Endoscopic suturing device

Abstract

This endoscopic suturing device is provided at a distal end of a tubular insertion part of an endoscope. The endoscopic suturing device has a pair of arm parts each having, on one end of the arms, a holding part for a suture needle. The endoscopic suturing device is configured to be capable of switching the arm part that holds the suture needle, when suturing a tissue by opening and closing one end of the arm. Each of the arm parts includes: a lock switching member that is configured to be able to advance and retreat with respect to a lock position on the one end of the arm in the arm part; a spring member that biases the lock switching member toward the lock position; and an operation wire that is disposed along the tubular insertion part and that retracts the lock switching member from the lock position by pulling the lock switching member toward a proximal with respect to a device body part. In each arm part, the suture needle is fixed to the holding part when the lock switching member is in the lock position, and the fixation of the suture needle in the holding part is released when the lock switching member is retracted from the lock position.

Description

Endoscopic suturing device

[0001] The present invention relates to an endoscopic suturing device.

[0002] Conventionally, a technique for suturing an incision under an endoscope to reduce the risk of complications after incision has been known, and an endoscopic suturing device for suturing an incision under an endoscope has also been proposed. For example, Patent Document 1 discloses a suturing device that has a pair of arms that hold a suture needle at their tip, and that performs suturing by switching the arm that holds the suture needle when opening and closing.

[0003] Japanese Patent Application Laid-Open No. 2019-107442

[0004] In this type of endoscopic suturing device, the distal suturing device is operated via a long wire from an operating section provided on the proximal side of the endoscope. The force transmission via the wire is relatively good when pulling the proximal side, but when applying a force to push the wire distally, the force transmission to the distal side decreases due to bending of the wire, etc. This makes it relatively difficult to fix the suture needle to the arm section.

[0005] The present invention has been made in consideration of the above situation, and aims to provide an endoscopic suturing device that can more reliably fix a suture needle to an arm portion while using a wire for operation.

[0006] One aspect of the present invention is an endoscopic suturing device provided at the distal end of a tubular insertion section of an endoscope. The endoscopic suturing device has a pair of arms, each having a suture needle holder at one end of the arm, and is configured to switch the arm that holds the suture needle when opening and closing the one end of the arm to suture tissue. Each arm has a lock switching member configured to be able to move forward and backward within the arm to a locked position at the arm end, a spring member that biases the lock switching member toward the locked position, and an operating line disposed along the tubular insertion section that retracts the lock switching member from the locked position when pulled proximally relative to the device main body. In each arm, the suture needle is fixed to the holding member when the lock switching member is in the locked position, and the fixation of the suture needle to the holding member is released when the lock switching member is retracted from the locked position.

[0007] According to one aspect of the present invention, an endoscopic suturing device can be provided that can more reliably fix a suturing needle to an arm portion while using a wire for operation.

[0008] 11 is a perspective view schematically showing an example of a suturing device according to the first embodiment. FIG. 12 is a plan view of the suturing device of FIG. 1. FIG. 13 is a side view of the suturing device of FIG. 1. FIG. 14 is a view showing an example of the configuration of an opening and closing mechanism of the first embodiment. FIG. 15 is a view showing an example of the configuration of an opening and closing mechanism of the first embodiment. FIG. 16 is a view showing an example of the configuration of an opening and closing mechanism of the first embodiment. FIG. 17 is a view showing an example of the configuration of an opening and closing mechanism of the fifth embodiment. FIG. 18 is a view showing an example of the configuration of an opening and closing mechanism of the fifth embodiment. Fig. 10 is a diagram showing a configuration example of an opening and closing mechanism part of a sixth embodiment; Fig. 11 is a diagram showing a configuration example of an opening and closing mechanism part of a seventh embodiment; Fig. 12 is a diagram showing a configuration example of an opening and closing mechanism part of an eighth embodiment; Fig. 13 is a diagram showing a configuration example of an opening and closing mechanism part of a ninth embodiment; Fig. 14 is a diagram showing the opening and closing mechanism part of the ninth embodiment as seen from the proximal side; Fig. 15 is a side view of a modified example of the suturing device;

[0009] Hereinafter, an example of the configuration of an endoscopic suturing device (hereinafter also referred to as a suturing device) according to an embodiment will be described with reference to the drawings. Note that the shapes, dimensions, etc. of each part in the drawings are shown schematically and do not represent the actual shapes, dimensions, etc.

[0010] In the following description, the side of the endoscope farther from the operator will be referred to as the distal side, and the side closer to the operator will be referred to as the proximal side. In the drawings, the longitudinal direction (axial direction) of the endoscope is indicated by the arrow Ax as appropriate. Furthermore, the direction approximately perpendicular to the longitudinal direction will be defined as the radial direction, and the rotational direction around the longitudinal direction will be defined as the circumferential direction.

[0011] (First embodiment) Fig. 1 is a perspective view schematically showing an example of a suturing device according to a first embodiment. Fig. 2 is a plan view of the suturing device of Fig. 1. Fig. 3 is a side view of the suturing device of Fig. 1.

[0012] The suturing device 1 is detachably provided at the distal end of a tubular insertion section 2 of an endoscope that is inserted into a biological lumen. Because the suturing device 1 is detachable from the tubular insertion section 2 of the endoscope, maintenance such as replacement and sterilization is easy. The suturing device 1 may also be supplied as a disposable product.

[0013] For example, an endoscope is a flexible scope having a bendable tubular insertion section 2, which is operated by an operator from the proximal side. An objective lens 3 of an imaging section, an illumination section 4, and a forceps port 5 are provided at the distal end of the tubular insertion section 2 of the endoscope.

[0014] The endoscope captures images of the inside of a living lumen using an imaging unit via a wide-angle objective lens 3, and can display and output the images of the inside of the living lumen in real time on a display device (not shown). The illumination unit 4 illuminates the inside of the living lumen with light guided from a light source via an optical fiber. The forceps opening 5 is provided for inserting and removing treatment tools such as forceps 6 and for collecting living tissue with the treatment tools. As shown in Figure 3, the endoscope allows the forceps 6 to be moved longitudinally through the forceps opening 5 of the tubular insertion section 2 to grasp living tissue with the forceps 6.

[0015] The suturing device 1 includes an attachment section 11, a pair of arms consisting of a first arm section 12 and a second arm section 13, an opening / closing mechanism section 14, an opening / closing wire 15, and operating wires 16a and 16b. The attachment section 11, the first arm section 12, the second arm section 13, and the opening / closing mechanism section 14 are disposed at the distal end of the tubular insertion section 2.

[0016] The first arm 12 and the second arm 13 each have a holder 18 at their distal end that holds the suture needle 17. Furthermore, the first arm 12 and the second arm 13 each have an internal needle fixing mechanism 30 that can switch between a locked state in which the suture needle 17 is fixed to the holder 18 and an unlocked state in which the suture needle 17 is not fixed to the holder 18. The configuration of the needle fixing mechanism 30 will be described later.

[0017] The attachment portion 11 is an annular member that corresponds to the outer diameter of the tubular insertion portion 2. The distal end of the tubular insertion portion 2 is detachably inserted into the inside of the attachment portion 11 and is held by the attachment portion 11. In addition, a first arm portion 12 and a second arm portion 13 are attached to the outer periphery of the attachment portion 11 via an opening / closing mechanism portion 14.

[0018] The first arm 12 and the second arm 13 are supported by the opening / closing mechanism 14 in a V-shape so as to protrude distally from the attachment portion 11, and can be opened and closed in a direction approximately parallel to the tangent direction of the outer periphery of the endoscope. As shown in Fig. 3, when the suturing device 1 is attached to the tubular insertion portion 2, the tips of the first arm 12 and the second arm 13 are located distally of the tubular insertion portion 2. Also, as shown in Fig. 3, the tips of the arms are located on the line of movement of the forceps 6 when the arms are closed.

[0019] The first arm 12 and the second arm 13 are mounted with their distal ends tilted radially inward relative to their proximal ends. For example, each arm may be mounted tilted radially inward from a position substantially parallel to the longitudinal direction by 0.5° to 50°, more preferably 3° to 35°. Mounting each arm with an inward tilt reduces interference between the suturing device 1 and objects on the radially outer side, improving the ease of insertion of the endoscope into an overtube or the body. Mounting each arm with an inward tilt also brings the tip of each arm closer to the center of the field of view of the endoscope's imaging unit, improving visibility during suturing. Furthermore, even if the endoscope moves, is positioned at a bend, or the arm position shifts slightly after insertion, the arm is more likely to be centered in the field of view, making it easier to view the entire arm under the endoscope.

[0020] Furthermore, the holding section 18 provided at the tip of each arm section is positioned within a 100% range from the center of the field of view of the imaging section of the endoscope. Specifically, when the field of view of the imaging section is θ1 and the range from the center of the field of view where the tip of each arm section is positioned is θ2, using the distal end of the tubular insertion section 2 as a reference, θ2 is preferably within 90% of θ1, more preferably within 80% of θ1, and particularly preferably within 70% of θ1. By positioning the tip of each arm section under the above conditions, it is possible to prevent the suturing point from being outside the field of view of the imaging section and to prevent visibility during suturing from being reduced due to the influence of aberrations in the imaging section.

[0021] Furthermore, when performing suturing by wrapping a large amount of biological tissue, such as in full-thickness suturing, it becomes necessary to sufficiently draw the biological tissue to be sutured toward the endoscope using the forceps 6 of the endoscope. Therefore, a certain amount of margin is required in the longitudinal dimension from the distal end of the tubular insertion portion 2 to the holding portion 18.

[0022] From this perspective, for example, the longitudinal dimension from the distal end of the tubular insertion section 2 to the tip of each arm section is preferably, for example, 1 mm to 80 mm, and more preferably 3 mm to 60 mm. For example, by making the distance from the distal end of the tubular insertion section 2 to the tip of each arm section 3 mm or more, the tips of the arms come into the field of view of the endoscope, making suturing under the endoscope easier. Furthermore, by making the distance from the distal end of the tubular insertion section 2 to the tip of each arm section 60 mm or less, it becomes easier to insert the tips of the arms without them getting caught on the overtube.

[0023] The opening and closing wire 15 is disposed in the longitudinal direction along the tubular insertion section 2, and its distal side is connected to the opening and closing mechanism 14. In the suturing device 1, by pulling the opening and closing wire 15 proximally, the first arm 12 and the second arm 13 that hold the suture needle 17 can be opened and closed via the opening and closing mechanism 14.

[0024] The operating wire 16a is disposed in the longitudinal direction along the tubular insertion section 2, and its distal side is connected to the needle fixing mechanism 30 of the first arm section 12. By pulling the operating wire 16a proximally, the needle fixing mechanism 30 of the first arm section 12 is activated, and it is possible to switch between a locked state in which the suture needle 17 is fixed by the holding section 18 of the first arm section 12 and a released state.

[0025] The operating wire 16b is disposed in the longitudinal direction along the tubular insertion section 2, and its distal side is connected to the needle fixing mechanism 30 of the second arm section 13. By pulling the operating wire 16b proximally, the needle fixing mechanism 30 of the second arm section 13 is activated, and it is possible to switch between a locked state in which the suture needle 17 is fixed by the holding section 18 of the second arm section 13 and a released state.

