through-hole 12. The opening / closing operation wire 254 and the ejection operation wire 274, which are inserted through the wire sheath 280, pass through the second through-hole 12 and extend to the tip end side.

[0027] As shown in Fig. 3 , 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. 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 the "lower side B2." In this embodiment, the upper side B1 and the lower side B2 are oriented along the up-down direction B.

[0028] Fig. 4 is a perspective view of the medical stapler 100 with the stapler gripping portion 2 in a closed state. Fig. 5 is a front view of the medical stapler 100 with the stapler gripping portion 2 in a closed state. When the cap 1 is attached to the distal end portion 211 of the endoscope 200, the objective lens 215 and the forceps port 214 are exposed from the distal end side opening 13 of the first through-hole 11 of the cap 1, as shown in Figs. 4 and 5 . The surgeon can observe the treatment target through the objective lens 215 even when the medical stapler 100 is attached to the distal end portion 211 of the endoscope 200.

[0029] Fig. 6 is a perspective view of the medical stapler 100 with the stapler gripping portion 2 in an open state. Fig. 7 is a front view of the medical stapler 100 with the stapler gripping portion 2 in an open state. Fig. 8 is a side view of the medical stapler 100 with the stapler gripping portion 2 in a closed state. Fig. 9 is a side view of the medical stapler 100 with the stapler gripping portion 2 in an open state. As shown in Fig. 6, the stapler gripping portion 2 has a first stapler gripping member 21, a second stapler gripping member 22, an opening / closing rotation shaft 23, and a movable pin 27.

[0030] As shown in Fig. 6, the first stapler gripping member 21 and the second stapler gripping member 22 are connected to each other so as to be able to open and close by an opening and closing rotation shaft 23. The opening and closing rotation shaft 23 is provided on the distal end side of the cap 1. An axial direction C of the opening and closing rotation shaft 23 is perpendicular to an axial direction A of the cap 1 and a vertical direction B. As shown in Fig. 7, the stapler gripping portion 2 is formed symmetrically with respect to a central axis O3 in the vertical direction B.

[0031] The first stapler gripping member 21 is fixed non-rotatably to the tip side of the cap 1. The first stapler gripping member 21 is fixed to the cap 1 on a side B2 below the central axis O of the cap 1. As shown in Fig. 3, the first stapler gripping member 21 is disposed at a position overlapping with the second through-hole 12 of the cap 1 in a front view. On the other hand, as shown in Fig. 7, the first stapler gripping member 21 is disposed at a position not overlapping with the objective lens 215 and the forceps port 214 of the endoscope 200 in a front view.

[0032] 6, the first stapler gripping member 21 has a first tip portion 21a and a first main body portion 21b, and is formed in a substantially T-shape in a plan view. The first tip portion 21a is located closer to the tip side than the first main 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 shaft 23. The first tip portion 21a is provided with a staple discharge portion 3. An opening 31a of the staple discharge portion 3 is provided on a surface (upper surface 21e) of the upper side B1 of the first tip portion 21a.

[0034] The first body portion 21b is an elongated member extending in the axial direction A. The tip of the first body portion 21b is fixed to the first tip portion 21a. The base end of the first body portion 21b is fixed to the cap 1 with the wire sheath 280 sandwiched therebetween. The first body portion 21b has an abutment pin 21c and a first engagement groove 21d (FIG. 8).

[0035] The contact pin 21c is provided at the base end of the first main body portion 21b, and contacts the second stapler gripping member 22 in the closed state to restrict the movable range of the second stapler gripping member 22.

[0036] 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 stapler gripping member 22 is attached to the first stapler gripping member 21 by an opening / closing rotation shaft 23 so as to be rotatable in the opening / closing direction R. As shown in Figures 6 and 7, the second stapler 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 portion 22b. In the closed state, the center portion of the U-shaped member 22a is disposed on the tip side of the first stapler gripping member 21. The center portion has a second tip portion 22c. The second tip portion 22c is formed in a substantially rectangular parallelepiped shape. The second tip portion 22c extends in the axial direction C of the opening / closing rotation shaft 23. A staple receiving portion 4 is provided in the second tip portion 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 the opening / closing rotation shaft 23. A guide groove 22d into which the first main body portion 21b is inserted is formed in the second main body portion 22b. A pair of side plate portions 22g of the second main body portion 22b that face each other in the axial direction C with the guide groove 22d therebetween are each formed with a second engagement groove 22e.

[0040] The second engagement groove 22e is a groove that penetrates in the axial direction C. As shown in Fig. 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 Fig. 8, the second engagement groove 22e is inclined downward B2 from the tip end side to the base end side in the axial direction A in a side view in the closed state.

[0041] 6, the second stapler gripping member 22 has a field of view space (through space) 25 penetrating in the opening / closing direction R between the staple receiving portion 4 on the distal end side and the opening / closing rotation shaft 23 on the proximal end side. In the present embodiment, the field of view space 25 is a space surrounded by the sides of a U-shaped member 22a formed in a substantially U-shape.

[0042] 8, the movable pin 27 engages with the first engagement groove 21d and the second engagement groove 22e, and moves forward and backward along the first engagement groove 21d in the axial direction A. The tip of an 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 forward and backward in the axial direction A, and in conjunction with this, the second stapler gripping member 22 opens and closes as shown in FIGS.

[0043] When the opening / closing operation wire 254 is advanced toward the distal end, the movable pin 27 rotates the second stapler gripping member 22 in the opening direction (R1) around the opening / closing rotation shaft 23, and the stapler gripping portion 2 is opened, as shown in Fig. 9. When the opening / closing operation wire 254 is retreated toward the proximal end, the movable pin 27 rotates the second stapler gripping member 22 in the closing direction (R2) around the opening / closing rotation shaft 23, and the stapler gripping portion 2 is closed, as shown in Fig. 8.

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

[0045] 9, when the stapler gripping portion 2 is in the open state, the staple receiving portion 4 is located closer to the base end than the opening / closing rotation shaft 23. When the stapler gripping portion 2 is in the open state, the staple receiving portion 4 is located closer to the base end than the staple discharging portion 3. When the stapler gripping portion 2 is in the open state, the optical axis A10 of the objective lens 215 passes through the field of view space 25. Furthermore, when the stapler gripping portion 2 is in the open state, the central axis A20 of the forceps opening 214 passes through the field of view space 25.

[0046] Figure 10 is a cross-sectional view of the stapler gripping portion 2 including the staple discharge portion 3. Figure 10 shows the state before the discharge operation wire 274 is pulled. The staple discharge portion 3 is provided at the first tip 21a of the first stapler gripping member 21, and can store and discharge staples S. The staple discharge portion 3 has a staple storage portion 31, a rectilinear member 32, and a rotating member 33.

[0047] The staple storage section 31 is a space for storing the 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 opens in the up-down direction B at an opening 31a provided on the upper surface 21e of the first tip portion 21a. The staples S are stored in the staple storage section 31 through the opening 31a. The staples S are stored in the staple storage section 31 with the needle tips S1 of the staples S facing the upper side 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 needle tips S1 at both ends aligned in the axial direction C.

[0050] The rectilinear member 32 is a member housed in 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 rectilinear member 32 has a recess 32a on the upper side B1 that supports the staple S. The staple S stored in the staple storage section 31 is fitted into the recess 32a.

