Medical stapler

Abstract

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

Description

medical stapler

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

[0002] In recent years, flexible staplers with a suturing mechanism supported by a flexible endoscope have been used in surgeries that enable intraluminal suturing. When using a flexible stapler, needles (hereinafter referred to as staples) are loaded into the suturing mechanism, and the stapler is inserted into the lumen, and the affected area is sutured by firing the staples while accessing the affected area.

[0003] When multiple staples are fired for a suturing procedure, the staples must be loaded multiple times, which requires the staples to be fired, then removed from the body, reloaded, and then reinserted multiple times.

[0004] Furthermore, in order to reload and fire the staples again, it is necessary to return the suturing mechanism to its initial position. Two possible methods for returning the suturing mechanism to its initial position are a method in which the operator performs an operation to return it to the initial position, and a method in which a mechanism that automatically returns it to the initial position is used.

[0005] An example of a conventional medical stapler is a surgical stapling device described in Patent Document 1. The surgical stapling device described in Patent Document 1 includes a firing trigger that is operated by a doctor (operator) to fire staples, and a spring that returns the firing trigger to its initial position after the staples have been fired.

[0006] Japanese Patent Application Laid-Open No. 2008-212674

[0007] However, when a mechanism for automatically returning to the initial position is used, as in the surgical stapling device described in Patent Document 1, there are concerns that the increased complexity of the mechanism will increase the number of components and the size of the components. Furthermore, there is a risk that it will be difficult for the operator to recognize whether the stapling has automatically returned to the initial position. On the other hand, when the operator manually performs the operation to return the stapling to the initial position, there are concerns that the number of steps in the operation will increase, or that the operator will forget to perform the operation and the stapling will not be returned to the initial position.

[0008] In consideration of the above circumstances, the present invention aims to provide a medical stapler that can easily return the suturing mechanism to its initial position and that allows the operator to easily recognize that the suturing mechanism has been returned to its initial position.

[0009] In order to solve the above problems, the present invention proposes the following means: A medical stapler of the present invention is a medical stapler provided at the tip of an endoscope, and comprises a staple discharge portion having a wire extending in the axial direction of the endoscope, a cartridge capable of accommodating staples, and an ejection mechanism connected to the tip of the wire and capable of ejecting the staples from the cartridge, the cartridge being detachably provided on the staple discharge portion, the ejection mechanism being movable from a first position which is an initial position to a second position where the staples are ejected by advancing and retracting the wire, the ejection mechanism being located at the second position when the cartridge is removed from the staple discharge portion, and moving from the second position to the first position when the cartridge is attached to the staple discharge portion.

[0010] According to the medical stapler of the present invention, it is possible to provide a medical stapler in which the suturing mechanism can be easily returned to the initial position and in which the operator can easily recognize that the suturing mechanism has been returned to the initial position.

[0011] FIG. 1 is a diagram showing the overall configuration of a medical system including a medical stapler according to the present invention. FIG. 2 is a perspective view of a wire sheath operating portion included in the medical stapler. FIG. 3 is a perspective view of the medical stapler. FIG. 4 is a front view of a cap included in the medical stapler. FIG. 5 is a perspective view of the medical stapler with a gripping portion in a closed state. FIG. 6 is a front view of the medical stapler with a gripping portion in a closed state. FIG. 7 is a perspective view of the medical stapler with a gripping portion in an open state. FIG. 8 is a front view of the medical stapler with a gripping portion in an open state. FIG. 9 is a side view of the medical stapler with a gripping portion in a closed state. FIG. 10 is a side view of the medical stapler with a gripping portion in an open state. FIG. 11 is a perspective view showing the connection between a first gripping member and a cap. FIG. 12 is a cross-sectional view of the gripping portion including a staple releasing portion. FIG. 13 is a cross-sectional view of the gripping portion after the releasing operation wire has been pulled. FIG. 14 is a cross-sectional view of the gripping portion and the cap that have advanced. FIG. 15 is a flowchart showing a procedure using a medical stapler by an operator. FIG. 16 is a diagram showing the operation of a protruding step performed by the medical stapler. FIG. 17 is a diagram showing the operation of an advancing step, a gripping step, and a retracting step performed by the medical stapler. FIG. 18 is a diagram showing the operation of a suturing step performed by the medical stapler. 26A is a diagram showing the operation of a removal step by a medical stapler. FIG. 26B is a diagram showing the operation of a medical stapler in a removal step. FIG. 26C is a diagram showing the operation of a medical stapler in a removal step. FIG. 26D is a diagram showing the operation of a medical stapler in a removal step. FIG. 27A is a diagram showing the operation of a medical stapler in a removal step. FIG. 27B is a diagram showing the operation of a medical stapler in a removal step. FIG. 27C is a diagram showing the operation of a medical stapler in a removal step. FIG. 27 ...

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

[0013] The medical system 300 is used in surgery for suturing the digestive tract, etc. The medical system 300 includes a medical stapler 100, an endoscope 200, an opening / closing operation unit 250, a discharge operation unit 270, a wire sheath 280, a resin sheath (long portion) 290, and a wire sheath operation unit 260.