[0026] The above-mentioned opening / closing wire 15 and operating wires 16a, 16b can be operated independently. By operating the opening / closing mechanism 14 and the needle fixing mechanism 30 using separate wires, precise operation of the suturing device 1 is possible. Furthermore, the needle fixing mechanisms 30 of the first arm 12 and the second arm 13 can be operated separately using different operating wires 16a, 16b. Therefore, compared to a configuration in which the needle fixing mechanisms of both arms are linked, the suturing device 1 of this embodiment makes it possible to recover if the needle lock on one arm fails by re-operating the needle fixing mechanism on the same side.

[0027] The mounting portion 11, the first arm portion 12, the second arm portion 13, and the opening / closing mechanism portion 14 may be made of a biocompatible metal, such as stainless steel, titanium, or nitinol. The opening / closing wire 15 and the operating wires 16a and 16b may be made of a thin metal wire, such as stainless steel, titanium, copper, or nitinol, or a thin polymer fiber wire, a fluorine tube, polyethylene, polypropylene, or nylon. The opening / closing wire 15 and the operating wires 16a and 16b may be made of the same material or different materials.

[0028] 4 is a diagram schematically illustrating an example of the configuration of the opening / closing mechanism 14 according to the first embodiment. The opening / closing mechanism 14 is not limited to the configuration shown in FIG. 4 and may be configured using other mechanisms that can be opened and closed by pulling the opening / closing wire 15.

[0029] The opening / closing mechanism 14 of the first embodiment is a link mechanism that drives the first arm 12 and the second arm 13, and includes a main body 21, a driving link 22, a first intermediate link 23, and a second intermediate link 24. The link mechanism of the opening / closing mechanism 14 is symmetrical on a plane based on the central axis C. Note that the central axis C includes a component that is inclined radially with respect to the longitudinal direction of the tubular insertion section 2.

[0030] The main body 21 is a thin box-shaped housing that rotatably supports the first arm 12 and the second arm 13 and houses the elements of the link mechanism. The main body 21 also functions as a cover that encloses the elements of the link mechanism. Covering the link mechanism with the main body 21 reduces the possibility of malfunction of the link mechanism due to tangled sutures or adhesion of body fluids, etc. In Figure 4, the main body 21 is drawn as a flat plate to make it easier to understand the structure of the opening / closing mechanism 14.

[0031] The overall shape of the main body 21 is formed into a trapezoid shape in which the distal side is longer than the proximal side, and the proximal side of the main body 21 is fixed to the attachment portion 11. As described above, the main body 21 is fixed to the attachment portion 11 so that the distal side is inclined radially inward (toward the depth of the paper in FIG. 4 ) relative to the proximal side.

[0032] Furthermore, on the distal side of the main body 21, a first arm 12 is attached to one end (left side in FIG. 4 ), and a second arm 13 is attached to the other end (right side in FIG. 4 ) spaced apart from the first arm 12. The base end of the first arm 12 is rotatably supported by the main body 21 via a first support shaft 25. The base end of the second arm 13 is rotatably supported by the main body 21 via a second support shaft 26. The first arm 12 and the second arm 13 are biased in the opening direction by a spring (not shown).

[0033] The driver 22 is a long, slender rectangular member, and is disposed within the main body 21 along the central axis C. The opening and closing wire 15 is connected to the proximal end of the driver 22. The proximal end of the first intermediate link 23 and the proximal end of the second intermediate link 24 are connected to the distal end of the driver 22. The driver 22 slides within the main body 22 along the central axis C when pulled by the opening and closing wire 15, thereby displacing relatively in the longitudinal direction of the tubular insertion section 2.

[0034] The first intermediate link 23 and the second intermediate link 24 are each an elongated rectangular member. The proximal end of the first intermediate link 23 and the proximal end of the second intermediate link 24 are both rotatably supported on the distal end of the driver link 22 by a pin 22a.

[0035] The distal end of the first intermediate link 23 is rotatably connected to the first arm 12 via a pin 27. The pin 27 of the first arm 12 is located between the tip of the arm and the first support shaft 25, and is closer to the first support shaft 25 than the tip of the arm.

[0036] Similarly, the distal end of the second intermediate link 24 is rotatably connected to the second arm 13 via a pin 28. The position of the pin 28 of the second arm 13 is located between the tip of the arm and the second support shaft 26, and is closer to the second support shaft 26 than the tip of the arm.

[0037] As described above, the first arm 12 and the second arm 13 are biased in the opening direction by the force of a spring (not shown). When the opening / closing wire 15 is not being pulled, no force acts on the first arm 12 or the second arm 13 in the closing direction, and therefore the arms of the suturing device 1 remain in the open state (FIG. 4(a)).

[0038] When the opening / closing wire 15 is pulled from the above state, the driver 22 of the opening / closing mechanism 14 is displaced proximally in the longitudinal direction. As a result, the positions of the proximal end of the first intermediate link 23 and the proximal end of the second intermediate link 24 move proximally in accordance with the displacement of the driver 22, and the first intermediate link 23 and the second intermediate link 24 are retracted proximally.

[0039] The first arm 12, which is rotatably supported by the main body 21 via the first support shaft 25, rotates in the closing direction around the first support shaft 25 due to displacement of the first intermediate link 23. Similarly, the second arm 13, which is rotatably supported by the main body 21 via the second support shaft 26, rotates in the closing direction around the second support shaft 26 due to displacement of the second intermediate link 24. In this way, the arm of the suturing device 1 changes from an open state to a closed state due to pulling of the opening / closing wire 15 ( FIG. 4( b) ).

[0040] The opening / closing mechanism 14 shown in Figure 4 directly transmits the movement of the opening / closing wire 15 to the arm via a link mechanism, and can convert the displacement of the driver 22 caused by the traction of the opening / closing wire 15 into opening and closing movement at the tip of the arm. Therefore, the opening / closing mechanism 14 can open and close the arm with a strong force while suppressing loss of force, thereby realizing a suturing device 1 suitable for full-thickness suturing, for example. Furthermore, the opening / closing mechanism 14 can switch between opening and closing the arm with a simple operation by traction of the opening / closing wire 15.

[0041] Next, an example of the configuration of the needle fixing mechanism 30 of the first embodiment will be described with reference to Figures 5 to 10. Note that the configuration of the arm portion and the needle fixing mechanism is common to the first arm portion 12 and the second arm portion 13. Therefore, in the following explanation, the configuration of the first arm portion 12 will be described, and a duplicated explanation of the configuration of the second arm portion 13 will be omitted.

[0042] A holder 18 for the suture needle 17 is provided on the inner surface of the tip (distal end) of the first arm 12. The holder 18 is a hole opened on the inner surface of the first arm 12, and can accommodate one end of the suture needle 17 inserted into the first arm 12.

[0043] Here, suture needle 17 has needle tips 17a formed on both ends and a hole (not shown) in the center for threading a suture thread. In addition, on both sides of suture needle 17, at positions inward of needle tips 17a, there are formed constricted grooves 17b that extend in a direction intersecting the extension direction of suture needle 17 and are recessed in a circular shape in the circumferential direction.

[0044] Needle fixing mechanism 30 is assembled using first arm 12 as a casing, and includes lock switching member 31, spring member 32, and operating wire 16a. First arm 12 also includes stopper 33 and spring seat 34 therein.

[0045] The lock switching member 31 is a member arranged in a distal end region within the first arm portion 12 so as to be able to advance and retreat along the extension direction of the first arm portion 12. As shown in Figures 5 and 7 , the lock switching member 31 has a rectangular pillar-shaped main body portion 40 and a needle support portion 41 extending distally from the main body portion 40. The thickness of the needle support portion 41 in the insertion / removal direction of the suture needle 17 is smaller than the thickness of the main body portion 40. A step 40a is formed on the distal side of the main body portion 40, protruding outward in the insertion / removal direction of the suture needle 17. In addition, an inclined portion 42 whose thickness decreases distally is formed at the connection portion between the main body portion 40 and the needle support portion 41.

[0046] As shown in Figure 6, the needle support part 41 on the tip side of the lock switching member 31 is formed with an engagement part 43 that engages with the groove 17b of the suture needle 17. The engagement part 43 is formed in the shape of a slit by cutting out the central part of the needle support part 41 in the width direction that intersects the extension direction of the first arm part 12 and the insertion / removal direction of the suture needle 17. The cutout width of the engagement part 43 is formed to be larger than the diameter of the groove 17b of the suture needle 17 and smaller than the outer diameter of the suture needle 17. Furthermore, the thickness of the engagement part 43 in the insertion / removal direction of the suture needle 17 is formed to be smaller than the width of the groove 17b of the suture needle 17.

[0047] As shown in Figure 6(b), when the lock switching member 31 is located on the distal end side of the first arm portion 12, the engaging portion 43 of the needle support portion 41 can be inserted into and engaged with the groove 17b of the suture needle 17 housed in the holding portion 18. When the needle support portion 41 is inserted into the groove 17b of the suture needle 17, the outer periphery of the suture needle 17 interferes with the needle support portion 41, and movement of the suture needle 17 is restricted by the lock switching member 31. As a result, when the lock switching member 31 is located on the distal end side of the first arm portion 12, the lock switching member 31 fixes the suture needle 17 to the holding portion 18. Hereinafter, the position of the lock switching member 31 when the suture needle 17 is fixed to the holding portion 18 will also be referred to as the locked position.

[0048] As described above, by forming the needle support portion 41 thinner than the main body portion 40 on the distal end side of the lock switching member 31, the suture needle 17 can be easily engaged with the engaging portion 43. Furthermore, because the weight of the lock switching member 31 is lighter, the force of the spring member 32, which will be described later, is less likely to be lost, making it easier to quickly and smoothly lock the needle fixing mechanism 30. Furthermore, the main body portion 40 on the proximal side functions as a guide within the arm portion, which can also prevent the lock switching member 31 from rattling in the insertion / removal direction of the suture needle 17.

[0049] On the other hand, when the lock switching member 31 is retracted from the locked position to the proximal side, the engagement between the engaging portion 43 of the needle support portion 41 and the groove 17b of the suture needle 17 is released, allowing the suture needle 17 to move freely in the insertion / removal direction. As a result, when the lock switching member 31 is retracted from the locked position, the fixation of the suture needle 17 by the holding portion 18 is released.

[0050] 7, stopper portion 33 of first arm portion 12 is disposed opposite lock switching member 31 on the tip side of first arm portion 12, and is formed in a shape corresponding to the distal side of lock switching member 31. Stopper portion 33 has a first portion 33a that abuts against step 40a and inclined portion 42 of main body portion 40, and a second portion 33b that houses needle support portion 41 in the locked position.

[0051] The first portion 33a of the stopper portion 33 abuts against the step 40a and inclined portion 42 of the main body portion 40 proximal to the holding portion 18, positioning the lock switching member 31 in the locked position. The second portion 33b of the stopper portion 33 has a space longer than the dimension of the needle support portion 41 in the extension direction of the first arm portion 12. Therefore, when the lock switching member 31 is in the locked position, the tip of the needle support portion 41, which has the engaging portion 43, does not come into contact with the wall surface distal to the second portion 33b.

[0052] 8, the main body 40 of the lock switching member 31 has a cylindrical notch 40b formed at its proximal end, the notch 40b having an inner diameter large enough to insert the spring member 32. The notch 40b of the main body 40 is an example of a positioning portion, and engages with the distal side of the spring member 32 to prevent malfunctions due to misalignment between the lock switching member 31 and the spring member 32. The distal end of the operating wire 16a is fixed to the center of the notch 40b of the main body 40. This allows the lock switching member 31 to be pulled proximally via the operating wire 16a, thereby retracting the lock switching member 31 from the locked position.