[0051] The first pulley 34 and the second pulley 36 serving as the rotating member 33 are rotatably attached inside the first stapler gripping member 21, and by rotating, move the rectilinear member 32 in the vertical direction B. A first rotation shaft 35 of the first pulley 34 and a second rotation shaft 37 of the second pulley 36 extend in the axial direction C and are substantially parallel to the opening / closing rotation shaft 23 of the gripping portion 2.

[0052] The first pulley 34 is rotatable around a first rotation shaft 35. The tip of a discharge operation wire 274 is connected to the first pulley 34, and the first pulley 34 rotates when the discharge operation wire 274 is pulled. The first pulley 34 has a protrusion (abutment portion) 38 on the tip side that supports the rectilinear member 32 from the lower side B2.

[0053] The second pulley 36 is rotatable around a second rotation shaft 37. The second pulley 36 is disposed closer to the base end than the first pulley 34, and is a bend pulley that changes the direction in which the discharge operation wire 274 travels.

[0054] The tip of the discharge operation wire 274 is connected to the first pulley 34 on the upper side B1 of the first rotary shaft 35. The discharge operation wire 274 extends from the first pulley 34 via the second pulley 36, through the second through-hole 12, and to the discharge operation unit 270.

[0055] 11 is a cross-sectional view of the stapler gripping portion 2 when the discharge operation wire 274 is pulled. By pulling the discharge operation wire 274, the upper side B1 of the first pulley 34 rotates toward the base end, and the lower side B2 of the first pulley 34 rotates toward the tip end. As a result, the convex portion 38 of the first pulley 34 pushes the rectilinear member 32 upward toward the upper side B1, and the stored staple S is discharged from the opening 31 a to the upper side B1.

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

[0057] [Gripping forceps (endoscopic treatment tool) 400] Fig. 12 is an overall view showing grasping forceps (endoscopic treatment tool) 400 used in the endoscope 200 of the medical system 300. Fig. 13 is a perspective view showing the state in which the medical stapler 100 (see Fig. 1) and the grasping forceps 400 are attached to the endoscope 200.

[0058] As shown in FIG. 12 , the grasping forceps 400 (also referred to as a treatment tool 400 ) includes a forceps grasping portion 5 , a forceps sheath (sheath) 6 , a forceps operating wire 7 , and a forceps operating portion 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. In addition, in the longitudinal direction A, the side that is inserted into the patient's body will be referred to as the "distal side A1," and the side of the forceps operation unit 8 will be referred to as the "proximal side A2." In the grasping forceps 400, the forceps grasping unit 5, the forceps sheath 6, the forceps operation wire 7, and the forceps operation unit 8 are arranged in this order from the distal side A1 to the proximal side A2 of the grasping forceps 400. The grasping forceps 400 is inserted into the treatment instrument channel 230 from a forceps insertion port 222 provided on the distal side of the operation unit 220 of the endoscope 200 shown in FIG. 1 . The grasping forceps 400 inserted through the forceps insertion port 222 passes through the treatment instrument channel 230 and protrudes from the tip of the grasping forceps 400 into the forceps port 214, which is the distal opening of the treatment instrument channel 230. Note that the term "patient" as used in this specification includes any living organism and includes the term "subject." The patient may be a human or an animal.

[0060] [Forceps gripping portion 5] The forceps gripping portion 5 is a forceps useful for therapeutic procedures on patients, such as preventing tissue bleeding, closing perforations and hemostasis, suturing and contracting internal wounds, traction on lesions (mucosal protuberances), and other surgical procedures. The forceps gripping portion 5 is rotatable about a longitudinal axis in the longitudinal direction A. The surgeon can easily rotate the entire grasping forceps 400 by, for example, operating the forceps operating portion 8. The forceps gripping portion 5 includes a rod 50, forceps jaws 51, and a connecting pin 54.

[0061] Here, the forceps blade 51 has a first forceps blade (first jaw) 52 and a second forceps blade (second jaw) 53 that open and close relative to the rod 50. The first forceps blade 52 and the second forceps blade 53 are provided on either side of the rod 50 in the up-down direction D of the grasping forceps 400, which is perpendicular to the longitudinal direction A, sandwiching the rod 50 between them via a connecting pin 54, and open and close independently of each other. The up-down direction D is the opening and closing direction of the first forceps blade 52 and the second forceps blade 53. Therefore, the up-down direction D is also referred to as the opening and closing direction D. As shown in FIG. 13 , in the up-down direction (opening and closing direction) D, the side on which the second forceps blade 53 is provided relative to the rod 50 is referred to as the upper side D1, and the side on which the first forceps blade 52 is provided relative to the rod 50 is referred to as the lower side D2. The direction perpendicular to the longitudinal direction A and the up-down direction (opening and closing direction) D is referred to as the width direction E.

[0062] [Rod 50] Figure 14 is a side view showing a state in which the first forceps blade 52 and the second forceps blade 53 of the forceps blade 51 of the grasping forceps 400 are in an open state 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 blade 52 and the second forceps blade 53 that are provided on both sides in the up-down direction (opening / closing direction) D. The rod 50 is provided at the distal end 6a of the forceps sheath 6. The rod 50 has a loading portion 500 formed on the distal end side A1 and a connecting portion 503 formed on the proximal end side A2.

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

[0064] The tip portion 501 is provided at the tip of the rod-shaped portion 502. As shown in Fig. 13 , the tip portion 501 is formed with its longitudinal direction in the up-down direction D so as to have a substantially diamond shape when viewed from the base end side in the longitudinal direction A. The tip portion 501 is formed so as to be asymmetric with respect to the central axis O4 of the rod-shaped portion 502 in the longitudinal direction A. Compared to the rod-shaped portion 502, the length of the tip portion 501 in the up-down direction D is greater than the length of the rod-shaped portion 502. The tip portion 501 includes a first convex portion 501a and a second convex portion 501b.

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

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

[0067] The distal end 501 can be manipulated and positioned by the surgeon to catch on biological tissue and lock the rod 50 to the biological tissue. Here, the protruding length of the first protruding portion 501a protruding to the lower side D2 in the vertical direction D is longer than the protruding length of the second protruding portion 501b protruding to the upper side D1 in the vertical direction D.

[0068] The rod-shaped portion 502 is a substantially round rod-shaped member, and is provided at its tip with a tip portion 501. Here, the rod 50 may be provided on the forceps sheath 6 with its central axis in the longitudinal direction A eccentric to a central axis O3 of the forceps sheath 6. In this embodiment, as shown in Fig. 14 , 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 the second protrusion side, with respect to the central axis O3 of the forceps sheath 6.

[0069] 14 , the rod-shaped portion 502 has a first protrusion 502a on a surface that is provided on the lower side D2 and faces the first forceps piece 52 in the opening / closing direction (up-down direction) D. The rod-shaped portion 502 also has a second protrusion 502b on a surface that is provided on the upper side D1 and faces the second forceps piece 53 in the opening / closing direction D.

[0070] 14 , the first protrusion 502a and the second protrusion 502b are multiple protrusions provided on the rod-shaped portion 502. The first protrusion 502a protrudes from the rod-shaped portion 502 toward the first forceps blade 52, which is disposed on the lower side D2 in the opening and closing direction D. The second protrusion 502b protrudes from the rod-shaped portion 502 toward the second forceps blade 53, which is disposed on the upper side D1 in the opening and closing direction D.