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

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

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

[0017] A treatment tool channel 230 through which an endoscopic treatment tool is inserted is formed in the insertion section 210. A forceps port 214, which is a distal end opening of the treatment tool channel 230, is provided at the distal end 212 of the insertion section 210. The treatment tool channel 230 extends from the distal end 212 of the insertion section 210 to the operation section 220.

[0018] The tip portion 211 of the insertion portion 210 is provided with an imaging unit (not shown) having a CCD or the like. An objective lens 215 of the imaging unit is exposed at the tip 212 of the insertion portion 210. The tip portion 211 of the insertion portion 210 has a hard portion 211a (see FIG. 14) on the tip side.

[0019] A knob 223 for operating the insertion portion 210 and a switch 224 for operating the imaging unit, etc. are provided on the proximal end side of the operation portion 220. The surgeon (operator) can bend the insertion portion 210 in a desired direction by operating the knob 223.

[0020] A forceps insertion port 222 that communicates with the treatment instrument channel 230 is provided on the distal end side of the operation section 220. The surgeon can insert an endoscopic treatment instrument into the treatment instrument channel 230 through the forceps insertion port 222.

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

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

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

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

[0025] The base end of the discharge operation wire 6 is connected to a discharge operation slider 273. The surgeon can advance and retract the discharge operation wire 6 by moving the discharge operation slider 273 forward and backward in the longitudinal direction relative to the discharge operation portion main body 272.

[0026] [Wire sheath 280] The wire sheath 280 is a sheath through which the opening / closing operation wire 5 and the releasing operation wire 6 are inserted. The wire sheath 280 is a metallic coil sheath. Note that the wire sheath 280 is not limited to a metallic coil sheath, and may be a sheath of another type.

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

[0028] [Resin sheath 290] The resin sheath 290 is a sheath through which the wire sheath 280 is inserted so as to be able to advance and retreat. The resin sheath 290 is formed of a resin material. As shown in FIG. 1 , the distal end side of the resin sheath 290 is connected to the insertion section 210 of the endoscope 200 by a band 291. The distal end of the resin sheath 290 is fixed to the cap 1 of the medical stapler 100. In addition, the proximal end of the resin sheath 290 is fixed to the wire sheath operating section 260.

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

[0030] The operation portion main body 261 is formed in a cylindrical shape and has a distal opening 262 and a proximal opening 263. The proximal end of a resin sheath 290 is fixed to the distal opening 262.

[0031] A wire sheath 280 extends from the proximal end opening 263. The surgeon can advance and retract the wire sheath 280 relative to the resin sheath 290 by advancing and retracting the wire sheath 280 relative to the operation portion main body 261.

[0032] The band attachment section 264 is a member attached to the operation section main body 261, and has a band insertion hole 265. By attaching a band (not shown) to the endoscope 200 after passing through the band insertion hole 265, the operation section main body 261 can be easily fixed to the endoscope 200.

[0033] By fixing the operation portion main body 261 to the endoscope 200, the surgeon can advance and retract the wire sheath 280 relative to the resin sheath 290 without holding the operation portion main body 261 by hand.

[0034] The proximal end opening 263 from which the wire sheath 280 extends is provided with a rubber stopper 266 that comes into contact with the wire sheath 280. The frictional force generated between the wire sheath 280 and the rubber stopper 266 can suppress unintended advancement and retraction of the wire sheath 280 during treatment.

[0035] [Medical stapler 100] Figure 3 is a perspective view of the medical stapler 100. The medical stapler 100 is a suturing mechanism that performs suturing treatment. The medical stapler 100 includes a cap 1, a gripping portion (suturing portion) 2, a staple releasing portion 3, a staple receiving portion 4, an opening / closing operation wire 5, and an ejection operation wire 6. The medical stapler 100 is detachable from the tip portion 211 of the insertion portion 210.

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

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

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

[0039] The second through hole 12 is a hole into which the resin sheath 290 is inserted. The inner diameter of the second through hole 12 is approximately the same as the outer diameter of the resin sheath 290. The tip end of the resin sheath 290 is inserted into the second through hole 12 and fixed therein.

[0040] The wire sheath 280, the opening / closing operation wire 5, and the ejection operation wire 6 that are inserted through the resin sheath 290 are inserted through the second through-hole 12 and extend to the tip side.

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

[0042] The third through hole 14 and the fourth through hole 15 are formed on both sides of the second through hole 12 in a front view seen in the direction along the axial direction A.

[0043] Fig. 5 is a perspective view of the medical stapler 100 with the gripping portion 2 in a closed state. Fig. 6 is a front view of the medical stapler 100 with the gripping portion 2 in a closed state.

[0044] 5 and 6 , when the cap 1 is attached to the distal end portion 211 of the endoscope 200, the objective lens 215 and the forceps port 214 are exposed from the distal opening 13 of the first through-hole 11 of the cap 1. Therefore, the surgeon can observe the treatment target through the objective lens 215 even when the medical stapler 100 is attached to the distal end portion 211 of the endoscope 200.

[0045] Fig. 7 is a perspective view of the medical stapler 100 with the gripping portion 2 in the open state. Fig. 8 is a front view of the medical stapler 100 with the gripping portion 2 in the open state.

[0046] Fig. 9 is a side view of the medical stapler 100 with the gripping portion 2 in a closed state. Fig. 10 is a side view of the medical stapler 100 with the gripping portion 2 in an open state.