[0053] The spring member 32 is arranged to be expandable and contractible along the extension direction of the first arm portion 12, and biases the lock switching member 31 toward the locked position. As a result, a force is applied to the lock switching member 31 by the spring member 32 in the distal direction.

[0054] The spring member 32 is formed of a compression spring whose proximal side is supported by the spring seat 34 and whose distal side engages with the notch 40b of the main body 40. Furthermore, an operating wire 16a is disposed concentrically with the spring member 32 at the center of the inner circumference of the spring member 32. By disposing the operating wire 16a within the spring member 32, the needle fixing mechanism 30 can be made more compact. Furthermore, because the compression / expansion direction of the spring member 32 coincides with the movement direction of the operating wire 16a, loss of force when the lock switching member 31 is pulled by the operating wire 16a can be suppressed.

[0055] The spring bearing portion 34 is provided on the proximal side of the spring member 32 and is formed in a stepped shape that protrudes inward from the inner circumferential surface of the first arm portion 12. The spring bearing portion 34 has an opening in the center through which the operating wire 16a passes, and a step on the outer circumferential side of the opening supports the proximal end of the spring member 32. The spring bearing portion 34 receives the reaction force of the spring member 32 that biases the lock switching member 31, making it easy for the spring member 32 to strongly bias the lock switching member 31 distally.

[0056] An example of the operation of the suturing device 1 of the first embodiment will be described below with reference to Figures 9 and 10. When suturing an incision in a biological lumen, a suturing needle 17 is held in a cantilevered manner by one of the arms. Figure 9(a) shows a state in which the suturing needle 17 is initially held by the holder 18 of the first arm 12.

[0057] 9(a), in the needle fixing mechanism 30 of the first arm portion 12, the lock switching member 31 is in the locked position, being biased distally by the spring member 32. At this time, the lock switching member 31 engages with the groove 17b of the suture needle 17 in the holding portion 18 of the first arm portion 12, and the suture needle 17 is fixed to the first arm portion 12.

[0058] Next, the operating wire 16b is pulled proximally. As a result, the needle fixing mechanism 30 of the second arm 13 transitions to a state in which the lock switching member 31 is retracted proximally. Thereafter, as shown in Figure 9(b), when the opening / closing wire 15 is pulled from the state shown in Figure 9(a) to close the first arm 12 and the second arm 13, the exposed needle tip 17a of the suture needle 17 is housed in the holder 18 of the other arm (the second arm 13).

[0059] 10(a), with the needle tip 17a of the suture needle 17 housed in the holding portion 18 of the second arm portion 13, the pulling of the operating wire 16b is stopped and the operating wire 16b is released. Then, in the needle fixing mechanism 30 of the second arm portion 13, the lock switching member 31 is biased distally by the spring member 32 and moves within the second arm portion 13.

[0060] The lock switching member 31, biased by the spring member 32, moves within the second arm portion 13 until it abuts against the stopper portion 33. When the step 40a and the inclined portion 42 of the main body portion 40 abut against the first portion 33a of the stopper portion 33, the lock switching member 31 stops and is positioned at the locked position.

[0061] In the locked position, the needle support part 41 is housed in the second part 33b of the stopper part 33, and the engagement part 43 of the needle support part 41 is inserted into the groove 17b of the suture needle 17. As a result, the lock switching member 31 in the holding part 18 of the second arm part 13 engages with the groove 17b of the suture needle 17, and the suture needle 17 is fixed to the second arm part 13.

[0062] When the lock switching member 31 stops at the locked position, the step 40a and the inclined portion 42 of the main body 40 abut against the first portion 33a of the stopper 33, but the tip of the needle support 41 having the engaging portion 43 does not come into contact with the distal wall surface of the second portion 33b. Therefore, when the lock switching member 31 stops at the locked position, it is possible to prevent the engaging portion 43 from colliding with the inner wall of the arm and becoming deformed.

[0063] Meanwhile, operating wire 16a is pulled proximally, and lock switching member 31 of needle fixing mechanism 30 of first arm 12 transitions to a state in which it is retracted proximally. Then, in first arm 12, lock switching member 31 is disengaged from groove 17b of suture needle 17, and suture needle 17 on the first arm 12 side becomes able to move freely in the insertion / removal direction.

[0064] 10(a) switches the arm holding suture needle 17. The above-mentioned switching of the locked state may be performed simultaneously for two arms, or the arm that has received suture needle 17 may be changed to the locked state after a time lag, when the arm that has received suture needle 17 is changed to the locked state.

[0065] 10(a) , when the pulling of the opening / closing wire 15 is stopped and the opening / closing wire 15 is released, the first arm 12 and the second arm 13 are urged in the opening direction by the force of a spring (not shown), and the arms of the suturing device 1 enter an open state. As a result, as shown in FIG. 10(b) , the suturing needle 17 is released from the holding portion 18 of the first arm 12, and the suturing needle 17 is held in a cantilevered manner by the holding portion 18 of the second arm 13. The suturing device 1 opens and closes the first arm 12 and the second arm 13 across the incision in the body lumen, and repeats the above operation. This allows the arm holding the suturing needle 17 to be alternately switched to suture the incision.

[0066] The effects of the suturing device 1 of the first embodiment are described below. The needle fixing mechanism 30 of the suturing device 1 includes a spring member 32 that biases the lock switching member 31 toward the locked position and operating wires 16a, 16b that retract the lock switching member 31 from the locked position when pulled proximally. In the needle fixing mechanism 30 of each arm, the suture needle 17 is fixed to the holding portion 18 when the lock switching member 31 is in the locked position, and the fixation of the suture needle 17 in the holding portion 18 is released when the lock switching member 31 retracts from the locked position. In the first embodiment, the biasing force of the spring member 32 presses the lock switching member 31 to the locked position to fix the suture needle 17. This allows the lock switching member 31 to reliably apply a pushing force, which is difficult to transmit using a wire due to bending. This improves the reliability of the operation of fixing the suture needle 17 with the needle fixing mechanism 30.

[0067] Second Embodiment Fig. 11 is a diagram schematically illustrating a needle fixing mechanism 30a according to a second embodiment. In the following description of each embodiment, elements common to the first embodiment are designated by the same reference numerals, and redundant description will be omitted where appropriate.

[0068] Also, in the second embodiment, the configuration of the needle fixing mechanism 30a is common to the first arm portion 12 and the second arm portion 13, so we will explain the configuration of the needle fixing mechanism 30a of the first arm portion 12 and omit redundant explanations regarding the second arm portion 13.

[0069] 11 includes an engagement piece 50, a lock switching member 51, a spring member 32, and an operating wire 16a. The engagement piece 50 is disposed distally of the holding portion 18 of the first arm portion 12 and has a recess that receives the groove 17b of the suture needle 17.

[0070] The lock switching member 51 is a flat plate-shaped member that can advance and retract within the first arm portion 12, and has an opening 51a that receives the needle tip 17a of the suture needle 17. The operating wire 16a is connected to the proximal side of the lock switching member 51. The lock switching member 51 is biased distally by a spring member 32 that is arranged concentrically around the outer periphery of the operating wire 16a. The proximal side of the spring member 32 is supported by a spring bearing (not shown), similar to the first embodiment.

[0071] In the needle fixing mechanism 30a of the second embodiment, when the suture needle 17 is housed in the holding portion 18, the opening 51a of the lock switching member 51 receives the needle tip 17a of the suture needle 17. Because the lock switching member 51 is biased distally by the spring member 32, a force acts distally on the suture needle 17 whose needle tip 17a is inserted into the opening 51a. When the lock switching member 51 moves to the locked position on the distal side, the groove 17b of the suture needle 17 is pressed against the engagement piece 50 provided on the distal side of the holding portion 18. As a result, the engagement piece 50 engages with the groove 17b of the suture needle 17, and the suture needle 17 is fixed to the holding portion 18.

[0072] On the other hand, when the operating wire 16a is pulled proximally, the lock switching member 51 retracts proximally from the locked position. This causes a proximal force to act on the suture needle 17, whose needle tip 17a is inserted into the opening 51a. This causes the groove 17b of the suture needle 17 to move away from the engagement piece 50 provided on the distal side of the holding portion 18, and the engagement between the engagement piece 50 and the suture needle 17 is released.

[0073] As described above, in the configuration of the second embodiment, the biasing force of the spring member 32 presses the lock switching member 51 to the locked position, engaging the suture needle 17 with the engaging piece 50, thereby reliably applying a pushing force to the lock switching member 51, which is difficult to transmit with a wire due to bending. This improves the reliability of the operation to secure the suture needle 17 with the needle securing mechanism 30a.

[0074] The shape of the engaging piece 50 in the second embodiment is not limited to the configuration shown in Fig. 11. For example, as shown in Fig. 12, a protruding engaging piece 50a may be provided on the distal side of the holding portion 18, and the engaging piece 50a may be engaged with the groove 17b of the suture needle 17 in the locked position.

[0075] 13 is a schematic diagram of a needle fixing mechanism 30b according to a third embodiment. The third embodiment is a modification of the first embodiment, in which a joint 60 is disposed between the lock switching member 31 and the spring member 32.

[0076] The joint 60 is formed, for example, of a chain member in which multiple parts are bendably connected so as not to cause axial compression. The distal end of the joint 60 is connected to the lock switching member 31, and the proximal end of the joint 60 is connected to a plate-shaped mounting base 61. The mounting base 61 is also connected to the spring member 32 and the operating wire 16a (16b), which are concentrically arranged.

[0077] The needle fixing mechanism 30b of the third embodiment can achieve substantially the same effects as the needle fixing mechanism 30 of the first embodiment. Furthermore, in the needle fixing mechanism 30b of the third embodiment, the lock switching member 31 is operated via the bendable joint 60, so that even if a bent portion is formed in the middle of the needle fixing mechanism 30b, the distal biasing force of the spring member 32 and the proximal traction force from the operating wire 16a (16b) can be transmitted to the lock switching member 31.

[0078] For example, as shown in FIG. 3, when the first arm portion 12 and the second arm portion 13 are attached to the attachment portion 11 at an inclination toward the radially inward direction, the joint portion 60 of the needle fixing mechanism 30b may be positioned so as to span the bend from the region along the longitudinal direction of the attachment portion 11 to each arm portion.

[0079] Alternatively, as shown in Figure 14, the arm portion of the suturing device 1 (only the second arm portion 13 is shown) may have a shape including a main body portion 13c extending in the longitudinal direction and a protruding end portion 13d formed at the distal end of the main body portion 13c. The protruding end portion 13d protrudes from the main body portion 13c toward the radially inner side of the tubular insertion portion 2. In the example of Figure 14, the shape of the first arm portion 12 is the same as that of the second arm portion 13. When the needle fixing mechanism 30b is applied to the arm portion configured as shown in Figure 14, a joint portion 60 is arranged to span the bent portion from the main body portion 13c to the protruding end portion 13d.

[0080] Although the joint portion 60 of the needle fixing mechanism 30b does not generate large compression in the axial direction, bending it in the axial direction can produce a slight cushioning effect, so it is also possible to adjust the biasing force of the spring member 32 using the joint portion 60.

[0081] The present invention is not limited to the above-described embodiment, and various improvements and design changes may be made without departing from the spirit of the present invention.