[0071] The first protrusion 502a and the second protrusion 502b are preferably formed to a size that does not interfere with the first forceps blade 52 and the second forceps blade 53 in the opening / closing direction D. In the present embodiment, the central axis O4 of the rod-shaped portion 502 in the longitudinal direction A is eccentric to the upper side D1 relative to the central axis O3 of the forceps sheath 6. Therefore, as shown in FIG. 14 , the first protrusion 502a is formed to be longer and larger in the opening / closing direction D than the second protrusion 502b. Note that the number of first protrusions 502a and second protrusions 502b is not particularly limited. Furthermore, the rod-shaped portion 502 does not necessarily have to include the first protrusion 502a and the second protrusion 502b.

[0072] The connecting portion 503 is connected to the base end of the loading portion 500. The connecting portion 503 is formed in a substantially cylindrical shape with a diameter larger than that of the rod-shaped portion 502 of the loading portion 500. 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 therethrough. 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 up-down direction D.

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

[0074] The rod 50 does not necessarily have to include the second protrusion 501b. For example, as shown in Fig. 15, a rod 50F does not include the second protrusion 501b at the tip end 501F of a loading part 500F, as compared to Fig. 14.

[0075] [Forceps jaws 51] Fig. 16 is a side view showing a state in which the second forceps jaw 53 of the forceps jaw 51 of the grasping forceps 400 is in an open state relative to the rod 50 and the first forceps jaw 52 is in a closed state. Fig. 17 is a side view showing a state in which the first forceps jaw 52 of the forceps jaw 51 of the grasping forceps 400 is in an open state relative to the rod 50 and the second forceps jaw 53 is in a closed state. Fig. 18 is a side view showing a state in which the first forceps jaw 52 and the second forceps jaw 53 of the forceps jaw 51 of the grasping forceps 400 are in a closed state relative to the rod 50.

[0076] The forceps blades (jaws) 51 are components for grasping biological tissue. The forceps blades 51 are formed of a metal material such as stainless steel. As shown in FIGS. 14 to 18 , the forceps blades 51 include a first forceps blade (first jaw) 52 and a second forceps blade (second jaw) 53. The first forceps blade 52 and the second forceps blade 53 can independently open and close relative to the rod 50. The first forceps blade 52 and the second forceps blade 53 are supported rotatably in an opening and closing direction (up and down direction) D around a connecting pin 54. The first forceps blade 52 and the second forceps blade 53 are also arranged symmetrically with respect to the central axis of the forceps blade 51 in the longitudinal direction A. Here, the central axis of the forceps blade 51 in the longitudinal direction A substantially 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 so as to be openable and closable on the lower side D2 of the rod 50 in the opening and closing direction D. The first forceps piece 52 extends in the longitudinal direction A relative to the rod 50 in a closed state. The first forceps piece 52 is rotatably attached to the rod 50 by a connecting pin 54 so as to open and separate on the lower side D2. The first forceps piece 52 includes a first arm portion 520 and a first connecting portion 522.

[0078] The first arm portion 520 is provided on the distal end side A1 of the first forceps piece 52. The first arm portion 520 is a flat plate made of, for example, resin or metal. As shown in FIGS. 16 and 18 , when the first arm portion 520 is closed relative to the rod 50, the obverse side faces the upper side D1 and the reverse side faces the lower side D2. Here, the obverse side of the first arm portion 520 refers to the inner surface that contacts the biological tissue and faces the rod 50 in the opening / closing direction D. Furthermore, 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. Note that when the first arm portion 520 is closed relative to the rod 50, the first arm portion 520 may be formed in a generally cup-like shape with the reverse side serving as the bottom. The first arm portion 520 includes an engagement portion 521 on the distal end 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 the upper side D1 when the first forceps piece 52 is closed relative to the rod 50. With this configuration, the number of parts required for the engaging portion 521 can be reduced, and the manufacturing process can be simplified.

[0080] The engaging portion 521 has a claw-like shape with a tip that is split into two, and engages with a first convex portion 501a of the tip portion 501 provided at the tip of the rod-shaped portion 502 of the rod 50. With this configuration, the first forceps piece 52 can reliably clamp biological tissue when closed on the rod 50.

[0081] The first connecting portion 522 is provided on the base end side A2 of the first forceps piece 52. The first connecting portion 522 is formed in a generally plate-like shape with a surface in the width direction E. The first connecting portion 522 is connected to the base 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 FIG. 14 or 17 , when the first forceps piece 52 is in an open state with respect 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 so that the first through-hole 522a does not overlap the connecting portion 503 of the rod 50 and is positioned above the connecting portion 503 on the side D1 above the connecting portion 503.

[0082] The first forceps piece 52 may have, for example, a marker that can be visually distinguished from the second forceps piece 53. The marker is not particularly limited, but may be any marker that can be distinguished from the second forceps piece 53 by color, pattern, shape, or the like.

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

[0084] The second arm portion 530 is provided on the distal end side A1 of the second forceps piece 53. The second arm portion 530 is a flat plate made of, for example, resin or metal. As shown in FIGS. 17 and 18 , the second arm portion 530 is disposed such that, when closed relative to the rod 50, its obverse surface faces downward D2 and its reverse surface faces upward D1. Here, the obverse surface of the second arm portion 530 refers to the inner surface that contacts the biological tissue and faces the rod 50 in the opening / closing direction D. Furthermore, 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. Note that, when closed relative to the rod 50, the second arm portion 530 may be formed in a generally cup-like shape with its reverse surface serving as the bottom. The second arm portion 530 includes an engagement portion 531 on the distal end 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 the lower side D2 when the second forceps piece 53 is closed relative to the rod 50. With this configuration, the number of parts required for the engaging portion 531 can be reduced, and the manufacturing process can be simplified.

[0086] The engaging portion 531 has a claw-like shape with a tip that is split into two, and engages with the second convex portion 501b of the tip portion 501 provided at the tip of the rod-shaped portion 502 of the rod 50. With this configuration, the second forceps piece 53 can reliably clamp biological tissue when closed on the rod 50.

[0087] The second connecting portion 532 is provided on the base end side A2 of the second forceps piece 53. The second connecting portion 532 is formed in a generally plate-like shape with a surface in the width direction E. The second connecting portion 532 is connected to the base 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 FIG. 14 or 16 , when the second forceps piece 53 is in an open state with respect 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 so 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 on the side D2.

[0088] The opening and closing angle of the first forceps piece 52 and the second forceps piece 53 relative to the rod 50 is not particularly limited, but it is preferable to set it 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] 14 to 18 , the connecting pin 54 is attached to the distal end side A1 of the connecting portion 503 of the rod 50. The connecting pin 54 connects the first connecting portion 522 of the first forceps blade 52 and the second connecting portion 532 of the second forceps blade 53 to the connecting portion 503 of the rod 50 in the width direction E. Specifically, when the first forceps blade 52 is closed relative to the rod 50, the connecting pin 54 is attached to the first connecting portion 522 on the distal end side A1 of the first through hole 522a. Furthermore, when the second forceps blade 53 is closed relative to the rod 50, the connecting pin 54 is attached to the second connecting portion 532 on the distal end side A1 of the second through hole 532a. The first forceps blade 52 and the second forceps blade 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 is a long member having a central axis O3 (see FIG. 14 ) and extending from a distal end 6 a to a proximal end 6 b. The forceps sheath 6 is flexible and can easily change shape within a lumen to conform to the curved shape of luminal tissue or the like. The forceps sheath 6 has an outer diameter that allows it to be inserted into the treatment instrument channel 230 of the endoscope 200. When inserted into the treatment instrument channel 230, the distal end 6 a of the forceps sheath 6 can be protruded and retracted through a forceps port 214, which is a distal opening of the treatment instrument channel 230. The distal end 6 a of the forceps sheath 6 is connected to the rod 50. The forceps sheath 6 is made of an insulating material, for example, a fluororesin such as PTFE (polytetrafluoroethylene) or a resin material such as HDPE (high-density polyethylene). Furthermore, a first control wire 71 and a second control wire 72 of the forceps control wire 7 are inserted through the forceps sheath 6.