[0047] The gripping portion 2 is provided on the distal end side of the cap 1 and is capable of suturing the gripped target tissue with staples S. The gripping portion 2 has a first gripping member 21, a second gripping member 22, an opening / closing rotation shaft 23, and a movable pin 27.

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

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

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

[0051] The two support members 26 are hard, elongated members that support the first gripping member 21 so that it can advance and retreat relative to the cap 1. The two support members 26 are inserted into the third through hole 14 and the fourth through hole 15 so that they can advance and retreat in the axial direction A. In other words, the two support members 26, the third through hole 14, and the fourth through hole 15 constitute an advance and retreat mechanism for the first gripping member 21.

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

[0053] 11 , the distal end of a wire sheath 280 through which the opening / closing operation wire 5 and the releasing operation wire 6 are inserted is fixed to the first gripping member 21. When the wire sheath 280 advances or retreats relative to the resin sheath 290, the first gripping member 21 connected to the wire sheath 280 advances or retreats relative to the cap 1.

[0054] As shown in Fig. 4, the first gripping member 21 is disposed at a position overlapping the second through-hole 12 in a front view. In addition, as shown in Fig. 8, the first gripping member 21 is disposed at a position not overlapping the objective lens 215 and the forceps port 214 of the endoscope 200 in a front view.

[0055] 7, the first gripping member 21 has a first tip portion 21 a and a first main body portion 21 b, and is formed in a substantially T-shape in a plan view. The first tip portion 21 a is disposed closer to the tip side than the first main body portion 21 b.

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

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

[0058] The abutment pin 21c is provided at the base end of the first main body portion 21b, and abuts against the second gripping member 22 in the closed state to restrict the movable range of the second gripping member 22.

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

[0060] The second gripping member 22 is rotatably attached to the first gripping member 21 by an opening / closing rotation shaft 23. The second gripping member 22 has a U-shaped member 22a formed in a substantially U-shape, and a second main body portion 22b that rotatably supports the U-shaped member 22a.

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

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

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

[0064] 7, the second gripping member 22 has a field of view 25 penetrating in the opening and closing direction R between the staple receiving portion 4 on the distal end side and the opening and closing rotation shaft 23 on the proximal end side. In the present embodiment, the field of view 25 is a space surrounded by the sides of the U-shaped member 22a formed in a substantially U-shape.

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

[0066] 9, when the opening / closing operation wire 5 is moved backward toward the base end, the movable pin 27 rotates the second grasping member 22 around the opening / closing rotation shaft 23, and the grasping portion 2 is brought into a closed state. In other words, the opening / closing operation wire 5 is a member that transmits power to rotate the first grasping member 21 and the second grasping member 22 relative to each other, causing the grasping portion 2 to grasp the target tissue.

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

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

[0069] When the gripping portion 2 is in the open state, as shown in Fig. 10, the staple receiving portion 4 is located closer to the base end than the opening / closing rotation shaft 23. When the gripping portion 2 is in the open state, as shown in Figs. 7, 8 and 10, the staple releasing portion 3 and the staple receiving portion 4 are located on either side of the optical axis X1 of the objective lens 215.

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

[0071] 12 is a cross-sectional view of the gripping portion 2 including the staple discharge portion 3. The staple discharge portion 3 is provided at the first tip 21a of the first gripping member 21, and is capable of storing and discharging staples S. The staple discharge portion 3 has a staple storage portion 31, a rectilinear member (support member) 32, and a rotating member (push-out member) 33.

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

[0073] The staple storage section 31 opens upward B1 at an opening 31a provided in the upper surface 21e of the first tip portion 21a. The staples S are stored in the staple storage section 31 through the opening 31a. The staples S are stored in the staple storage section 31 with the needle tips S1 of the staples S facing upward B1.

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

[0075] The rectilinear member (support member) 32 is a member housed in the staple storage section 31 and is movable in the vertical direction B within the internal space of the staple storage section 31. The rectilinear member 32 has recesses 32a that support the staples S from the lower side B2. The staples S stored in the staple storage section 31 are fitted into the recesses 32a.

[0076] The first pulley (first member) 34 and second pulley 36 included in the rotating member 33 are rotatably attached inside the first gripping member 21, and by rotating, move the rectilinear member 32 in the up-down direction B. The tip of the discharge operation wire 6 is connected to the first pulley 34. By pulling the discharge operation wire 6, the first pulley 34 can be rotated.

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

[0078] The tip of the discharge operation wire 6 is connected to the first pulley 34 at a position B1 above the rotation shaft 35. The discharge operation wire 6 extends from the first pulley 34 through the second pulley 36, passing through the second through-hole 12, and to the discharge operation unit 270.

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

[0080] 13 is a cross-sectional view of the gripping portion 2 after the discharge operation wire 6 has been pulled. By pulling the discharge operation wire 6, the upper B1 of the first pulley 34 rotates toward the base end around the rotation shaft 35 as the center of rotation, and the lower B2 of the first pulley 34 rotates toward the tip end. As a result, the convex portion 38 of the first pulley 34 pushes the rectilinear member 32 upward B1, and the stored staples S are discharged upward B1 from the opening 31a. In other words, the discharge operation wire 6 is a member that transmits power to the gripping portion 2 to discharge the staples S. The rotating member 33 is an ejection mechanism that can eject the staples S.