[0082] In the first embodiment described above, an example was described in which the engaging portion 43 of the lock switching member 31 is formed in a slit shape. However, the engaging portion 43 of the lock switching member 31 may have other shapes as long as it can secure the suture needle 17 to the holding portion 18. For example, the engaging portion 43 of the lock switching member 31 may be formed in a single-edged or needle shape that can be inserted into one side of the groove 17b, so that the holding portion 18 and the lock switching member 31 sandwich and secure the suture needle 17. Alternatively, the engaging portion 43 of the lock switching member 31 may be formed in a needle shape, and a hole that receives the engaging portion 43 may be formed in the suture needle 17, allowing the suture needle 17 and the engaging portion 43 to engage with each other.

[0083] Furthermore, when the engaging portion 43 is formed in a slit shape in the first embodiment, a portion narrower than the diameter of the groove 17b of the suture needle 17 may be formed on the tip side. In this case, the tip side of the engaging portion 43 is elastically deformed and widened, so that the groove 17b of the suture needle 17 engages with the engaging portion 43, and the tip of the engaging portion 43 narrows due to elastic deformation, making it even more difficult for the suture needle 17 to fall off.

[0084] Furthermore, for example, in a procedure in which a full-thickness suture is performed after a full-thickness resection of a lesion such as the submucosal layer, it is necessary to pass a suture needle deep into biological tissue under an endoscope, and therefore a suturing device of this type having a higher suturing force is desired. On the other hand, from the viewpoint of facilitating the procedure, it is preferable that the suturing device be easy to operate. In the following embodiment, an endoscopic suturing device that can generate a high suturing force with a simple operation is provided.

[0085] (Fourth embodiment) Fig. 15 is a perspective view schematically showing an example of a suturing device according to a fourth embodiment. Fig. 16 is a plan view of the suturing device of Fig. 15. Fig. 17 is a side view of the suturing device of Fig. 15.

[0086] The suturing device 101 is detachably provided at the distal end of a tubular insertion section 102 of an endoscope that is inserted into a biological lumen. Because the suturing device 101 is detachable from the tubular insertion section 102 of the endoscope, maintenance such as replacement and sterilization is easy. The suturing device 101 may also be supplied as a disposable product.

[0087] For example, the endoscope is a flexible scope having a bendable tubular insertion section 102, which is operated by an operator from the proximal side. An objective lens 103 of the imaging section, an illumination section 104, and a forceps port 105 are provided at the distal end of the tubular insertion section 102 of the endoscope.

[0088] The endoscope captures images of the inside of a living lumen using an imaging unit via a wide-angle objective lens 103, and can display and output the images of the inside of the living lumen in real time on a display device (not shown). The illumination unit 104 illuminates the inside of the living lumen with light guided from a light source via an optical fiber. The forceps port 105 is provided for inserting and removing treatment tools such as forceps 106 and for collecting living tissue with the treatment tool. As shown in FIG. 17 , the endoscope allows the forceps 106 to be moved longitudinally through the forceps port 105 of the tubular insertion section 102 to grasp living tissue with the forceps 106.

[0089] The suturing device 101 includes an attachment portion 111, a pair of arms consisting of a first arm portion 112 and a second arm portion 113, an opening / closing mechanism portion 114, and an operating wire 115. The attachment portion 111, the first arm portion 112, the second arm portion 113, and the opening / closing mechanism portion 114 are disposed at the distal end of the tubular insertion portion 102. The operating wire 115 is disposed in the longitudinal direction along the tubular insertion portion 102, and its distal side is connected to the opening / closing mechanism portion 114. The suturing device 101 can open and close the first arm portion 112 and the second arm portion 113, which hold the suture needle 116, via the opening / closing mechanism portion 114, by pulling the operating wire 115 proximally.

[0090] The mounting portion 111, the first arm portion 112, the second arm portion 113, and the opening / closing mechanism portion 114 can be made of a biocompatible metal, such as stainless steel, titanium, nitinol, etc. The operating wire 115 can be made of a thin metal wire such as stainless steel, titanium, copper, nitinol, or a thin polymer fiber wire, a fluorine tube, polyethylene, polypropylene, nylon, or the like.

[0091] The attachment portion 111 is an annular member having a diameter corresponding to the outer diameter of the tubular insertion portion 102. The distal end of the tubular insertion portion 102 is detachably inserted into the inside of the attachment portion 111 and is held by the attachment portion 111. In addition, a first arm portion 112 and a second arm portion 113 are attached to the outer periphery of the attachment portion 111 via an opening / closing mechanism portion 114.

[0092] The first arm unit 112 and the second arm unit 113 are supported by the opening / closing mechanism unit 114 in a V-shape so as to protrude distally from the attachment unit 111, and can open and close in a direction approximately parallel to the tangent direction of the outer periphery of the endoscope. As shown in Fig. 17 , when the suturing device 101 is attached to the tubular insertion unit 102, the tips of the first arm unit 112 and the second arm unit 113 are located distally of the tubular insertion unit 102. Also, as shown in Fig. 17 , the tips of the arms are located on the line of movement of the forceps 106 when the arms are closed.

[0093] Fig. 18 is a diagram showing an example of the structure of first arm unit 112. Fig. 19 is a diagram showing an example of the opening and closing operation of first arm unit 112 and second arm unit 113. Note that since first arm unit 112 and second arm unit 113 have a common structure, the following description will focus on the structure of first arm unit 112, and redundant description of second arm unit 113 will be omitted.

[0094] A holder 120 for a suture needle 116 is provided on the inner surface of the tip (distal end) of the first arm 112. The suture needle 116 has needle tips 116a formed on both ends and a hole 116b in the center through which a suture thread (not shown) is passed. In addition, grooves 116c extending in a direction intersecting the extension direction of the suture needle 116 are formed on both sides of the suture needle 116, at positions more inward than the needle tips 116a.

[0095] On the other hand, the holding portion 120 has a recess 121 that receives the suture needle 116 inside the first arm portion 112, and a holding piece 122 that engages with the groove 116c of the suture needle 116. The holding piece 122 is disposed inside the first arm portion 112 and is slidable in the extension direction of the first arm portion 112. The holding piece 122 also has an engaging portion 122a that engages with the groove 116c of the suture needle 116, and a hole 122b that allows the suture needle 116 to pass through. By sliding the holding piece 122 in the extension direction of the first arm portion 112, it is possible to switch between a locked state in which the engaging portion 122a is located in the recess 121, and an unlocked state in which the hole 122b is located in the recess 121.

[0096] When suturing an incision in a biological lumen, a suture needle 116 is held in a cantilevered manner by one of the arms. The example in Figure 19(a) shows a state in which the suture needle 116 is initially held by the holding portion 120 of the first arm 112. In Figure 19(a), the engaging portion 122a of the holding piece 122 engages with the groove 116c of the suture needle 116 within the holding portion 120 of the first arm 112, and the suture needle 116 is locked to the first arm 112.

[0097] 19(b), when the first arm unit 112 and the second arm unit 113 are closed from the state shown in FIG. 19(a), the exposed needle tip 116a of the suture needle 116 is housed in the holding portion 120 of the other arm unit (the second arm unit 113). At this time, the holding portion 120 of the second arm unit 113 is in an unlocked state in which the hole 122b of the holding piece 122 is positioned in the recess 121.

[0098] 19(c), the sliding of the retaining piece 122 on the second arm 113 causes the engaging portion 122a of the retaining piece 122 to engage with the groove 116c of the suture needle 116, locking the suture needle 116 to the second arm 113. Furthermore, the sliding of the retaining piece 122 on the first arm 112 causes the engaging portion 122a of the retaining piece 122 to retract from the groove 116c of the suture needle 116, unlocking the suture needle 116 on the first arm 112. This switches the arm that holds the suture needle 116. Note that the above-mentioned switching between the locked state and the unlocked state may be performed simultaneously on the two arms, or the arm that received the suture needle 116 may be changed to the locked state after a time lag has elapsed.

[0099] When the first arm unit 112 and the second arm unit 113 are opened from the state shown in Fig. 19(c), the suturing needle 116 is released from the holder 120 of the first arm unit 112, and the suturing needle 116 is held in a cantilevered manner by the holder 120 of the second arm unit 113, as shown in Fig. 19(d). The suturing device 1 opens and closes the first arm unit 112 and the second arm unit 113, sandwiching the incision in the body lumen, and repeats the above operation. This allows the arm unit holding the suturing needle 116 to be alternately switched to suture the incision.

[0100] Returning to FIG. 17 , each arm is mounted with its distal side tilted radially inward relative to its proximal side. For example, each arm is mounted tilted radially inward from a position substantially parallel to the longitudinal direction by 0.5° to 50°, more preferably 3° to 35°. Mounting each arm with an inward tilt reduces interference between the suturing device 101 and objects on the radially outer side, improving the ease of insertion of the endoscope into an overtube or the body. Mounting each arm with an inward tilt also brings the tip of each arm closer to the center of the field of view of the endoscope's imaging unit, improving visibility during suturing. Furthermore, even if the endoscope moves, is positioned at a bend, or the arm position shifts slightly after insertion, the arm is more likely to be centered in the field of view, making it easier to check the entire arm under the endoscope.

[0101] Furthermore, the holding section 120 provided at the tip of each arm section is positioned within a 100% range from the center of the field of view of the imaging section of the endoscope. Specifically, when the field of view of the imaging section is θ1 and the range from the center of the field of view where the tip of each arm section is positioned is θ2, using the distal end of the tubular insertion section 102 as a reference, θ2 is preferably within 90% of θ1, more preferably within 80% of θ1, and particularly preferably within 70% of θ1. By positioning the tip of each arm section under the above conditions, it is possible to prevent the suturing point from being outside the field of view of the imaging section and to prevent visibility during suturing from being reduced due to the influence of aberrations in the imaging section.

[0102] Furthermore, when performing suturing by wrapping a large amount of biological tissue, such as in full-thickness suturing, it becomes necessary to sufficiently draw the biological tissue to be sutured toward the endoscope using the forceps 106 of the endoscope. Therefore, a certain amount of margin is required in the longitudinal dimension from the distal end of the tubular insertion portion 102 to the holding portion 120.

[0103] From this perspective, for example, the longitudinal dimension from the distal end of the tubular insertion section 102 to the tip of each arm section is preferably, for example, 1 mm to 80 mm, and more preferably 3 mm to 60 mm. For example, by making the distance from the distal end of the tubular insertion section 102 to the tip of each arm section 3 mm or more, the tips of the arms come into the field of view of the endoscope, making suturing under the endoscope easier. Furthermore, by making the distance from the distal end of the tubular insertion section 102 to the tip of each arm section 60 mm or less, it becomes easier to insert the tips of the arms without them getting caught on the overtube.

[0104] 20 is a diagram showing an example of the configuration of the opening / closing mechanism 114 of the fourth embodiment. The opening / closing mechanism 114 of the fourth embodiment is a link mechanism that drives the first arm 112 and the second arm 113, and has a main body 131, a driving link 132, a first intermediate link 133, and a second intermediate link 134. The link mechanism of the opening / closing mechanism 114 is line-symmetrical on a plane based on the central axis C. Note that the central axis C includes a component that is inclined radially with respect to the longitudinal direction of the tubular insertion section 102.

[0105] The main body 131 is a thin box-shaped housing that rotatably supports the first arm 112 and the second arm 113 and houses the elements of the link mechanism. The main body 131 also functions as a cover that encloses the elements of the link mechanism. Covering the link mechanism with the main body 131 reduces the possibility of malfunction of the link mechanism due to tangled sutures or adhesion of body fluids, etc. In Figure 20, the main body 131 is drawn as a flat plate to make it easier to understand the structure of the opening / closing mechanism 114.