[0091] 12 to 18 , the forceps control wire 7 includes a first control wire 71 and a second control wire 72. The first control wire 71 and the second control wire 72 are inserted through an internal space (not shown) of the forceps sheath 6.

[0092] The first operation wire 71 is inserted into the forceps sheath 6 so as to be movable back and forth in the longitudinal direction A. As shown in FIGS. 14 and 17 , the distal end of the first operation wire 71 is connected to a first through-hole 522a of a first connecting portion 522 of the first forceps piece 52. When the first operation wire 71 advances toward the distal side A1 in the longitudinal direction A, the distal end of the first operation wire 71 protrudes upward D1 from a groove 503h formed in the connecting portion 503 of the rod 50 provided at the distal end 6a of the forceps sheath 6, causing the first connecting portion 522 to rotate. This causes the first arm portion 520 of the first forceps piece 52 to rotate downward D2 around the connecting pin 54. The proximal end of the first operation wire 71 is fixed to the first slider 82 of the forceps operation unit 8. The first operation wire 71 may be formed, for example, of a solid or stranded metal wire. The outer circumferential surface of the first operation wire 71 may be covered with a non-conductive material, etc. The first operation wire 71 is fixed to the first through-hole 522a of the first connecting portion 522 by various known methods, for example, by adhesive bonding or welding.

[0093] The second operation wire 72 is inserted into the forceps sheath 6 so as to be movable back and forth in the longitudinal direction A. As shown in FIGS. 14 and 16 , the distal end of the second operation wire 72 is connected to a second through-hole 532a of a second connecting portion 532 of the second forceps piece 53. When the second operation wire 72 advances toward the distal side A1 in the longitudinal direction A, the distal end of the second operation wire 72 protrudes downward D2 from a groove 503h formed in the connecting portion 503 of the rod 50 provided at the distal end 6a of the forceps sheath 6, causing the second connecting portion 532 to rotate. This causes the second arm portion 530 of the second forceps piece 53 to rotate upward D1 around the connecting pin 54. The proximal end of the second operation wire 72 is fixed to the second slider 83 of the forceps operation unit 8. The second operation wire 72 may be formed, for example, of a solid or stranded metal wire. The outer circumferential surface of the second operation wire 72 may be covered with a non-conductive material, etc. The second operation wire 72 is fixed to the second through-hole 532a of the second connecting portion 532 by various known methods, such as adhesive bonding or welding.

[0094] With the above-described configuration, the first forceps blade 52 and the second forceps blade 53 are opened and closed by advancing and retracting the first operating wire 71 and the second operating wire 72 in the longitudinal direction A.

[0095] 12 , the forceps operation unit 8 is provided on the proximal end side A2 of the forceps sheath 6. The forceps operation unit 8 sandwiches the first operation wire 71 and the second operation wire 72 therebetween and operates the forceps gripping unit 5. The forceps operation unit 8 includes a forceps operation unit main body 81, a first slider 82, a second slider 83, a simultaneous opening / closing assist unit (abutment unit) 84, a forceps rotation unit 85, and a finger hook 86.

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

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

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

[0099] The first slider 82 is attached to the first side portion 813 of the forceps manipulation unit main body 81 so as to be slidable along the longitudinal direction A. The first slider 82 may be attached by being inserted through the first side portion 813, or may be attached by assembling multiple components to the first side portion 813 of the forceps manipulation unit main body 81. The first slider 82 is formed in a generally ring shape on the side D1 above the center of the forceps manipulation unit main body 81, making it easy for the surgeon to hook the fingers thereon. In addition, a proximal end of the first manipulation wire 71 is fixed to the first slider 82. The surgeon advances and retracts the first manipulation wire 71 by advancing and retracting the first slider 82 relative to the forceps manipulation unit main body 81. Specifically, when the first slider 82 advances toward the distal end side A1 along the forceps manipulation unit main body 81 in the longitudinal direction A, the first manipulation wire 71 advances and retracts in tandem toward the distal end side A1 in the longitudinal direction A. As a result, the first forceps piece 52 fixed to the distal end 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 be opened and closed in the opening and closing direction D.

[0100] The second slider 83 is attached to the second side portion 814 of the forceps manipulation unit main body 81 so as to be slidable along the longitudinal direction A. The second slider 83 may be attached by inserting it through the second side portion 814, or by assembling multiple components to the second side portion 814 of the forceps manipulation unit main body 81. The second slider 83 is formed in a generally ring shape on the side D2 below the center of the forceps manipulation unit main body 81, making it easy for the surgeon to hook his or her fingers. The proximal end of the second manipulation wire 72 is fixed to the second slider 83. The surgeon advances and retracts the second manipulation wire 72 by advancing and retracting the second slider 83 relative to the forceps manipulation unit main body 81. Specifically, when the second slider 83 advances toward the distal end side A1 along the forceps manipulation unit main body 81 in the longitudinal direction A, the second manipulation wire 72 advances toward the distal end side A1 in the longitudinal direction A in conjunction with the second slider 83. As a result, the second forceps piece 53 fixed to the distal end 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. Note that 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 / closing assist portion (abutment portion) 84 is attached to the forceps operating portion main body 81, straddling the first side portion 813 and the second side portion 814. The simultaneous opening / closing assist portion 84 is able to come into contact with the base end portion of the first slider 82 and the base end portion of the second slider 83. When the simultaneous opening / closing assist portion 84 is moved toward the distal end side A1 in the longitudinal direction A in the forceps operating portion main body 81, it simultaneously comes into contact with the base end portion of the first slider 82 and the base end portion of the second slider 83, causing the first slider 82 and the second slider 83 to simultaneously slide toward the distal end side A1 in the longitudinal direction A. Then, the simultaneous opening / closing assist portion 84 sandwiches the first slider 82 and the second slider 83 therebetween, allowing the first forceps blade 52 and the second forceps blade 53 to open simultaneously.

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

[0103] The finger hook 86 is a generally ring-shaped finger hook portion formed on the base end side A2 of the forceps operation unit main body 81. The surgeon can retract the grasping forceps 400 to the base end side A2 by holding the finger hook 86 and pulling the grasping forceps 400 toward the base end side A2.

[0104] 19 to 31 , a method of using the medical stapler 100 using the grasping forceps 400 will be described. Specifically, the method will be described of performing a suture treatment on a defect (resection hole) G formed after a full-thickness resection of a lesion formed in the stomach by endoscopic treatment.