[0081] The staple receiving portion 4 is provided on the underside 22f of the second tip portion 22c of the second gripping member 22. The staple receiving portion 4 is provided with a plurality of pockets 41 capable of receiving the staples S discharged from the staple discharging portion 3. In this embodiment, since two U-shaped staples are discharged from the staple discharging portion 3, four pockets are provided in the staple receiving portion 4. When the gripping portion 2 is in the closed state, as shown in Fig. 12, the opening 31a through which the staples S are discharged and the pockets 41 of the staple receiving portion 4 face each other in the up-down direction B.

[0082] 14 is a cross-sectional view of the gripping portion 2 and the cap 1 that have been advanced. Even in the advanced state, the gripping portion 2 is connected to the opening / closing operation wire 5 and the release operation wire 6 that are inserted through the wire sheath 280. The surgeon can advance and retract the opening / closing operation wire 5 and the release operation wire 6 even when the gripping portion 2 is advanced.

[0083] 14 is disposed at the most advanced position relative to the cap 1. In the wire sheath 280, the length Y1 of the distal end portion 285 that can protrude distally from the second through-hole 12 of the cap 1 is equal to or less than the length Y2 of the hard portion 211a in the distal end portion 211 of the endoscope 200.

[0084] [Operation of Medical Stapler 100] Next, an example of the operation of the medical stapler 100 will be described. Fig. 15 is a flowchart showing a procedure performed by an operator using the medical stapler 100. Figs. 16 to 19 are diagrams illustrating the operation of the medical stapler 100.

[0085] First, the surgeon starts a procedure using the medical stapler 100 (step S10). Next, the surgeon performs an attachment step S11. In the attachment step S11, the surgeon attaches the medical stapler 100 to the distal end portion 211 of the endoscope 200.

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

[0087] The surgeon also brings the distal end 211 of the endoscope 200, to which the medical stapler 100 is attached, close to the treatment target T (an example of target tissue). The surgeon operates the opening / closing operation unit 250 to advance the opening / closing operation wire 5, thereby opening the gripping unit 2. Because the optical axis X1 of the objective lens 215 passes through the field of view 25, the surgeon can observe the treatment target T through the imaging unit of the endoscope 200.

[0088] 16 is a diagram showing the operation of the protruding step S13 by the medical stapler 100. The surgeon performs the protruding step S13 to protrude the grasping forceps (treatment instrument) G from the forceps opening 214. In the protruding step S13, the central axis X2 of the forceps opening 214 passes through the field of view space 25, and therefore, as shown in FIGS. 11 and 16 , the surgeon can protrude the grasping forceps G from the forceps opening 214.

[0089] FIG. 17 is a diagram showing the operations of the medical stapler 100 in the advancing step S14, the grasping step S15, and the retracting step S16.

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

[0091] The surgeon also performs the grasping step S15, and grasps the treatment target T by protruding the grasping forceps G from the field of view (through-space) 25 of the gripping portion 2 that has been advanced.

[0092] 17 , the surgeon performs a retraction step S16, and retracts the grasping forceps G while grasping the treatment target T with the grasping forceps G. The surgeon retracts the grasping forceps G until the tip of the grasping forceps G passes through the field of view space (through-space) 25, thereby retracting the treatment target T until the treatment target T passes through the field of view space (through-space) 25.

[0093] As a result, the treatment target T is positioned closer to the proximal end than the staple discharge portion 3. The surgeon may pull in the treatment target T by advancing the gripping portion 2 relative to the gripping forceps G. In other words, the treatment target T is pulled in by retracting the gripping forceps G relatively to the gripping portion 2.

[0094] Here, as shown in FIG. 17, since the first grasping member 21 presses down on the periphery of the treatment target T, the surgeon can easily pull in the treatment target T with the grasping forceps G.

[0095] The advancing step S14 may be performed before the grasping step S15 or before the retracting step S16. In either case, the first grasping member 21 can press down on the periphery of the treatment target T in the retracting step S16.

[0096] FIG. 18 is a diagram showing the operation of the suturing step S17 by the medical stapler 100.

[0097] 18 , the surgeon performs the suturing step S17 and operates the opening / closing operation unit 250 to retract the opening / closing operation wire 5 and close the gripping unit 2. The treatment target T is clamped between the staple releasing portion 3 of the first gripping member 21 and the staple receiving portion 4 of the second gripping member 22.

[0098] When the gripping portion 2 is in a closed state, a portion of the treatment target T gripped by the gripping forceps G can be contained within the space (field of view space 25) formed by the U-shaped member 22a and the second main body portion 22b of the second gripping member 22, making it easy to fix the treatment target T clamped between the staple release portion 3 and the staple receiving portion 4.

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

[0100] 18 , with the treatment target T sandwiched between the staple discharge portion 3 and the staple receiving portion 4, the surgeon operates the discharge operation portion 270 to pull the discharge operation wire 6 and discharge the stored staples S toward the staple receiving portion 4. The needle tips S1 of the staples S penetrate the treatment target T and are bent by contacting the pockets 41 of the staple receiving portion 4. As a result, the treatment target T is sutured with the staples S.