[0106] The overall shape of the main body 131 is formed into a trapezoid shape in which the distal side is longer than the proximal side, and the proximal side of the main body 131 is fixed to the attachment portion 111. As described above, the main body 131 is fixed to the attachment portion 111 so that the distal side is inclined radially inward (toward the depth of the paper in FIG. 20 ) relative to the proximal side.

[0107] Furthermore, a first arm unit 112 is attached to one end (left side in FIG. 20 ) on the distal side of the main body unit 131, and a second arm unit 113 is attached to the other end (right side in FIG. 20 ) spaced apart from the first arm unit 112. The base end of the first arm unit 112 is rotatably supported by the main body unit 131 via a first support shaft 141. The base end of the second arm unit 113 is rotatably supported by the main body unit 131 via a second support shaft 142. The first arm unit 112 and the second arm unit 113 are biased in the opening direction by a spring (not shown).

[0108] The driver 132 is an elongated rectangular member, and is disposed within the main body 131 along the central axis C. The operating wire 115 is connected to the proximal end of the driver 132. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are connected to the distal end of the driver 132. The driver 132 slides within the main body 132 along the central axis C when pulled by the operating wire 115, thereby displacing relatively in the longitudinal direction of the tubular insertion section 102.

[0109] 21(a), the driver 132 may be configured to slide within a region of the opening / closing mechanism 114 that is inclined radially inward relative to the longitudinal direction. Alternatively, as shown in Fig. 21(b), the driver 132 may be formed from a bendable, elastically deformable member, and the driver 132 may slide across the opening / closing mechanism 114 from a region along the longitudinal direction to a region inclined radially inward.

[0110] The first intermediate link 133 and the second intermediate link 134 are each an elongated rectangular member. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are both rotatably supported on the distal end of the driver link 132 by a pin 132a.

[0111] The distal end of the first intermediate link 133 is rotatably connected to the first arm 112 via a pin 143. The pin 143 of the first arm 112 is located between the tip of the arm and the first support shaft 141, and is closer to the first support shaft 141 than the tip of the arm.

[0112] Similarly, the distal end of the second intermediate link 134 is rotatably connected to the second arm portion 113 via a pin 144. The position of the pin 144 of the second arm portion 113 is disposed between the tip end of the arm and the second support shaft 142, and is closer to the second support shaft 142 than the tip end of the arm.

[0113] As described above, the first arm 112 and the second arm 113 are biased in the opening direction by the force of a spring (not shown). When the operating wire 115 is not being pulled, no force acts on the first arm 112 or the second arm 113 in the closing direction, and therefore the suturing device 101 maintains the arm open state (FIG. 20(a)).

[0114] When the operating wire 115 is pulled from the above state, the driver 132 of the opening / closing mechanism 114 is displaced proximally in the longitudinal direction. As the driver 132 is displaced, the positions of the proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 move proximally, and the first intermediate link 133 and the second intermediate link 134 are each retracted proximally.

[0115] The first arm 112, which is rotatably supported by the main body 131 via the first support shaft 141, rotates in the closing direction around the first support shaft 141 due to displacement of the first intermediate link 133. Similarly, the second arm 113, which is rotatably supported by the main body 131 via the second support shaft 142, rotates in the closing direction around the second support shaft 142 due to displacement of the second intermediate link 134. In this way, the arm of the suturing device 101 changes from an open state to a closed state due to pulling of the operating wire 115 ( FIG. 20( b) ).

[0116] The suturing device 101 of the fourth embodiment transmits the movement of the operating wire 115 directly to the arm portion via the link mechanism of the opening / closing mechanism 114, and can convert the displacement of the driving link 132 caused by the traction of the operating wire 115 into opening and closing movement at the tip of the arm portion. Therefore, according to the fourth embodiment, the opening / closing mechanism 114 can open and close the arm portion with strong force while suppressing force loss, thereby realizing a suturing device 101 that is suitable for full-thickness suturing, for example. Furthermore, according to the fourth embodiment, the arm portion can be switched between open and closed states with a simple operation of traction of the operating wire 115.

[0117] Fifth Embodiment Fig. 22 is a diagram showing an example of the configuration of an opening / closing mechanism 114A of a fifth embodiment. Note that in the following embodiments, the basic configuration of the suturing device 101 is the same as that of the fourth embodiment, but the configuration of the opening / closing mechanism is different. In addition, in the description of the following embodiments, elements common to the fourth embodiment are assigned the same reference numerals, and duplicate description will be omitted as appropriate.

[0118] The opening / closing mechanism 114A of the fifth embodiment is a link mechanism that drives the first arm 112 and the second arm 113, and includes a main body 131 and a driving link 132. The link mechanism of the opening / closing mechanism 114A is symmetrical with respect to a plane based on the central axis C.

[0119] The main body 131 of the fifth embodiment has a first guide portion 151 that slidably holds the first support shaft 141 and a second guide portion 152 that slidably holds the second support shaft 142. For example, the first guide portion 151 is a groove formed in one end (left side in FIG. 22 ) on the distal side of the main body 131, and the second guide portion 152 is a groove formed in the other end (right side in FIG. 22 ) on the distal side of the main body 131. Furthermore, the first guide portion 151 and the second guide portion 152 extend linearly from the proximal side to the distal side such that a gap opens between them.

[0120] In the fifth embodiment, the first arm portion 112 and the second arm portion 113 are bent members in which base ends 112b, 113b are bent and connected to arm bodies 112a, 113a at the distal ends, respectively. The lengths of the arm bodies 112a, 113a of each arm portion are set to be sufficiently longer than the lengths of the base ends 112b, 113b.

[0121] The first arm unit 112 and the second arm unit 113 are attached to the main body 131 so that the bent portions face outward and the arm bodies 112 a, 113 a and the base ends 112 b, 113 b face inward. The first arm unit 112 and the second arm unit 113 are biased in the opening direction by a spring (not shown).

[0122] The first arm 112 is rotatably supported on the main body 131 by a first support shaft 141 inserted through the bending portion. The first support shaft 141 is inserted into a first guide portion 151 of the main body 131 and is slidable in the extension direction of the first guide portion 151. A base end portion 112b of the first arm 112 is connected to the driving link 132.

[0123] The second arm 113 is rotatably supported on the main body 131 by a second support shaft 142 inserted through the bent portion. The second support shaft 142 is inserted into a second guide portion 152 of the main body 131 and is slidable in the extension direction of the second guide portion 152. A base end 113b of the second arm 113 is connected to the driving link 132.

[0124] The driver 132 is a long, slender rectangular member, and is disposed within the main body 131 along the central axis C. The operating wire 115 is connected to the proximal end of the driver 132. The base end 112b of the first arm 112 and the base end 113b of the second arm 113 are each rotatably connected to the distal end of the driver 132 via a pin 132a. The driver 132 slides within the main body 131 along the central axis C when pulled by the operating wire 115, thereby displacing relatively in the longitudinal direction of the tubular insertion section 102.

[0125] As described above, the first arm 112 and the second arm 113 are biased in the opening direction by the force of a spring (not shown). When the operating wire 115 is not being pulled, no force acts on the first arm 112 and the second arm 113 in the closing direction, and therefore the arms of the suturing device 101 remain in the open state (FIG. 22(a)).

[0126] Furthermore, a force directed outward from the main body is applied to each of the first arm portion 112 and the second arm portion 113 by the biasing force of the spring in the opening direction, causing the first support shaft 141 of the first arm portion 112 to move distally from the first guide portion 151, and the second support shaft 142 of the second arm portion 113 to move distally from the second guide portion 152.

[0127] When the operating wire 115 is pulled from the above state, the driving link 132 of the opening / closing mechanism 114A is displaced proximally in the longitudinal direction. Consequently, the first arm 112 and the second arm 113 are each retracted proximally in accordance with the displacement of the driving link 132. At this time, the first support shaft 141 of the first arm 112 moves from the distal side to the proximal side along the first guide portion 151, and the second support shaft 142 of the second arm 113 moves from the distal side to the proximal side along the second guide portion 152.

[0128] Furthermore, the first arm portion 112 rotates about the first support shaft 141 so that the inclination of the base end portion 112b with respect to the central axis C becomes smaller. As a result, the tip side of the first arm portion 112 moves in the closing direction. Similarly, the second arm portion 113 rotates about the second support shaft 142 so that the inclination of the base end portion 113b with respect to the central axis C becomes smaller. As a result, the tip side of the second arm portion 113 moves in the closing direction.

[0129] In this way, the arm portion of the suturing device 101 changes from an open state to a closed state by pulling the operating wire 115 (FIG. 22(b)). In the suturing device 101 of the fifth embodiment, the movement of the operating wire 115 is also transmitted directly to the arm portion via the link mechanism of the opening / closing mechanism 114A, and the displacement of the driving link 132 caused by pulling the operating wire 115 can be converted into opening and closing movement of the tip side of the arm portion. Therefore, the fifth embodiment can also achieve the same effects as the fourth embodiment.

[0130] 23 is a diagram showing an example of the configuration of an opening / closing mechanism 114B according to a sixth embodiment. The opening / closing mechanism 114B according to the sixth embodiment is a link mechanism that drives the first arm 112 and the second arm 113, and includes a main body 131, a driving link 132, a first intermediate link 133, and a second intermediate link 134. The link mechanism of the opening / closing mechanism 114B is symmetrical with respect to a plane based on the central axis C.

[0131] The main body 131 rotatably supports the first arm 112 and the second arm 113. The overall shape of the main body 131 is formed into a trapezoid shape with the distal side longer than the proximal side, and the proximal side of the main body 131 is fixed to the attachment portion 111.

[0132] The first arm portion 112 and the second arm portion 113 of the sixth embodiment are bent members in which base end portions 112b, 113b are bent and connected to distal arm bodies 112a, 113a. The lengths of the arm bodies 112a, 113a of each arm portion are set to be sufficiently longer than the lengths of the base end portions 112b, 113b.

[0133] The first arm unit 112 and the second arm unit 113 are attached to the main body 131 so that the bent portions face outward and the arm bodies 112 a, 113 a and the base ends 112 b, 113 b face inward. The first arm unit 112 and the second arm unit 113 are biased in the opening direction by a spring (not shown).

[0134] The first arm 112 is rotatably supported by the main body 131 by a first support shaft 141 inserted through the bending portion. The first support shaft 141 is disposed at one end (left side in FIG. 23 ) on the distal side of the main body 131. Similarly, the second arm 113 is rotatably supported by the main body 131 by a second support shaft 142 inserted through the bending portion. The second support shaft 142 is disposed at the other end (right side in FIG. 23 ) on the distal side of the main body 131, spaced apart from the first support shaft 41.

[0135] The driver 132 is an elongated rectangular member and is disposed within the main body 131 along the central axis C. The operating wire 115 is connected to the proximal end of the driver 132, and the driver 132 is slidable within the main body 131 so as to be relatively displaced in the longitudinal direction by pulling the operating wire 115. Furthermore, the proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are each connected to the distal end of the driver 132.

[0136] The first intermediate link 133 and the second intermediate link 134 are each an elongated rectangular member. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are both rotatably supported by a pin 132a at the distal end of the driver link 132. The distal end of the first intermediate link 133 is rotatably connected to the base end 112b of the first arm 112 by a pin 143. Similarly, the distal end of the second intermediate link 134 is rotatably connected to the base end 113b of the second arm 113 by a pin 144.