[0105] <Marking Step> Figure 19 is a diagram showing the state in which the endoscope 200 is brought close to the lesion. The surgeon or an assistant (hereinafter simply referred to as the "surgeon") inserts the insertion section 210 of the endoscope 200, to which the medical stapler 100 is attached, through a natural orifice, and brings the tip section 211 close to the treatment target T, which is located below the endoscope 200 on the side B2. The surgeon inserts a marking treatment tool, such as a high-frequency knife, into the treatment tool channel 230 using a conventionally known method to mark the periphery of the lesion in the treatment target T. The marking treatment tool may be a high-frequency forceps, a high-frequency snare, a heating element such as a heat probe, an ultrasonic device, or the like. The surgeon presses the blade of the high-frequency knife against the surrounding tissue surrounding the lesion in the treatment target T to cauterize it, thereby forming a pair of markings in the surrounding tissue on both sides of the lesion.

[0106] <Full-thickness resection step> Using a marking treatment instrument, the surgeon performs full-thickness resection of the stomach wall (tissue) M, which includes the mucosal layer M1 and the muscle layer M2 formed on the abdominal cavity side (muscle layer side) P1 of the mucosal layer M1, along the markings. Then, air in the stomach escapes to the abdominal cavity side P1 through a defect (resection hole) 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 Step> Figure 20 is a diagram showing the placement step. The surgeon places the medical stapler 100 attached to the distal end of the endoscope 200 in an approach direction toward the defect G of the treatment target T. Here, the approach direction is the same as the axial direction (longitudinal direction) A of the medical stapler 100. Because the stomach contracts during the full-thickness resection step, the approach direction is a direction along a tangential direction H that is nearly parallel to the surface of the stomach wall M. Note that, when the medical stapler 100 faces the approach direction, the abdominal cavity side (muscular layer side) P1 is in the same direction as the lower side B2 in the up-down direction B. The defect G has a first end Ta at its periphery, which is the end on the proximal side H1 of the tangential direction H. The defect G also has a second end Tb at its periphery, which is the end on the distal side H2 of the tangential direction H.

[0108] Next, with the medical stapler 100 attached to the distal end 211 of the endoscope 200, the surgeon tilts the insertion section 210 so that the distal end 211 of the insertion section 210 faces the defect G in order to observe the treatment target T through the objective lens 215. When the stapler gripper 2 is in the open state, the optical axis A10 of the objective lens 215 passes through the field of view 25, allowing the surgeon to observe the treatment target T by sandwiching the imaging unit of the endoscope 200 between them. However, when the stomach is contracted, it is difficult for the surgeon to adjust the approach direction to a direction perpendicular to the tangential direction H that makes it easy to observe the treatment target T. Therefore, the approach direction remains along the tangential direction H. At the periphery of the defect G, the muscle layer M2 exposed at the first end Ta of the proximal side H1 of the tangential direction H is hidden by the mucosal layer M1. This makes it difficult for the surgeon to accurately visualize the first end Ta. In this state, the surgeon operates the opening / closing operation section 250 of the endoscope 200 to move the opening / closing operation wire 254 forward, thereby bringing the stapler gripping section 2 into an open state.

[0109] <Insertion Step> Figure 21 is a diagram showing the insertion step of the grasping forceps 400. The surgeon inserts the grasping forceps 400 as a retraction treatment instrument into the treatment instrument channel 230. Specifically, the surgeon inserts the grasping forceps 400 toward the treatment instrument channel 230 from the forceps insertion port 222 provided on the distal end side of the operation unit 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 distal end of the grasping forceps 400 into the forceps port 214, which is the distal 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] <Placement Step of Grasping Forceps> In the placement step, the surgeon rotates and places the forceps gripping portion 5 about the longitudinal axis in the longitudinal direction A. The surgeon can easily rotate the forceps gripping portion 5 of the grasping forceps 400, for example, by operating the forceps rotation portion 85 provided on the forceps manipulation unit 8. In this embodiment, the first forceps blade 52 provided on the lower side D2 of the rod 50 in the forceps gripping portion 5 is placed on the lower side B2 in the vertical direction B of the cap 1, as shown in FIGS. 21 to 29 . At this time, the opening / closing direction D is the same as the vertical direction B. The first forceps blade 52 is placed on the abdominal cavity side (muscle layer side) P1, which is the same as the lower side B2 in the vertical direction B. Note that when the opening / closing direction D is the same as the vertical direction B, the axial direction E is the same as the axial direction C. Furthermore, if the first forceps piece 52 has a marker that can be visually identified and distinguished from the second forceps piece 53, the surgeon can easily position the first forceps piece 52 on the abdominal cavity side P1 by sandwiching the imaging unit of the endoscope 200 between them.

[0111] <First Opening / Closing Step> Figure 22 is a diagram showing a first opening / closing step of the grasping forceps 400. As shown in Figure 22, the surgeon opens and closes the first forceps blade 52 near the first end Ta of the defect G, which is the treatment target T. More specifically, the surgeon slides the first slider 82 of the forceps operating unit 8 toward the distal end side A1 in the longitudinal direction A on the forceps operating unit body 81. As a result, the first operating wire 71 fixed to the first slider 82 moves toward the distal end side A1 in the longitudinal direction A within the forceps sheath 6. The distal end of the first operating wire 71 is connected to the first through-hole 522a of the first connecting portion 522. The distal end of the first operating wire 71 protrudes from the groove 503h provided in the connecting portion 503 of the rod 50 toward the upper side D1, rotating the first connecting portion 522. As a result, the first forceps blade 52 rotates toward the lower side D2 around the connecting pin 54. The first forceps blade 52 rotates downward D2 in the opening / closing direction D so as to move away from the distal end side A1 of the rod 50. As a result, the first forceps blade 52 is opened relative to the rod 50.

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

[0113] <Hooking Step> The tip 501 of the rod 50 has a first convex portion 501a on the lower side D2 in the up-down direction D. The surgeon hooks the first convex portion 501a of the tip 501 onto a muscle layer M2 formed on the abdominal cavity side P1 of the mucosal layer M1, thereby engaging the rod 50 with the stomach wall M. The surgeon may rotate the forceps gripping portion 5 during the hooking step.

[0114] <Pulling-up Step> Figure 24 is a diagram showing the pulling-up step of the grasping forceps 400. As shown in Figure 24, the surgeon pulls the rod 50 from the abdominal cavity side P1 to the stomach inner side (mucosal layer side) P2 opposite to the abdominal cavity side P1, with the first convex portion 501a of the tip portion 501 of the rod 50 hooked and locked onto the muscle layer M2 of the first end Ta.

[0115] Here, the protrusion length of the first convex portion 501a protruding to the lower side D2 in the vertical direction D is longer than the protrusion length of the second convex portion 501b protruding to the upper side D1 in the vertical direction D. Therefore, even if the surgeon cannot accurately visually confirm the first end portion Ta on the proximal side H1 of the defect G, the surgeon can easily pull in the first end portion Ta together with the muscle layer M2.