[0101] FIG. 19 is a diagram showing the operation of the medical stapler 100 in the removal step S18.

[0102] The surgeon performs the removal step S18, and operates the opening / closing operation unit 250 to open the grasping unit 2 again, as shown in Fig. 19. The surgeon then removes the grasping forceps G from the treatment target T, completing the suturing treatment. The surgeon then removes the medical stapler 100 and the endoscope 200 from the body.

[0103] In the insertion step S12 and the removal step S18, the surgeon positions the gripping portion 2 at the most retracted position so that the medical stapler 100 can easily pass through the body.

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

[0105] Here, the cartridge 30 will be described. The operation in the reloading step S20 will be described later.

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

[0107] 20 , the staple discharger 3 has a cartridge 30 having a staple storage section 31. The cartridge 30 is a member detachably provided on the first tip 21 a of the first gripping member 21, and is a separate member from the first gripping member 21.

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

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

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

[0111] The snap fit portion 133 has a snap fit 133a that is provided inward in the width direction C from the pair of through holes 134. The snap fit 133a has a thin rod shape that extends in the up-down direction B, and a locking portion 133b that protrudes outward in the width direction C is formed on the lower B2 side.

[0112] The locking portion 133b has a triangular shape when viewed from the axial direction A, and the apex q that protrudes most in the width direction C is non-sharp. Both outer sides of the locking portion 133b in the width direction C are chamfered, and a connecting surface 133e is formed as a smoothly curved surface that connects the outer surface 133c and the lower end surface 133d.

[0113] The through-holes 134 penetrate the first member 131 in the thickness direction. The through-holes 134 include a first through-hole 134a formed in the first member 131 on the outer side of the snap fit 133a in the width direction C, a second through-hole 134b formed on the inner side of the snap fit 133a in the width direction C, and a third through-hole 134c formed below the snap fit 133a at a position B2.

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

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

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

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

[0118] It is preferable that the width of the second through hole 134b is such that when the straight-moving member 32 passes through the engaging portion 133b of the snap fit 133a in the vertical direction B, the snap fit 133a displaced in the width direction C does not abut against the inner surface 134d of the second through hole 134b.

[0119] 21 and 24, the protruding portion 32c of the linear-movement member 32 is inserted into the third through-hole 134c. The protruding portion 32c is a rectangular pillar-shaped convex portion of the linear-movement member 32 that protrudes toward the front A1 in the axial direction A, and abuts against the lower end of the snap fit 133a from the lower B2 side.

[0120] The protrusion 32c of the linear-movement member 32 has a generally rectangular shape when viewed from the front A1 side, and a pair of corners on the upper B1 side are rounded and chamfered. The rounded surface 32d of the protrusion 32c abuts against the locking portion 133b of the snap fit 133a located on the upper B1 side from the lower B2 side.

[0121] The protruding length of the protruding portion 32c along the axial direction A is approximately equal to the thickness of the snap fit 133a. Note that the protruding length of the protruding portion 32c along the axial direction A and the thickness of the snap fit 133a may be different dimensions as long as the rigidity of both can be ensured.

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

[0123] The through hole 135 is formed at a position opposite to the through hole 134 of the first member 131 in the axial direction A. The through hole 135 penetrates the second member 132 in the thickness direction. The through hole 135 is formed long in the up-down direction B and is approximately equal to the combined length of the first through hole 134a and the third through hole 134c of the first member 131. The through hole 135 opens to the lower surface of the second member 132. As shown in FIG. 25 , a protrusion 32g protruding rearward A2 from the rectilinear member 32 is inserted into the through hole 135.

[0124] 23 , the positioning hole 136 is an elongated hole formed in the up-down direction B, which is narrower than the through-hole 135 and has a shorter length than the through-hole 135. The positioning hole 136 is formed in approximately the center of the second member 132 in the up-down and left-right directions.

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

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

[0127] The lower surface (lower B2 surface) 139a of the pushing portion 139 is a flat surface extending in the axial direction A and the width direction C. At the tip of the pushing portion 139, which is bent in an L-shape in the width direction C, the upper B1 corner is chamfered to form a sloped portion 139b. Therefore, the dimension of the through hole 135 between the sloped portions 139b in the width direction C becomes narrower as it goes downward B2. The dimension of the through hole 135 between the sloped portions 139b in the width direction C is also smaller than the dimension of the protrusion 38 of the first pulley 34 in the width direction C.

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

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

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

[0131] 26A shows a state in which the discharge operation wire 6 is pulled to rotate the first pulley 34, and the rectilinear member 32 is moved upward B1 by the convex portion 38 of the first pulley 34. At this time, the convex portion 38 of the first pulley 34 is inserted into the through-hole 135 of the second member 132.

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

[0133] 26B , the surgeon moves the cartridge 30 upward B1 relative to the first gripping member 21. At this time, the convex portion 38 of the first pulley 34 moves the through hole 135 downward B2 relative to the cartridge 30. Note that the surgeon may move the cartridge 30 by grasping it with his / her hand, or may move the cartridge 30 using a jig or tool or the like.