[0137] As described above, the first arm 112 and the second arm 113 are biased in the opening direction by the force of a spring (not shown). When the operating wire 115 is not being pulled, no force acts on the first arm 112 or the second arm 113 in the closing direction, and therefore the arms of the suturing device 101 remain in the open state (FIG. 23(a)).

[0138] When the operating wire 115 is pulled from the above state, the driver 132 of the opening / closing mechanism 114B is displaced proximally in the longitudinal direction. As the driver 132 is displaced, the proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 move proximally, and the first intermediate link 133 and the second intermediate link 134 are retracted proximally.

[0139] As the first intermediate link 133 is displaced, the base end 112b of the first arm 112, which is connected to the first intermediate link 133 by the pin 143, is displaced so that the pin 143 approaches the line connecting the first support shaft 141 and the pin 132a. As a result, the first arm 112 rotates about the first support shaft 141 in accordance with the displacement of the base end 112b, and the tip side of the arm body 112a moves in the closing direction.

[0140] Similarly, as the second intermediate link 134 is displaced, the base end 113b of the second arm 113, which is connected to the second intermediate link 134 by the pin 144, is displaced so that the pin 144 approaches the line connecting the second support shaft 142 and the pin 132a. As a result, the second arm 113 rotates about the second support shaft 142 in accordance with the displacement of the base end 113b, and the tip side of the arm body 113a moves in the closing direction.

[0141] In this way, the arm portion of the suturing device 101 changes from an open state to a closed state by pulling the operating wire 115 (FIG. 23(b)). In the suturing device 101 of the sixth embodiment, the movement of the operating wire 115 is also transmitted directly to the arm portion via the link mechanism of the opening / closing mechanism 114B, and the displacement of the driving link 132 caused by pulling the operating wire 115 can be converted into opening and closing movement of the tip side of the arm portion. Therefore, the sixth embodiment can also achieve the same effects as the fourth embodiment.

[0142] 24 is a diagram showing an example of the configuration of an opening / closing mechanism 114C according to a seventh embodiment. The opening / closing mechanism 114C according to the seventh embodiment is a link mechanism that drives the first arm 112 and the second arm 113, and includes a main body 131, a driving link 132, a first intermediate link 133, and a second intermediate link 134. The link mechanism of the opening / closing mechanism 114C is symmetrical with respect to a plane based on the central axis C.

[0143] The main body 131 of the seventh embodiment is a frame that extends along the central axis C and rotatably supports the first arm 112 and the second arm 113. The proximal side of the main body 131 is fixed to the attachment portion 111, and the distal side of the main body 131 rotatably supports the first arm 112 and the second arm 113. A cover that covers elements of the link mechanism may be attached to the main body 131.

[0144] The first arm portion 112 and the second arm portion 113 of the seventh embodiment are bent members in which base end portions 112b, 113b are bent and connected to distal arm bodies 112a, 113a. The lengths of the arm bodies 112a, 113a of each arm portion are set to be sufficiently longer than the lengths of the base end portions 112b, 113b.

[0145] The first arm unit 112 and the second arm unit 113 are attached to the main body 131 with their bent portions facing outward, their arm bodies 112a, 113a, and their base ends 112b, 113b facing inward, and their base ends 112b, 113b crossing each other. The first arm unit 112 and the second arm unit 113 are rotatably supported on the main body 131 by a support shaft 145 at the crossing portion of the base ends 112b, 113b. The support shaft 145 of each arm unit is located midway between the proximal end of the base ends 112b, 113b and the bent portion. The first arm unit 112 and the second arm unit 113 are biased in the opening direction by a spring (not shown).

[0146] On the other hand, the driver 132 is a rectangular member arranged in the main body 131 along the central axis C. The operating wire 115 is connected to the proximal end of the driver 132. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are respectively connected to the distal end of the driver 132. The driver 132 slides within the main body 131 along the central axis C when pulled by the operating wire 115, thereby displacing relatively in the longitudinal direction of the tubular insertion section 102.

[0147] The first intermediate link 133 and the second intermediate link 134 are each an elongated rectangular member. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are both rotatably supported on the distal end of the driver link 132 by a pin 132a.

[0148] The distal end of the first intermediate link 133 is rotatably connected to the proximal end of the base end 112b of the first arm 112 via a pin 143. Similarly, the distal end of the second intermediate link 134 is rotatably connected to the proximal end of the base end 113b of the second arm 113 via a pin 144.

[0149] As described above, the first arm 112 and the second arm 113 are biased in the opening direction by the force of a spring (not shown). When the operating wire 115 is not being pulled, no force acts on the first arm 112 or the second arm 113 in the closing direction, and therefore the arms of the suturing device 101 remain in the open state (FIG. 24(a)).

[0150] When the operating wire 115 is pulled from the above state, the driver 132 of the opening / closing mechanism 114C is displaced proximally in the longitudinal direction. As the driver 132 is displaced, the proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 move proximally, and the first intermediate link 133 and the second intermediate link 134 are retracted proximally.

[0151] As the first intermediate link 133 is displaced, the base end 112b of the first arm 112, which is connected to the first intermediate link 133 by the pin 143, is displaced so as to reduce its inclination with respect to the central axis C. As a result, the first arm 112 rotates about the support shaft 145 in accordance with the displacement of the base end 112b, and the tip side of the arm body 112a moves in the closing direction.

[0152] Similarly, as the second intermediate link 134 is displaced, the base end 113b of the second arm 113, which is connected to the second intermediate link 134 by the pin 144, is displaced so as to reduce its inclination with respect to the central axis C. As a result, the second arm 113 rotates about the support shaft 145 in accordance with the displacement of the base end 113b, and the tip side of the arm body 113a moves in the closing direction.

[0153] In this way, the arm portion of the suturing device 101 changes from an open state to a closed state by the pulling of the operating wire 115 (FIG. 24(b)). In the suturing device 101 of the seventh embodiment, the movement of the operating wire 115 is also transmitted directly to the arm portion via the link mechanism of the opening / closing mechanism 114C, and the displacement of the driving link 132 caused by the pulling of the operating wire 115 can be converted into an opening / closing movement on the tip side of the arm portion. Therefore, the same effects as in the fourth embodiment can be obtained in the seventh embodiment.

[0154] 25 is a diagram showing an example of the configuration of an opening / closing mechanism 114D according to an eighth embodiment. The opening / closing mechanism 114D according to the eighth embodiment is a link mechanism that drives the first arm 112 and the second arm 113, and includes a main body 131, a driving link 132, a first intermediate link 133, and a second intermediate link 134. The link mechanism of the opening / closing mechanism 114D is symmetrical with respect to a plane based on the central axis C.

[0155] The main body 131 is a frame that rotatably supports the first arm 112 and the second arm 113, and is fixed at its proximal side to the mounting portion. The main body 131 has a guide portion 153 that is an opening extending along the central axis C. A cover that covers elements of the link mechanism may be attached to the main body 131.

[0156] The first arm portion 112 and the second arm portion 113 of the eighth embodiment are bent members in which base ends 112b1 and 113b1 are bent relative to tip ends 112a1 and 113a1. The first arm portion 112 and the second arm portion 113 are attached to the main body portion 131 with the bent portions facing outward and the tip ends 112a1 and 113a1 and the base ends 112b1 and 113b1 facing inward. The base end 112b1 of the first arm portion 112 and the base end 113b1 of the second arm portion 113 are rotatably supported by a support shaft 145 on the distal side of the main body portion 131. The first arm portion 112 and the second arm portion 113 are biased in a closing direction by a spring (not shown).

[0157] On the other hand, the driver 132 is a rectangular member arranged in the main body 131 along the central axis C. The operating wire 115 is connected to the proximal end of the driver 132. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are each connected to the distal end of the driver 132. The driver 132 slides along the guide section 153 of the main body 131 when pulled by the operating wire 115, thereby displacing relatively in the longitudinal direction of the tubular insertion section 102.

[0158] The first intermediate link 133 and the second intermediate link 134 are each an elongated rectangular member. The proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are both rotatably supported on the distal end of the driver link 132 by a pin 132a.

[0159] The distal end of the first intermediate link 133 is rotatably connected to the bent portion of the first arm 112 via a pin 143. Similarly, the distal end of the second intermediate link 134 is rotatably connected to the bent portion of the second arm 113 via a pin 144.

[0160] As described above, the first arm 112 and the second arm 113 are biased in the closing direction by the force of a spring (not shown). When the operating wire 115 is not being pulled, no force acts on the first arm 112 or the second arm 113 in the opening direction, and therefore the arms of the suturing device 101 remain in the closed state (FIG. 25(a)).

[0161] When the operating wire 115 is pulled from the above state, the driver 132 of the opening / closing mechanism 114D is displaced proximally in the longitudinal direction. As the driver 132 is displaced, the proximal end of the first intermediate link 133 and the proximal end of the second intermediate link 134 are guided by the guide 153 and move proximally along the central axis C, and the first intermediate link 133 and the second intermediate link 134 are retracted proximally.

[0162] The first arm portion 112 connected to the first intermediate link 133 by the pin 143 rotates in the opening direction around the support shaft 145. Similarly, the second arm portion 113 connected to the second intermediate link 134 by the pin 144 rotates in the opening direction around the support shaft 145. As a result, the tip portions 112a1 and 113a1 of the first arm portion 112 and the second arm portion 113 each move in the opening direction.

[0163] In this way, the arm portion of the suturing device 101 changes from a closed state to an open state by pulling the operating wire 115 (FIG. 25(b)). In the suturing device 101 of the eighth embodiment, the movement of the operating wire 115 is also directly transmitted to the arm portion via the link mechanism of the opening / closing mechanism 114D, and the displacement of the driving link 132 caused by pulling the operating wire 115 can be converted into opening and closing movement at the tip end of the arm portion. Therefore, the eighth embodiment can also achieve the same effects as the fourth embodiment. Note that with the configuration of the eighth embodiment, the arm portion can be operated to close when the operating wire 115 is pulled.

[0164] Ninth Embodiment Fig. 26 is a diagram showing a configuration example of an opening / closing mechanism 114E of a ninth embodiment. Fig. 27 is a diagram showing the opening / closing mechanism 114E in the arm open state shown in Fig. 26(a) as viewed from the proximal side. The opening / closing mechanism 114E of the ninth embodiment is a modified example of the fifth or sixth embodiment, and is an example in which a groove-shaped cam is formed in the driver link 132.

[0165] The opening / closing mechanism 114E of the ninth embodiment is a link mechanism that drives the first arm 112 and the second arm 113, and includes a main body 131 and a driving link 132. The link mechanism of the opening / closing mechanism 114E is symmetrical with respect to a plane based on the central axis C.

[0166] The main body 131 of the ninth embodiment is a thin box-shaped housing that rotatably supports the first arm 112 and the second arm 113 and houses elements of the link mechanism. The overall shape of the main body 131 is trapezoidal, with the distal side longer than the proximal side, and the proximal side of the main body 131 is fixed to the attachment portion 111. Furthermore, on the distal side of the main body 131, the first arm 112 is attached to one end (left side in FIG. 26 ), and the second arm 113 is attached to the other end (right side in FIG. 26 ) spaced apart from the first arm 112.