[0116] <First Grasping Step> Figure 25 is a diagram showing the first grasping step of the grasping forceps 400. When the surgeon confirms that the first end Ta, pulled in by the first convex portion 501a of the distal end 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 manipulation unit 8 toward the base end side A2 in the longitudinal direction A in the forceps manipulation unit body 81. This causes the first manipulation wire 71 fixed to the first slider 82 to move toward the base end side A2 in the longitudinal direction A within the forceps sheath 6. The distal end of the first manipulation wire 71 rotates the first connecting portion 522 so as to pull it into the groove 503h provided in the connecting portion 503. This causes the first forceps piece 52 to rotate upward D1 around the connecting pin 54. The first forceps blade 52 rotates upward D1 in the opening / closing direction D so as to approach the distal end side A1 of the rod 50. As a result, the first forceps blade 52 closes relative to the rod 50, and the rod 50 and the first forceps blade 52 grasp the first end Ta of the defect G. At this time, both the muscle layer M2 and the mucosal layer M1 of the first end Ta of the defect G are grasped by the first forceps blade 52 and the rod 50. The surgeon may rotate the forceps gripping portion 5 during the first grasping step. While operating the first slider 82 and the second slider 83 with one hand, the surgeon can easily rotate the forceps rotation portion 85 in the axial direction of the grasping forceps 400 with the other hand that is not operating the sliders. Therefore, even if the stomach wall M of the stomach is in a direction that makes it difficult for the grasping forceps 400 to grasp, the surgeon can rotate the forceps gripping portion 5 to make it easier to grasp.

[0117] <Re-grasping step> After performing the first grasping step, the surgeon can again operate the forceps operating portion 8 in the re-grasping step to rotate the first forceps piece 52 and move the first forceps piece 52 to an open state relative to the rod 50, thereby re-grasping the first end Ta of the defect portion G.

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

[0119] <Second Opening / Closing Step> Figure 26 is a diagram showing a second opening / closing step of the grasping 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 manipulation unit 8 toward the distal end side A1 in the longitudinal direction A on the forceps manipulation unit body 81. As a result, the second manipulation wire 72 fixed to the second slider 83 moves toward the distal end side A1 in the longitudinal direction A within the forceps sheath 6. The distal end of the second manipulation wire 72 is connected to the second through-hole 532a of the second connecting portion 532. The distal end of the second manipulation wire 72 protrudes from the groove 503h provided in the connecting portion 503 of the rod 50 toward the lower side D2, rotating the second connecting portion 532. As a result, the second forceps piece 53 rotates toward the upper side D1 around the connecting pin 54. The second forceps piece 53 rotates upward D1 in the opening / closing direction D so as to move away from the distal end 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 state 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 at a position that allows easy observation using the imaging unit of the endoscope 200. Therefore, the surgeon can easily position the distal end 501 of the rod 50 on the abdominal cavity side P1 of the muscle 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 surgeon can use the rod 50 to lift the muscle layer M2 at the second end Tb of the defect G from the abdominal cavity side P1 to the stomach inner side P2. Note that, similar to the first end Ta, the second end Tb of the defect G may be pulled from the abdominal cavity side P1 to the stomach inner side P2 by the second convex portion 501b of the distal end 501 of the rod 50. Both the muscle 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 is a diagram showing the second grasping step of the grasping forceps 400. Once the surgeon confirms that the second end Tb is positioned between the second forceps blade 53 and the rod 50, the surgeon slides the second slider 83 of the forceps manipulation unit 8 toward the proximal end side A2 in the longitudinal direction A in the forceps manipulation unit body 81. This causes the second manipulation wire 72, fixed to the second slider 83, to move toward the proximal end side A2 in the longitudinal direction A within the forceps sheath 6. The distal end of the second manipulation wire 72 rotates the second connecting portion 532 so as to draw it into the groove 503h provided in the connecting portion 503. This causes the second forceps blade 53 to rotate downward D2 around the connecting pin 54 as the rotation center. The second forceps blade 53 rotates downward D2 in the opening / closing direction D so as to approach the distal end side A1 of the rod 50. As a result, the second forceps piece 53 is closed relative to the rod 50, and the rod 50 and the second forceps piece 53 grasp the second end Tb of the defect G.

[0122] As with the first grasping step, the surgeon may perform a re-grasping step after performing the second grasping step. This re-grasping step allows the surgeon to perform the first grasping step and the second grasping step multiple times. The surgeon may also rotate the forceps gripping portion 5 during the second grasping step.

[0123] <Simultaneous Opening / Closing Step> The surgeon may also perform the first opening / closing step and the second opening / closing step simultaneously. The surgeon moves a simultaneous opening / closing assisting portion (abutting portion) 84 provided on the forceps operating portion 8 toward the distal end side A1 in the longitudinal direction A. The simultaneous opening / closing assisting portion 84 simultaneously abuts against the proximal end portions of the first slider 82 and the second slider 83, thereby simultaneously sliding the first slider 82 and the second slider 83 toward the distal end side A1 in the longitudinal direction A. With this configuration, the simultaneous opening / closing assisting portion 84 can sandwich the first slider 82 and the second slider 83 therebetween, thereby simultaneously opening the first forceps blade 52 and the second forceps blade 53.

[0124] <Retraction Step> Figure 28 is a diagram showing the retraction step. The surgeon holds the finger grip portion 86 of the forceps operating unit 8 and retracts the grasping forceps 400 toward the proximal end. The first forceps piece 52 and the second forceps piece 53 are retracted toward the proximal end while grasping the first end Ta and the second end Tb of the defect (resection hole) G. The surgeon retracts the grasping forceps 400 so that the tip of the grasping forceps 400 is positioned proximal to the staple release unit 3.

[0125] 29 to 31 are views showing the suturing step. The surgeon operates the opening / closing operation unit 250 to retract the opening / closing operation wire 254, thereby closing the stapler gripping portion 2. The surgeon clamps the suture area located in the surrounding tissue outside the defect G relative to the first end Ta and the second end Tb between the staple releasing portion 3 of the first stapler gripping member 21 and the staple receiving portion 4 of the second stapler gripping member 22. The suture area may be marked or otherwise visibly identified by the surgeon.

[0126] 29 , when the stapler gripping portion 2 is in the closed state, the optical axis A10 of the objective lens 215 passes through the upper side B1 of the first stapler gripping member 21 and the second stapler gripping member 22. Therefore, even when the stapler gripping portion 2 is in the closed state, the surgeon can observe the treatment target T by sandwiching the imaging unit of the endoscope 200 therebetween.

[0127] With the sutured portion sandwiched between the staple discharge portion 3 and the staple receiving portion 4, the surgeon operates the discharge operation portion 270 to pull the discharge operation wire 274, thereby ejecting the stored staple S toward the staple receiving portion 4. The needle tip S1 of the staple S penetrates the sutured portion and is bent by contacting the pocket 41 of the staple receiving portion 4. As a result, the sutured portion is sutured.

[0128] If the suturing of the defect G is insufficient, the surgeon may suture other sutured areas. When all suturing is complete, the surgeon completes the suturing procedure using the grasping forceps 400 on the defect G formed after full-thickness resection.

[0129] According to the suturing method of this embodiment, when a full-thickness digestive tract such as the stomach is resected, even if air in the digestive tract escapes to the abdominal cavity side P1, causing the digestive tract to collapse and become deformed, the surgeon can use the grasping forceps 400 to accurately grasp the stomach wall M of the stomach and perform the suturing procedure.

[0130] In this embodiment, the first forceps piece 52 and the second forceps piece 53 of the forceps pieces 51 provided on the forceps gripping portion 5 of the grasping forceps 400 can be opened and closed independently. Therefore, the surgeon can easily grasp the defect G using the grasping forceps 400, and draw the tissue into the base end side A2 of the grasping forceps 400 and suture it.