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

[0135] 26B , the surgeon further moves the cartridge 30 upward B1, causing the convex portions 38 to be pressed from above B1 against the sloped portions 139b of the pair of pushing portions 139 in the second member 132. As the convex portions 38 are pressed against the sloped portions 139b from above B1, the pair of pushing portions 139 move in a direction away from the convex portions 38 in the width direction C. At this time, the pushing portions 139 move in the width direction C due to the elasticity of the material, for example.

[0136] When the protrusions 38 are pressed against the pair of push-in portions 139, the pair of push-in portions 139 move away from each other in the width direction C, and the protrusions 38 pass from upper B1 to lower B2 between the pair of push-in portions 139 in the through-holes 135 (slits). That is, the gap between the pair of push-in portions 139 in the width direction C is widened to the right C1 and left C2 in the width direction C by the protrusions 38, and the protrusions 38 pass downward B2 while widening the gap between the pair of push-in portions 139.

[0137] After the protrusion 38 passes between the pair of push-in portions 139, the pair of push-in portions 139 return to their original positions due to the elasticity of the material. That is, the pair of push-in portions 139 approach each other in the width direction C and return to the position shown in FIG.

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

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

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

[0141] Next, with reference to Figures 27A to 27C, the operation of reloading the cartridge 30 into the staple discharging section 3 after removing the cartridge 30 from the staple discharging section 3 will be described.

[0142] Fig. 27A is a cross-sectional view showing the operation subsequent to Fig. 26D in the reloading step S20 of the medical stapler. The operation shown in Fig. 27A is the operation of reloading the cartridge 30 into the staple discharge portion 3 from which the cartridge 30 was removed.

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

[0144] 27A , the surgeon inserts the cartridge 30 to be reloaded from above B1 into the recess 21g of the first gripping member 21. At this time, since staples S are stored in the staple storage portion 31 of the cartridge 30, the rectilinear member 32 is in a state of having moved downward B2 relative to the staple storage portion 31.

[0145] 27A , when the cartridge 30 is reloaded, the lower surface 139a of the pushing portion 139 of the second member 132 abuts against the convex portion 38 from above B1. Therefore, when the cartridge 30 is moved downward B2 relative to the first gripping member 21, the convex portion 38 is pushed downward B2 by the pushing portion 139, causing the first pulley 34 to rotate. At this time, the surgeon is not operating the release operation wire 6.

[0146] 27B is a cross-sectional view showing the operation subsequent to that shown in FIG. 27A in the reloading step S20 of the medical stapler. As shown in FIG. 27B, when the cartridge 30 is further moved downward B2 from the state shown in FIG. 27A, the convex portion 38 of the first pulley 34 is pushed by the pushing portion 139, and further rotates, moving downward B2.

[0147] 27C is a cross-sectional view showing the operation subsequent to that shown in FIG. 27B in the reloading step S20 of the medical stapler. As shown in FIG. 27C, when the cartridge 30 is further moved downward B2 from the state shown in FIG. 27B, the convex portion 38 of the first pulley 34 is pushed by the pushing portion 139 and rotates further, and moves further to the base end side than the pushing portion 139.

[0148] Since the convex portion 38 is located closer to the base end than the pushing portion 139, the pushing portion 139 can move to a position B2 below the convex portion 38. Therefore, the cartridge 30 can be fully inserted into the first gripping member 21, and the cartridge 30 can be attached to the staple discharge portion 3. At this time, the convex portion 38 and the rectilinear member 32 are not in contact with each other.

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

[0150] 27C is referred to as a "first position." The first position is the initial position of the rotating member 33. That is, in the reloading step S20, the surgeon can return the rotating member 33 to the initial position by attaching the cartridge 30 to the staple discharger 3.

[0151] After the cartridge 30 containing the staples S is reloaded into the staple discharge portion 3 in the reloading step S20, the surgeon returns to the insertion step S12 and performs the subsequent steps again. For example, if all suturing of the treatment target T has not been completed in the first suturing step S17, the surgeon performs the suturing treatment again using the staples S contained in the cartridge 30 reloaded in the reloading step S20.

[0152] When the steps from the insertion step S12 onwards are to be performed again after the reloading step S20, the surgeon operates the discharge operation wire 6 to rotate the rotation member 33 in the suturing step S17.

[0153] At this time, since the rotating member 33 is located at the first position by the reloading step S20, the surgeon pulls the discharge operation wire 6 to bring the convex portion 38 into contact with the linear member 32, resulting in the state shown in FIG.

[0154] The surgeon further pulls the discharge operation wire 6 to fire the staples S from the staple discharge section 3 and performs the suturing treatment again. At this time, as described above, the rotating member 33 has rotated to the position shown in Fig. 26A. Here, the position of the rotating member 33 shown in Fig. 26A is referred to as the "second position." That is, the second position of the rotating member 33 is the position at which the staples S are fired from the staple discharge section 3.

[0155] The rotating member 33 can be rotated from a first position, which is an initial position, to a second position where the staples S are fired, by advancing and retracting the discharge operation wire 6. Furthermore, in the reloading step S20, when the cartridge 30 is removed from the staple discharge section 3, the rotating member 33 is located at the second position. Furthermore, when the cartridge 30 is attached to the staple discharge section 3, the rotating member 33 rotates from the second position to the first position and returns to the initial position.