[0167] The driver 132 is an elongated rectangular member, and is disposed within the main body 131 along the central axis C. The operating wire 115 is connected to the proximal end of the driver 132. The driver 132 slides within the main body 131 along the central axis C when the operating wire 115 is pulled, thereby displacing the driver 132 relatively in the longitudinal direction of the tubular insertion section 102.

[0168] Additionally, a cam plate portion 132b is provided at the distal end of the driver 132, and is connected to the first arm portion 112 and the second arm portion 113. The cam plate portion 132b is a thin plate-like portion housed within the main body portion 131, and has a first guide portion 161 and a second guide portion 162. For example, the first guide portion 161 is a groove formed on one side (the left side in FIG. 26 ) of the cam plate portion 132b, and the second guide portion 162 is a groove formed on the other side (the right side in FIG. 26 ) of the cam plate portion 132b. The first guide portion 161 and the second guide portion 162 extend linearly from the proximal side to the distal side such that a gap opens between them.

[0169] In the ninth embodiment, the first arm portion 112 and the second arm portion 113 are bent members in which base ends 112b, 113b are bent and connected to arm bodies 112a, 113a at the distal ends, respectively. The lengths of the arm bodies 112a, 113a of each arm portion are set to be sufficiently longer than the lengths of the base ends 112b, 113b.

[0170] The first arm unit 112 and the second arm unit 113 are attached to the main body 131 so that the bent portions face outward and the arm bodies 112 a, 113 a and the base ends 112 b, 113 b face inward. The first arm unit 112 and the second arm unit 113 are biased in the opening direction by a spring (not shown).

[0171] First arm portion 112 is rotatably supported on main body portion 131 by first support shaft 141 inserted through the bent portion. A first pin 163 that rotatably connects first arm portion 112 and cam plate portion 132b is inserted into base end portion 112b of first arm portion 112. First pin 163 is inserted into first guide portion 161 of cam plate portion 132b and is slidable in the extension direction of first guide portion 161.

[0172] Second arm portion 113 is rotatably supported on main body portion 131 by first support shaft 142 inserted through the bent portion. A second pin 164 that rotatably connects second arm portion 113 and cam plate portion 132b is inserted into base end portion 113b of second arm portion 113. Second pin 164 is inserted into second guide portion 162 of cam plate portion 132b and is slidable in the extension direction of second guide portion 162.

[0173] 27 , the base end 112b of the first arm portion 112 and the base end 113b of the second arm portion 113 are each partially notched in the thickness direction (the vertical direction in FIG. 27 ). The notches in the first arm portion 112 and the second arm portion 113 are alternately formed in the thickness direction. Therefore, the first arm portion 112 and the second arm portion 113 can be positioned so that the notches in the first arm portion 112 and the second arm portion 113 overlap. The cam plate portion 132b of the driver link 132 is positioned so that it overlaps the notches in the first arm portion 112 and the second arm portion 113, and is sandwiched between the base end 112b of the first arm portion 112 and the base end 113b of the second arm portion 113 in the thickness direction.

[0174] This makes it possible to compactly accommodate the base end 112b of the first arm portion 112, the base end 113b of the second arm portion 113, and the cam plate portion 132b of the driving link 132 within the main body portion 131 without interfering with the base end 112b of the first arm portion 112 and the base end 113b of the second arm portion 113.

[0175] As described above, the first arm 112 and the second arm 113 are biased in the opening direction by the force of a spring (not shown). When the operating wire 115 is not being pulled, no force acts on the first arm 112 and the second arm 113 in the closing direction, and therefore the arms of the suturing device 101 remain in the open state (FIG. 26(a)).

[0176] Furthermore, a force directed outward from the main body is applied to first arm portion 112 and second arm portion 113 by the biasing force of the spring in the opening direction. As a result, first pin 163 inserted through first arm portion 112 moves closer to the proximal side of first guide portion 161 of cam plate portion 132b. Similarly, second pin 164 inserted through second arm portion 113 moves closer to the proximal side of second guide portion 162 of cam plate portion 132b.

[0177] When the operating wire 115 is pulled from the above state, the driver 132 of the opening / closing mechanism 114E is displaced proximally in the longitudinal direction. As a result, the first arm 112 and the second arm 113 connected to the cam plate 132b of the driver 132 are each retracted proximally. At this time, the first pin 163 inserted in the first arm 112 moves from the proximal side to the distal side along the first guide 161, and the second pin 164 inserted in the second arm 113 moves from the proximal side to the distal side along the second guide 162.

[0178] Furthermore, the first arm portion 112 rotates about the first support shaft 141 so that the inclination of the base end portion 112b with respect to the central axis C becomes smaller. As a result, the tip side of the first arm portion 112 moves in the closing direction. Similarly, the second arm portion 113 rotates about the second support shaft 142 so that the inclination of the base end portion 113b with respect to the central axis C becomes smaller. As a result, the tip side of the second arm portion 113 moves in the closing direction.

[0179] In this way, the arm portion of the suturing device 101 changes from an open state to a closed state by the pulling of the operating wire 115 (FIG. 26(b)). In the ninth embodiment of the suturing device 101, the movement of the operating wire 115 is also transmitted directly to the arm portion via the link mechanism of the opening / closing mechanism 114E, and the displacement of the driving link 132 caused by the pulling of the operating wire 115 can be converted into an opening / closing movement on the tip side of the arm portion. Therefore, the ninth embodiment can also achieve the same effects as the fourth embodiment.

[0180] Furthermore, in the opening / closing mechanism 114E of the ninth embodiment, the base ends of the arms are respectively connected to a pair of guide sections formed on the driver link 132, and the first arm section, the second arm section, and the driver link form a link mechanism. This allows the number of parts in the opening / closing mechanism 114E to be reduced in the ninth embodiment. Furthermore, the opening / closing mechanism 114E of the ninth embodiment can be easily made smaller in size, and is suitable for realizing a minimally invasive suturing device 101 that can be easily delivered to an affected area.

[0181] In the fourth to ninth embodiments described above, examples of configurations have been described in which the arms of the suturing device 101 are attached tilted radially inward. However, the configuration of each arm is not limited to the configurations of the above embodiments, and may be, for example, the following configurations.

[0182] Figure 28 is a side view of a modified example of the suturing device 101. The arm portion (only the second arm portion 113 is shown) of the suturing device 101 shown in Figure 28 has a main body portion 113c extending in the longitudinal direction and a protruding end portion 113d formed on the distal end side of the main body portion 113c. The protruding end portion 113d protrudes from the main body portion 113c toward the radially inward side of the tubular insertion portion 102. Note that in the modified example, the shape of the first arm portion 112 is also the same as that of the second arm portion 113.

[0183] 28, the arm portion and the opening / closing mechanism portion 114 can both be arranged along the longitudinal direction, which makes it difficult for the operating wire 115 to be rubbed. As a result, loss of the force pulling the operating wire 115 can be further reduced.

[0184] Furthermore, the embodiments disclosed herein should be considered to be illustrative and not restrictive in all respects. The scope of the present invention is defined by the claims, not by the above description, and is intended to include all modifications within the meaning and scope of the claims.

[0185] This application claims priority based on Japanese Patent Application No. 2023-108761, filed on June 30, 2023, and incorporates the entire contents of that Japanese patent application by reference.

[0186] The disclosure of the above embodiments encompasses the following technical ideas: (1) An endoscopic suturing device provided at the distal end of a tubular insertion section of an endoscope, the endoscopic suturing device having a pair of arms each having a suture needle holder on one end of the arm, the arm holding the suture needle being switchable when the arm one end is opened and closed to suture tissue, each arm having a lock switching member configured to be able to move within the arm to and from a locked position on the arm one end, a spring member that biases the lock switching member toward the locked position, and an operating line disposed along the tubular insertion section that retracts the lock switching member from the locked position when pulled proximally relative to the device main body, the endoscopic suturing device having the suture needle fixed to the holder when the lock switching member is in the locked position and the fixation of the suture needle to the holder when the lock switching member is retracted from the locked position. (2) The endoscopic suturing device according to (1) above, wherein the lock switching member has an engaging portion that engages with the suture needle and engages with the suture needle at the locked position to fix the suture needle to the holding portion. (3) The endoscopic suturing device according to (1) above, wherein the arm portion further has an engaging piece that engages with the suture needle, and the lock switching member receives the suture needle so that the suture needle engages with the engaging piece at the locked position and moves the suture needle away from the engaging piece when retracting from the locked position. (4) The endoscopic suturing device according to any one of (1) to (3) above, wherein the spring member is a compression spring disposed within the arm portion and the operating wire is disposed on the inner periphery of the compression spring within the arm portion. (5) The endoscopic suturing device according to (4) above, wherein the arm portion has a stepped portion on its inner side that supports the proximal side of the compression spring. (6) The endoscopic suturing device according to (4) or (5), wherein the lock switching member has a positioning portion on a proximal side that engages with the distal side of the compression spring. (7) The endoscopic suturing device according to (2), wherein the engaging portion is formed on the distal side of the lock switching member and the engaging portion has a thickness in the insertion / removal direction of the suture needle that is smaller than that on the proximal side of the lock switching member.(8) The endoscopic suturing device according to (7) above, wherein the lock switching member has a stepped portion protruding in the insertion / removal direction of the suture needle on the proximal side of the engaging portion, and the arm portion receives the stepped portion on the proximal side of the holding portion and has an internal stopper portion that positions the lock switching member at the locked position. (9) The endoscopic suturing device according to any one of (1) to (8) above, wherein the lock switching member receives force from the spring member via a joint portion that is bendable in the extension direction of the arm portion. (10) The endoscopic suturing device according to (9) above, wherein the arm portion has a portion that is inclined radially inward with respect to the extension direction of the tubular insertion portion, and the joint portion is disposed across a bent portion with respect to the extension direction of the tubular insertion portion. (11) The endoscopic suturing device according to any one of (1) to (10) above, wherein the operating wire can be operated independently of an opening / closing wire that opens and closes the arm portion. (12) The endoscopic suturing device according to any one of (1) to (11), wherein the endoscopic suturing device is detachable from the tubular insertion section of the endoscope. (13) An endoscopic suturing device provided at the distal end of the tubular insertion section of an endoscope, the endoscopic suturing device having a pair of arms each having a holding portion for a suture needle at one end of the arm, the arm section holding the suture needle being alternately switchable when opening and closing the one end of the arm to suture tissue, the endoscopic suturing device comprising: an operating wire arranged along the tubular insertion section; and a link mechanism having a driver that is displaced relatively in the longitudinal direction of the tubular insertion section when the operating wire is pulled proximally with respect to the device main body, the link mechanism converting the displacement of the driver into opening and closing operation of the one end of the arm.(14) The link mechanism further has a first intermediate link and a second intermediate link, each of whose other ends is rotatably connected to one end of the driving link, and the arm portion has a first arm portion connected to the first intermediate link and a second arm portion connected to the second intermediate link, and the first arm portion rotates around a first support shaft provided on the other end of the arm and is rotatably connected to one end of the first intermediate link via a first pin at a position between the one end of the arm and the first support shaft, and the second arm portion rotates around a second support shaft provided on the other end of the arm and is rotatably connected to one end of the second intermediate link via a second pin at a position between the one end of the arm and the second support shaft. (15) The endoscopic suturing device according to (13), wherein the arm section has a first arm section and a second arm section each rotatably connected to the driver section, the first arm section rotates about a first support shaft provided between the one arm end and the other arm end, and the other arm end is rotatably connected to one end of the driver section, and the second arm section rotates about a second support shaft provided between the one arm end and the other arm end, and the other arm end is rotatably connected to one end of the driver section. (16) The endoscopic suturing device according to (15), wherein the driver section has a first guide section that receives a first pin connected to the other arm end of the first arm section and movably guides the first pin when the arm sections are opened and closed, and a second guide section that receives a second pin connected to the other arm end of the second arm section and movably guides the second pin when the arm sections are opened and closed. (17) The link mechanism further has a first intermediate link and a second intermediate link, each of whose other ends is rotatably connected to one end of the driving link, and the arm portion has a first arm portion connected to the first intermediate link and a second arm portion connected to the second intermediate link, the first arm portion rotates around a first support shaft provided between the one end of the arm and the other end of the arm, and the other end of the arm is rotatably connected to one end of the first intermediate link by a first pin, and the second arm portion rotates around a second support shaft provided between the one end of the arm and the other end of the arm, and the other end of the arm is rotatably connected to one end of the second intermediate link by a second pin.(18) The link mechanism further has a first intermediate link and a second intermediate link, each of whose other ends is rotatably connected to one end of the driving link, and the arm portion has a first arm portion and a second arm portion that rotate around a common support shaft and intersect with each other, the support shaft of the first arm portion being located between the one arm end side and the other arm end side, and the other arm end side being rotatably connected to one end side of the first intermediate link by a first pin, and the support shaft of the second arm portion being located between the one arm end side and the other arm end side, and the other arm end side being rotatably connected to one end side of the second intermediate link by a second pin. (19) The endoscopic suturing device according to any one of (13) to (19), further comprising a cover that covers the link mechanism, wherein the link mechanism further comprises a first intermediate link and a second intermediate link, the other ends of which are rotatably connected to one end of the driver link, and a guide portion that receives the connecting portion of the first intermediate link and the second intermediate link and guides the connecting portion in the longitudinal direction, the connecting portion displacing together with the driver link, the arm portion having a first arm portion and a second arm portion that rotate about a common spindle, the spindle being located on the other end of the arm of the first arm portion and being rotatably connected to one end of the first intermediate link via a first pin at a position between the one end of the arm and the spindle, and the spindle being located on the other end of the arm of the second arm portion and being rotatably connected to one end of the second intermediate link via a second pin at a position between the one end of the arm and the spindle. (21) The endoscopic suturing device according to any one of (13) to (20), wherein the arm portion has a main body portion extending in the longitudinal direction and a protruding end portion at one end of the arm that protrudes from the main body portion toward the radially inward direction of the tubular insertion portion. (22) The endoscopic suturing device according to any one of (13) to (21), wherein the endoscope further has forceps that advance and retract in the longitudinal direction from the distal end of the tubular insertion portion, and the holding portion is arranged in a line of movement of the forceps when the arm portion is closed. (23) The endoscopic suturing device according to any one of (13) to (22), wherein the endoscopic suturing device is detachable from the tubular insertion portion of the endoscope.