[0131] In this embodiment, the rod 50 provided on the forceps gripping portion 5 of the grasping 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 distal end portion 501 has a first convex portion 501a that protrudes downward D2 and is longer than the protrusion length of the second convex portion 501b that protrudes upward D1 in the vertical direction D. Therefore, even if the surgeon cannot accurately visually confirm the first end portion Ta on the proximal side H1 of the defect G, the surgeon can easily hook and lock the first convex portion 501a onto the muscle layer M2 of the first end portion Ta from the abdominal cavity side P1. In addition, with the first convex portion 501a hooked and locked onto the muscle layer M2, the surgeon can pull the first end portion Ta together with the muscle layer M2 toward the stomach inner side P2, opposite the abdominal cavity 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 the second protrusion side, with respect to the central axis O3 of the forceps sheath 6. Therefore, even if the protrusion length of the first convex portion 501a is longer than the protrusion length of the second convex portion 501b, the grasping forceps 400 can be manufactured without changing the overall length and size in the opening / closing direction D.

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

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

[0136] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and modified examples can be configured by appropriately combining them.

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

[0138] Fig. 32 is an enlarged view of the distal end side A1 of the grasping forceps. Fig. 33 is a side view showing the grasping forceps with the first forceps piece 52A in the open state and the second forceps piece 53 in the closed state.

[0139] As shown in Fig. 32 , the forceps gripping portion 5A of the grasping forceps (endoscopic treatment tool) according to the second embodiment of the present invention includes a rod 50A, forceps jaws 51, and a connecting pin 54. The rod 50A also includes a distal end portion 501A (see Fig. 33 ) of a load section 500A, a rod-shaped portion 502, and a connecting portion 503. The forceps jaws 51 include a first forceps jaw 52A and a second forceps jaw 53.

[0140] As shown in Fig. 33 , compared to the first embodiment, the tip portion 501A is formed symmetrically with respect to the central axis of the rod-shaped portion 502A in the longitudinal direction A. Furthermore, as shown in Fig. 33 , the tip portion 501A includes an anchor (first convex portion) 55 that extends from the tip portion 501A to a lower side (first protruding side) B2 in the up-down direction (protruding direction) B when the first forceps blade 52A of the forceps blade 51 is in an open state with respect 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, as in the first embodiment.

[0141] The anchor (first convex portion) 55 is a rod-shaped member to which the fixed end of the anchor 55 is connected at the center of the distal end portion 501A. As shown in Fig. 32, the anchor 55 has a fixing pin (fixing portion) 55b at the fixed end. The anchor 55 is rotatable around the fixing pin 55b toward the base end side A2 in the longitudinal direction A relative to the distal end portion 501A. The anchor 55 also has a convex portion wire 73A.

[0142] One end of the protrusion wire 73A is connected to the movable end side, which is closer to the fixed end of the anchor 55 than the fixing pin 55b. The other end of the protrusion wire 73A is connected to a first operation wire (first wire) 71 that is connected to the first connecting portion 522 of the first forceps piece 52A. When the first operation wire 71 moves forward or backward in the longitudinal direction A, the protrusion wire 73A moves forward or backward along the longitudinal direction A in conjunction with the first operation wire 71.

[0143] 33 , when the convex wire 73A advances toward the distal end side A1 in the longitudinal direction A in conjunction with the first operating wire 71, the anchor 55 rotates about the fixing pin 55b, causing the distal end 55a to protrude downward D2 beyond the distal end 501A. When the first forceps blade 52A of the forceps blade 51 is in an open state with respect to the rod 50A, the anchor 55 protrudes from the distal end 501A toward the first forceps blade 52A provided on the lower side D2 in the vertical direction D. At this time, the distal end 501A of the rod 50A includes the anchor (first convex portion) 55 protruding downward D2 by a length longer than the protruding length of the second convex portion 501b protruding upward D1 in the vertical direction D.

[0144] 32 , when the convex wire 73A moves toward the base end side A2 along the longitudinal direction A in conjunction with the first operating wire 71, the anchor 55 rotates so that the tip portion 55a is retracted toward the base end side A2. When the first forceps piece 52A of the forceps piece 51 is in a closed state with respect to the rod 50A, the anchor 55 is folded between the first forceps piece 52A and the rod 50A with the tip portion 55a facing the base end side A2.

[0145] Compared to the first forceps blade 52 of the first embodiment, the first forceps blade 52A has a marker that allows it to be visually distinguished from the second forceps blade 53. In this embodiment, the first forceps blade 52A has a different color from the second forceps blade 53. Note that the first forceps blade 52A may have any color as long as it is visually distinguishable from the second forceps blade 53, and may have, for example, a pattern or a different shape.

[0146] In this embodiment, as in the first embodiment described above, the tip 501A of the rod 50A is equipped with an anchor (first convex portion) 55, so that even if the surgeon cannot accurately visualize the first end Ta on the proximal side H1 of the defect G, the surgeon can hook and engage the anchor 55 from the abdominal cavity side P1 of the muscle layer of the first end Ta, and then pull the muscle layer M2 together toward the inner side of the stomach P2.

[0147] In addition, in this embodiment, when the first forceps piece 52A of the forceps piece 51 is in a closed state with respect to the rod 50A, the anchor 55 is folded between the first forceps piece 52A and the rod 50A. Therefore, the anchor 55 does not interfere when the first forceps piece 52A is closed with respect to the rod 50A.

[0148] Furthermore, in this embodiment, the first forceps piece 52A has a marker that can be visually identified to distinguish it from the second forceps piece 53. Therefore, when the surgeon operates the grasping forceps with the imaging unit of the endoscope 200 sandwiched therebetween, the surgeon can easily confirm that the first forceps piece 52A opens and closes on the lower side D1 where the anchor 55 is arranged relative to the rod 50A.

[0149] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0150] Third Embodiment Next, a third embodiment of the present invention will be described with reference to Figures 34 and 35. In this embodiment, the forceps gripping portion of the grasping forceps is different from that of the first embodiment. Therefore, the following description will focus on the differences from the first embodiment.

[0151] Fig. 34 is an enlarged view of the distal end side A1 of the grasping forceps. Fig. 33 is a side view showing the grasping forceps in a state where the first forceps piece 52 is in an open state and the second forceps piece 53B is in an open state.

[0152] 34 , a forceps gripping portion 5B of a grasping forceps (endoscopic treatment tool) according to the second embodiment of the present invention includes a rod 50B, forceps jaws 51B, and a connecting pin 54. The rod 50B also includes a tip portion 501B and a rod-shaped portion 502B of a loading portion 500B, and a connecting portion 503.

[0153] 34 and 35 , compared to the first embodiment, the tip portion 501B is formed in a substantially triangular shape so as to taper toward the tip side A1 in the longitudinal direction A. The tip portion 501B also includes a second convex portion 501Bb that protrudes toward the upper side D1 in the vertical direction D, and a first convex portion 501Ba that protrudes toward the lower side D2 in the vertical direction D and has a longer protrusion length than the second convex portion 501Bb.

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

[0155] The length of the second forceps piece 53B of the forceps piece 51B in the longitudinal direction A 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 state relative to the rod 50B, it fits into a second recess 502Bg provided in the rod-shaped portion 502B.