[0156] In the reloading step S20, when the cartridge 30 is removed from the staple discharging section 3, the pushing portion 139 of the cartridge 30 moves from the lower side B2 to the upper side B1 of the rotating member 33 located at the second position. When the cartridge 30 is attached to the staple discharging section 3, the pushing portion 139 pushes the rotating member 33 located at the second position from the upper side B1 to the lower side B2, thereby rotating the rotating member 33 to the first position and returning it to the initial position.

[0157] In this way, after the suturing step S17, the surgeon removes the cartridge 30 from the staple discharge portion 3 and attaches the cartridge 30 containing the staples S to the staple discharge portion 3, thereby reloading the staples S into the medical stapler 100 and continuing the suturing treatment. Furthermore, because the action of attaching the cartridge 30 to the staple discharge portion 3 returns the rotating member 33 to the initial position (first position), the surgeon (operator) can easily return the rotating member 33 to the initial position and can easily recognize that the rotating member 33 has been returned to the initial position.

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

[0159] When the reloading step S20 is performed to perform a suturing procedure multiple times, there is a risk that the surgeon may have difficulty visually recognizing the staple S used for suturing at the already sutured portion. Therefore, it is preferable to provide the staple S used in the medical stapler 100 with a marking member to improve visibility.

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

[0161] The marking member M is formed of a material that is enhanced by image-enhancing light, such as NBI or AFI. NBI is a technology (method) that highlights capillaries on the mucosal surface and fine mucosal patterns by irradiating light of two narrow-band wavelengths that are easily absorbed by hemoglobin in blood. NBI focuses on the use of light that is both strongly absorbed by blood and strongly reflected and scattered by the mucosal surface to observe blood vessels with high contrast. Narrow-band blue light (390-445 nm) is used to observe capillaries on the mucosal surface, and narrow-band green light (530-550 nm) is used to enhance the contrast between the observation of thick blood vessels deep inside and the capillaries on the mucosal surface.

[0162] For example, when light hits a solid, the wavelengths of light specific to the solid material are absorbed. Also, the wavelengths of light that are not absorbed by the solid material are reflected. Because the wavelengths of light that are not absorbed by the material reach the human eye, the color of the wavelengths of the reflected light is perceived as the color of the material. Therefore, the color of the solid material is the complementary color of the color of the light absorbed by the solid material.

[0163] Therefore, by using a color for the marking member M that is less likely to absorb the NBI light, the marking member M can be emphasized. Specifically, the marking member M can be emphasized by using a violet or green color. Also, by using a violet or green color for the staples S, not only the marking member M but also the staples S can be emphasized.

[0164] The means for highlighting the staples S and the marking material M are not limited to the method using NBI, but for example, a fluorescent substance such as ICG, which is excited to fluoresce when irradiated with near-infrared light, may be used in the staples S and the marking material M to highlight them.

[0165] The dimensions of the marking member M need only be such that the surgeon can visually recognize it through the imaging unit of the endoscope 200. For example, if the marking member M is made of a material that is enhanced by image-enhancing light, the marking member M may be smaller than the staples S. Even if the marking member M is small, visibility can be improved by enhancing it with image-enhancing light. It is preferable that the marking member M be made of a biocompatible material.

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

[0167] Furthermore, when the staples S to which the marking members M are fixed are housed in the cartridge 30, it is preferable that the cartridge 30 has a space (recess) in which the marking members M can be accommodated. For example, by forming the recess 32a of the rectilinear member 32 into a shape that can accommodate the marking members M, the cartridge 30 can have a recess in which the marking members M can be accommodated. It is preferable that the marking members M have a dimension (width) that can be accommodated in the recess that the cartridge 30 has.

[0168] As described above, the staple S has the marking member M, which can improve the visibility of the staple S. The marking member M may be any member that can improve the visibility of the staple S, and a resin member, a metal member, a tape-like member, a thread-like member, or the like can be used as the marking member M.

[0169] The medical stapler 100 of this embodiment is provided with a staple ejection section 3 having a rotating member 33 (ejection mechanism) that can rotate (move) between a first position, which is an initial position, and a second position where the staples S are ejected, by moving the ejection operation wire 6 back and forth, and a cartridge 30 that is detachably provided on the staple ejection section 3.

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

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

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

[0173] Although one embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like are also included within the scope of the present invention. Furthermore, the components shown in the above-described embodiment and the following modified examples can be appropriately combined to form a configuration.

[0174] (Modification 1) In the above embodiment, the cartridge 30 is rotated to the first position by being pushed by the pushing portion 139, but the cartridge is not limited to this.

[0175] The cartridge may be configured such that the rectilinear member 32 pushes the rotation member 33 downward B2, thereby rotating the rotation member 33 to the first position. In this case, the cartridge does not have the pushing portion 139.

[0176] Furthermore, when the rotary member 33 is pushed in by the linear member 32, there is a risk that the linear member 32 will move upward B1 by the rotary member 33. When the rotary member 33 is pushed in by the linear member 32, for example, by inserting a cover member that restricts the movement of the linear member 32 upward B1 into the staple storage section 31 from the upper side B1, it is possible to prevent the rotary member 33 from moving the linear member 32 upward B1.