[0187] 1,101...suturing device, 2,102...tubular insertion portion, 3,103...objective lens, 4,104...illumination portion, 5,105...forceps port, 6,106...forceps, 11,111...mounting portion, 12,112...first arm portion, 13,113...second arm portion, 14,114,114A,114B,114C,114D,114E...opening / closing mechanism portion, 15...opening / closing wire, 16a,16b,115...operation wire, 17,116...suturing needle, 17a...needle tip, 1 7b...groove, 18, 120...holding portion, 30, 30a, 30b...needle fixing mechanism, 31, 51...lock switching member, 32...spring member, 33...stopper portion, 34...spring receiving portion, 43...engaging portion, 50, 50a...engaging piece, 60...joint portion, 131...main body portion, 132...driving link, 132a...pin, 133...first intermediate link, 134...second intermediate link, 141...first support shaft, 142...second support shaft, 143, 144...pin, 145...support shaft, 153...guide portion

Claims

1. An endoscopic suturing device provided at the distal end of a tubular insertion section of an endoscope, comprising a pair of arms each having a suture needle holding section at one end of the arm, and configured to be able to switch the arm section which holds the suture needle when the arm one end is opened and closed to suture tissue, each of the arm sections having: a lock switching member configured to be able to advance and retreat within the arm section to a locked position at the arm one end side; a spring member which urges the lock switching member towards the locked position; and an operating line disposed along the tubular insertion section and which retracts the lock switching member from the locked position when pulled proximally relative to the device main body, wherein in each of the arm sections, the suture needle is fixed to the holding section when the lock switching member is in the locked position, and the fixation of the suture needle to the holding section is released when the lock switching member retracts from the locked position.

2. The endoscopic suturing device according to claim 1, wherein the lock switching member has an engagement portion that engages with the suturing needle, and engages with the suturing needle in the locked position to fix the suturing needle to the holding portion.

3. An endoscopic suturing device as claimed in claim 1, wherein the arm portion further has an engagement piece that engages with the suturing needle, and the lock switching member receives the suturing needle so that the suturing needle engages with the engagement piece in the locked position, and moves the suturing needle away from the engagement piece when retracted from the locked position.

4. An endoscopic suturing device according to any one of claims 1 to 3, wherein the spring member is a compression spring disposed within the arm portion, and the operating wire is disposed on the inner circumference of the compression spring within the arm portion.

5. The endoscopic suturing device according to claim 4, wherein the arm portion has a stepped portion on the inside thereof for supporting the proximal side of the compression spring.

6. The endoscopic suturing device according to claim 4, wherein the lock switching member has a positioning portion on the proximal side that engages with the distal side of the compression spring.

7. An endoscopic suturing device as claimed in claim 2, wherein the engagement portion is formed on the distal side of the lock switching member, and the engagement portion has a smaller thickness in the direction in which the suturing needle is inserted and removed than the proximal side of the lock switching member.

8. An endoscopic suturing device as set forth in claim 7, wherein the lock switching member has a stepped portion that protrudes in the direction of insertion / removal of the suturing needle proximal to the engaging portion, and the arm portion receives the stepped portion proximal to the holding portion and has an internal stopper portion that positions the lock switching member in the locked position.

9. An endoscopic suturing device according to any one of claims 1 to 3, wherein the lock switching member receives force from the spring member via a joint portion that is bendable in the extension direction of the arm portion.

10. An endoscopic suturing device as described in claim 9, wherein the arm portion has a portion that is inclined radially inward with respect to the extension direction of the tubular insertion portion, and the joint portion is positioned across a bent portion with respect to the extension direction of the tubular insertion portion.

11. An endoscopic suturing device according to any one of claims 1 to 3, wherein the operating wire can be operated independently of an opening / closing wire that opens and closes the arm portion.

12. The endoscopic suturing device according to any one of claims 1 to 3, wherein the endoscopic suturing device is detachable from the tubular insertion portion of the endoscope.

13. An endoscopic suturing device provided at the distal end of a tubular insertion section of an endoscope, comprising a pair of arms each having a holder for a suturing needle at one end of the arm, and configured to be capable of alternately switching the arm that holds the suturing needle when opening and closing the one end of the arm to suture tissue, comprising: an operating wire arranged along the tubular insertion section; and a link mechanism having a driving joint that is displaced relatively in the longitudinal direction of the tubular insertion section by pulling the operating wire proximally relative to the device body, and converting the displacement of the driving joint into opening and closing operation of the one end of the arm.

14. The endoscopic suturing device according to claim 13, wherein the link mechanism further has a first intermediate joint and a second intermediate joint, each of whose other ends is rotatably connected to one end of the driving joint, and the arm portion has a first arm portion connected to the first intermediate joint and a second arm portion connected to the second intermediate joint, and the first arm portion rotates around a first support shaft provided on the other end of the arm and is rotatably connected to one end of the first intermediate joint via a first pin at a position between the one end of the arm and the first support shaft, and the second arm portion rotates around a second support shaft provided on the other end of the arm and is rotatably connected to one end of the second intermediate joint via a second pin at a position between the one end of the arm and the second support shaft.

15. An endoscopic suturing device as described in claim 13, wherein the arm portion has a first arm portion and a second arm portion each rotatably connected to the driver joint, the first arm portion rotates about a first support shaft provided between the one end side of the arm and the other end side of the arm, and the other end side of the arm is rotatably connected to one end side of the driver joint, and the second arm portion rotates about a second support shaft provided between the one end side of the arm and the other end side of the arm, and the other end side of the arm is rotatably connected to one end side of the driver joint.

16. An endoscopic suturing device as described in claim 15, wherein the driving link has: a first guide portion that receives a first pin connected to the other end of the arm of the first arm portion, and movably guides the first pin when the arm portion is opened or closed; and a second guide portion that receives a second pin connected to the other end of the arm of the second arm portion, and movably guides the second pin when the arm portion is opened or closed.

17. The endoscopic suturing device according to claim 13, wherein the link mechanism further has a first intermediate joint and a second intermediate joint, each of whose other ends is rotatably connected to one end of the driving joint; the arm portion has a first arm portion connected to the first intermediate joint and a second arm portion connected to the second intermediate joint; the first arm portion rotates around a first support shaft provided between the one end of the arm and the other end of the arm, and the other end of the arm is rotatably connected to one end of the first intermediate joint by a first pin; and the second arm portion rotates around a second support shaft provided between the one end of the arm and the other end of the arm, and the other end of the arm is rotatably connected to one end of the second intermediate joint by a second pin.

18. The endoscopic suturing device according to claim 13, wherein the link mechanism further has a first intermediate section and a second intermediate section, the other end of each of which is rotatably connected to one end of the driving section, and the arm section has a first arm section and a second arm section which rotate about a common support axis and intersect with each other, the support axis of the first arm section being located between the one end side and the other end side of the arm, and the other end side of the arm being rotatably connected to one end side of the first intermediate section by a first pin, and the support axis of the second arm section being located between the one end side and the other end side of the arm, and the other end side of the arm being rotatably connected to one end side of the second intermediate section by a second pin.

19. The endoscopic suturing device according to claim 13, wherein the link mechanism further comprises a first intermediate section and a second intermediate section, the other ends of which are rotatably connected to one end of the driver section, and a guide section which receives the connecting portion of the first intermediate section and the second intermediate section and guides the connecting portion in the longitudinal direction as it displaces together with the driver section; the arm section has a first arm section and a second arm section which rotate about a common support axis, the support axis of the first arm section being located on the other end side of the arm and being rotatably connected to one end of the first intermediate section via a first pin at a position between the one end side of the arm and the support axis, and the second arm section has the support axis located on the other end side of the arm and being rotatably connected to one end of the second intermediate section via a second pin at a position between the one end side of the arm and the support axis.

20. An endoscopic suturing device according to any one of claims 13 to 19, further comprising a cover for covering the link mechanism.

21. An endoscopic suturing device as claimed in any one of claims 13 to 19, wherein the arm portion has a main body portion extending in the longitudinal direction and a protruding end portion protruding from the main body portion toward the radially inward direction of the tubular insertion portion at one end of the arm.

22. An endoscopic suturing device as claimed in any one of claims 13 to 19, wherein the endoscope further has forceps which advance and retract in a longitudinal direction from the distal end of the tubular insertion portion, and the holding portion is positioned on the path of movement of the forceps when the arm portion is closed.

23. The endoscopic suturing device according to any one of claims 13 to 19, wherein the endoscopic suturing device is detachable from the tubular insertion portion of the endoscope.