[0156] In this embodiment, when the first forceps blade 52 of the forceps blade 51B is in a closed state relative to the rod 50B, the engaging portion 521 fits into the first recess 502Bh. Furthermore, when the second forceps blade 53B is in a closed state relative to the rod 50A, the engaging portion 521 fits into the second recess 502Bg provided in the rod-shaped portion 502B. Therefore, the width and thickness of the grasping forceps in the up-down direction D and the width direction E can be made as small as possible, making it easier to perform suturing treatment on even a small defect (resection hole) G.

[0157] Although the third embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0158] (Modification) The tip portion provided on the rod of the grasping forceps according to the above-described embodiment may be formed so that the tip faces the base end in the longitudinal direction. For example, as shown in Fig. 36 , the rod 50C of the forceps gripping portion 5C includes a tip portion 501C provided on a loading portion 500C. Compared to the first convex portion 501Ba of the third embodiment, the first convex portion 501Ca of the tip portion 501C is formed so that the tip faces the base end side A2 in the longitudinal direction A. This configuration makes it easier for the first convex portion 501Ca of the tip portion 501C to hook onto biological tissue.

[0159] Furthermore, the thickness of the forceps pieces of the grasping forceps according to the above-described embodiment is not particularly limited. For example, as shown in Fig. 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, the grasping forceps can be formed with even smaller widths and thicknesses in the up-down direction D and width direction E when the forceps pieces are in a closed state relative to the rod.

[0160] 37 , the rod 50D of the grasping forceps according to the embodiment described above may have a recess 501Dh recessed toward the distal end side A1 in the longitudinal direction A on a surface (hooking surface) provided on the base end side A2 in the longitudinal direction A of the first convex portion 501Da of the distal end portion 501D provided on the loading section 500D. With this configuration, after the first convex portion 501Da is hooked onto the muscle layer at the first end Ta, tissue can be allowed to enter the recess 501Dh, making it difficult for the first convex portion 501Da to come off.

[0161] 38 , compared to the protrusion wire 73E of the third embodiment, the other end of the protrusion wire 73E of the rod 50E of the grasping forceps according to the above-described embodiment may be connected to the first connecting portion 522 of the first forceps piece 52. Even in this configuration, when the first operating wire 71 advances or retreats in the longitudinal direction A, the first connecting portion 522 rotates, and the protrusion wire 73E can advance or retreat 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 may not have the protruding wire 73A by being made elastic when moving upward from a downwardly protruding state. Even in this case, the surgeon can hook and lock the anchor 55 from the abdominal cavity side of the muscle layer and pull the muscle layer toward the inside of the stomach. Furthermore, when the first forceps blade of the forceps blade changes from an open state to a closed state relative to the rod, the anchor 55 is pushed upward, so that it can be folded between the first forceps blade and the rod.

[0163] In any of the above-described embodiments, the grasping forceps and suturing method of the present invention make it possible to reliably grasp the mucosal layer and muscle layer around the edge of the resection hole, and to suture the resection hole using the grasping forceps.

[0164] DESCRIPTION OF SYMBOLS 1...Cap (attachment member) 2...Staple gripping portion 3...Staple discharge portion 4...Staple receiving portion 21...First stapler gripping member 22...Second stapler gripping member 25...Field of view space (through space) 100...Medical stapler 200...Endoscope 211...Tip portion 212...Tip portion 214...Forceps port 215...Objective lens 300...Medical system 400...Grabbing forceps (endoscopic treatment tool) 5 (5A, 5B, 5C)...Forceps gripping portion 50 (50A, 50B, 50C, 50D, 50E, 50F)...Rod 500 (500A, 500B, 500C, 500D, 500F)...Load portion 501 (501A, 501B, 501C, 501D, 501F)...Tip portion DESCRIPTION OF THE SYMBOLS 501a (501Ba, 501Ca, 501Da)...First convex portion 501b...Second convex portion 501Dh...Concave portion 502 (502A, 502B)...Rod-shaped portion 51 (51B)...Forceps blade (jaw) 52 (52A, 52C)...First forceps blade (first jaw) 53 (52B, 52C)...Second forceps blade (second jaw) 55...Anchor (first convex portion) 55a...Fixing pin (fixing portion) 6...Forceps sheath (sheath) 7...Forceps operating wire 71...First operating wire (first wire) 72...Second operating wire 73E...Concave wire 8...Forceps operating portion 82...First slider 83...Second slider 84...Simultaneous opening and closing assist portion (abutment portion) S...Staple T...Treatment target G...Defective portion M...Stomach wall (tissue) M1...Mucosa layer M2...Muscular layer

Claims

1. a longitudinally extending sheath; a gripping portion including a rod provided at a tip of the sheath and extending in the longitudinal direction, a first jaw connected to a base end side of the rod and adapted to open and close toward the tip side of the rod, and a second jaw connected to the base end side of the rod on the opposite side of the first jaw across the rod and adapted to open and close toward the tip side of the rod; Equipped with the rod has a tip end portion provided with a first protrusion portion protruding toward the first jaw on a first protruding side, The first protrusion has a fixing portion that is provided on a fixed end side of the first protrusion and is connected to the rod, and is rotatable around the fixing portion toward the base end side in the longitudinal direction. Grasping forceps.

2. The central axis of the rod in the longitudinal direction is offset from the central axis of the sheath in the longitudinal direction to a side opposite to the first protruding side. The grasping forceps according to claim 1 .

3. The first protrusion further includes a protrusion wire, one end of which is connected to a movable end side that is opposite to the fixed end side relative to the fixed portion, and the other end of which is connected to the first jaw, The protrusion wire rotates the first protrusion in conjunction with the first jaw. The grasping forceps according to claim 1 .

4. A first wire that connects the first jaw so as to be able to open and close and moves back and forth in the longitudinal direction; a protrusion wire having one end connected to a movable end side of the fixed portion opposite to the fixed end side in the first protrusion and the other end connected to the first wire; Further equipped with The convex portion wire rotates the first convex portion in conjunction with the first wire. The grasping forceps according to claim 1 .

5. a longitudinally extending sheath; a gripping portion including a rod provided at a tip of the sheath and extending in the longitudinal direction, a first jaw connected to a base end side of the rod and adapted to open and close toward the tip side of the rod, and a second jaw connected to the base end side of the rod on the opposite side of the first jaw across the rod and adapted to open and close toward the tip side of the rod; Equipped with the rod has a first protrusion at the tip end thereof protruding toward the first jaw on a first protruding side, The central axis of the rod in the longitudinal direction is offset from the central axis of the sheath in the longitudinal direction toward a second protruding side opposite to the first protruding side. Grasping forceps.

6. The first jaw has a marker that is visually distinguishable from the second jaw. The grasping forceps according to claim 5.

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

8. The first protrusion further includes a protrusion wire, one end of which is connected to a movable end side that is opposite to the fixed end side relative to the fixed portion, and the other end of which is connected to the first jaw, The protrusion wire rotates the first protrusion in conjunction with the first jaw. The grasping forceps according to claim 7.

9. A first wire that connects the first jaw so as to be able to open and close and moves back and forth in the longitudinal direction; a protrusion wire having one end connected to a movable end side of the fixed portion opposite to the fixed end side in the first protrusion and the other end connected to the first wire; Further equipped with The convex portion wire rotates the first convex portion in conjunction with the first wire. The grasping forceps according to claim 7.