[0177] In this case, when attaching the cartridge to the staple discharging section 3, the cover member is inserted into the staple storage section 31 of the cartridge from above B1 and fixed. After attaching the cartridge to the staple discharging section 3 in a state in which the cover member restricts the movement of the rectilinear member 32 in the upward direction B1, the surgeon removes the cover member from the cartridge. By removing the cover member, the rectilinear member 32 can move in the upward direction B1, and the staples S can be fired.

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

[0179] The visibility of the staples may be improved by coating the surfaces of the staples with a material that is enhanced by image-enhancing light, or by forming the staples with a material that is enhanced by image-enhancing light.

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

[0181] The recesses of the cartridge may be fitted with the staples S, and when the staples S are fired, the recesses may be connected to the staples S and fired from the staple discharge portion 3 together with the staples S. In a suturing treatment, the staples S are fired in a connected state with the recesses, and the treatment target T is sutured, thereby improving the visibility of the staples S by the recesses. At this time, the recesses may be connected (coupled) with the staples S when the staples S fired from the staple discharge portion 3 are pressed against the pockets 41 of the staple receiving portion 4 and deformed.

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

[0183] 300 Medical system 200 Endoscope 210 Insertion section 250 Opening / closing operation section 270 Discharge operation section 100 Medical stapler 5 Opening / closing operation wire 6 Discharge operation wire (wire) 2 Grip section (suturing section) 21 First gripping member 22 Second gripping member 3 Staple discharge section 30 Cartridge 32 Linear member (support member) 32a Recessed section 33 Rotating member (ejection mechanism) 34 First pulley (first member) 36 Second pulley 38 Convex section (contact section) 135 Through hole (slit) 139 Push-in section 4 Staple receiving section A Axial direction B Vertical direction B1 Upward B2 Downward S Staple M Marking member

Claims

1. A medical stapler provided at the tip of an endoscope, a wire extending in the axial direction of the endoscope; a staple ejection section including a cartridge capable of accommodating staples and an ejection mechanism connected to the tip of the wire and capable of ejecting the staples from the cartridge; Equipped with the cartridge is detachably provided in the staple discharge portion, The injection mechanism includes: The wire can be operated to move from a first position, which is an initial position, to a second position where the staple is fired, When the cartridge is removed from the staple discharge portion, it is located in the second position; When the cartridge is attached to the staple discharger, it moves from the second position to the first position. Medical stapler.

2. the cartridge has a support member that supports the staples from below and is movable in the up and down direction, When the wire is pulled, the injection mechanism moves the support member from the lower side to the upper side while moving from the first position to the second position, The staples are driven upward from the staple discharge portion by the support member.

2. The medical stapler according to claim 1.

3. the cartridge has a pushing portion located below the support member, The pushing portion is When the cartridge is removed from the staple discharge portion, the firing mechanism moves from the lower position to the upper position, the firing mechanism being positioned at the second position; When the cartridge is attached to the staple discharge portion, the firing mechanism located at the second position is moved to the first position by pushing the firing mechanism from the upper side to the lower side.

3. The medical stapler according to claim 2.

4. The pushing portion is The slit is open downward, When the cartridge is removed from the staple discharge portion, the firing mechanism passes through the slit, thereby moving from the lower portion to the upper portion of the firing mechanism.

4. The medical stapler according to claim 3.

5. The cartridge is attached to the staple discharge portion in a state in which the staples are housed therein.

2. The medical stapler according to claim 1.

6. the injection mechanism is rotatable between the first position and the second position; 2. The medical stapler according to claim 1.

7. a cover member that restricts upward movement of the staples and is detachable from the cartridge; The cartridge comprises: The staple discharger is attached to the staple discharge portion with the cover member attached, the cover member is removed when the injection mechanism moves from the second position to the first position; 2. The medical stapler according to claim 1.

8. The cartridge is capable of accommodating the staples, which are substantially U-shaped and have an opening at the top, A marking member including a material that is highlighted by image highlighting light is connected below the staple.

2. The medical stapler according to claim 1.

9. the staple includes a material that is highlighted by image-enhancing light; 9. The medical stapler according to claim 8.

10. The dimension of the portion of the marking member protruding from the staple is larger than the wire diameter of the staple.

9. The medical stapler according to claim 8.

11. the cartridge has a support member that supports the staples from below and is movable in the up and down direction, The support member has a recess capable of accommodating the marking member.

9. The medical stapler according to claim 8.

12. The marking member has a size that allows it to be accommodated in the recess. The medical stapler of claim 11.

13. The marking member is fixed to the staple.

9. The medical stapler according to claim 8.

14. When the ejection mechanism moves from the first position to the second position, the support member is connected to the staple and is ejected upward from the staple ejection portion together with the staple.

3. The medical stapler according to claim 2.

15. the support member has a recessed portion formed with a groove shape recessed downward so that the staple can be supported from below, The diameter of the groove shape in the recess is slightly smaller than the diameter of the staple.

15. The medical stapler of claim 14.

16. the support member has a recessed portion formed with a groove shape recessed downward so that the staple can be supported from below, The recess has a groove shape in which at least a portion of the upper opening is smaller than a diameter of the staple.

15. The medical stapler of claim 14.

17. the support member has a recessed portion formed with a groove shape recessed downward so that the staple can be supported from below, The recess has a claw portion capable of fixing the staple to the upper opening of the groove shape.

15. The medical stapler of claim 14.