CN111671480B - Endoscopic stapling device for performing fundoplication - Google Patents
Endoscopic stapling device for performing fundoplication Download PDFInfo
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- CN111671480B CN111671480B CN202010533229.7A CN202010533229A CN111671480B CN 111671480 B CN111671480 B CN 111671480B CN 202010533229 A CN202010533229 A CN 202010533229A CN 111671480 B CN111671480 B CN 111671480B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/309—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using white LEDs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2560/00—Constructional details of operational features of apparatus; Accessories for medical measuring apparatus
- A61B2560/04—Constructional details of apparatus
- A61B2560/0462—Apparatus with built-in sensors
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Abstract
The invention discloses an endoscope nailing device for implementing a fundoplication, which comprises a handle, a conical protective sleeve, an insertion tube, a rigid section, a bending part and a top end part, wherein the front end of the handle is fixedly connected with the insertion tube through the conical protective sleeve, and the front end of the insertion tube is sequentially and fixedly connected with the rigid section, the bending part and the top end part; the side part of the rigid section and the end part of the top end part form a nailing mechanism; the top end part is provided with a miniature camera, an ultrasonic detector and a surgical stapling device; by controlling the bending angle of the bending portion by the handle, the end face of the distal end portion can be made to correspond to the side face of the rigid segment, and the distal end portion can be brought into the stapled state. The invention can be used for endoscopic surgical fundus folding minimally invasive stapling operation, and is a treatment technology for resisting gastroesophageal reflux disease. The whole operation process is operated under the endoscope stapler system, and can be completed within 1-2 hours, so that the compliance of patients is high, and the wound is small. Is a more attractive treatment technique than traditional surgical or life-long administration of gastroesophageal reflux disease.
Description
Technical Field
The invention relates to a minimally invasive surgical treatment instrument, in particular to an endoscopic stapling device for performing fundoplication.
Background
Gastroesophageal reflux disease (GERD) refers to reflux of excessive contents of the stomach or duodenum into the esophagus, causing symptoms such as acid regurgitation, heartburn, etc., and can cause esophagitis and tissue damage outside the esophagus such as pharynx, larynx, trachea, etc. Gastroesophageal reflux disease (GERD) is a common disease in western countries, and research has shown that the incidence of gastroesophageal reflux disease in western countries is about 10% to 20% and the incidence in australia is about 11.6% and asian countries is about 5% in recent years. The incidence rate increases with the age, 40-60 years of age is the peak incidence age, and men and women have no difference, but the patients with reflux esophagitis have more men and women. Along with the improvement of the living standard of residents, the requirements of people on the living quality are continuously improved, and statistics of the digestion disease school of China show that the incidence rate of the gastroesophageal reflux in China is 5.77%. For patients with gastroesophageal reflux disease in general, it can be cured by changing lifestyle or medication. However, for patients with cardiac relaxation or hiatus hernia, some of them have poor effects after treatment with drugs, some of them can only solve part of the symptoms after treatment with drugs, and some of them need to take medicine for a long period of time, and for such patients, surgical treatment is necessary. Studies show that about 25% -30% of GERD patients have poor drug treatment effect or cannot tolerate long-term administration, and a surgical treatment mode is needed.
The existing operation treatment of the gastroesophageal reflux disease generally adopts a laparoscopic fundoplication or endoscopic stitching technology and a radio frequency ablation technology, and can solve the problem of repeated symptom attacks, but the postoperative is often accompanied by complications, and the postoperative life quality is greatly influenced, so that the mode of the operation treatment of the gastroesophageal reflux disease is not popularized, and once the gastroesophageal reflux disease is suffered, the life quality of a patient is obviously reduced.
Disclosure of Invention
The technical problem to be solved by the invention is to provide an endoscopic stitching device for performing a fundoplication, which can be used for minimally invasive treatment of gastroesophageal reflux disease under an endoscope.
In order to solve the technical problems, the technical solution of the endoscopic stitching device for performing the fundoplication of the invention is as follows:
the device comprises a handle 1, a conical protective sleeve 2, an insertion tube 3, a rigid section 4, a bending part 5 and a top end part 6, wherein the front end of the handle 1 is fixedly connected with the insertion tube 3 through the conical protective sleeve 2, and the front end of the insertion tube 3 is sequentially and fixedly connected with the rigid section 4, the bending part 5 and the top end part 6; the side part of the rigid section 4 and the end part of the top end part (6) form a nailing mechanism; by controlling the bending angle of the bending portion 5 by the handle 1, the end face of the distal end portion 6 can be made to correspond to the side face of the rigid section 4, thereby bringing the distal end portion 6 into the stapled state; the side surface of the rigid section 4 is provided with a nail bin seat assembly, and M titanium nail accommodating grooves 4-3-1 are formed in the nail bin seat assembly; the end face of the top end part 6 is fixedly provided with a cutting board 6-2; when the top end part 6 is in a nailing state, the titanium nail containing groove 4-3-1 on the nail bin seat assembly corresponds to the chopping board 6-2 of the top end part 6; the rigid section 4 comprises a rigid section shell 4-1, a nail bin seat groove 4-1-1 extending along the axial direction is formed in the side part of the rigid section shell 4-1, and a titanium nail firing part 4-7 is movably arranged in the nail bin seat groove 4-1-1; one end of the titanium nail firing part 4-7 is fixedly connected with one end of the transmitting steel wire 4-8, and the other end of the transmitting steel wire 4-8 is connected with the handle 1; a nail bin seat assembly is arranged in the nail bin seat groove 4-1-1, the titanium nail accommodating groove 4-3-1 is formed in the nail bin seat assembly, the titanium nail accommodating groove 4-3-1 is movably provided with a titanium nail 4-4 and a propeller 4-6, and the propeller 4-6 is positioned at the inner side of the titanium nail 4-4; the nail bin seat assembly is positioned at the outer side of the titanium nail firing part 4-7; the handle 1 pulls the transmitting steel wire 4-8 to drive the titanium nail firing part 4-7 to move forwards along the nail bin seat groove 4-1, and the titanium nail firing part 4-7 pushes the titanium nail 4-4 to move outwards and leave the titanium nail accommodating groove 4-3-1 through the propeller 4-6, so that the firing of the titanium nail 4-4 is realized; the top end part 6 comprises a top end seat 6-1, a cutting board 6-2 is fixedly arranged on the end face of the top end seat 6-1, and the surface of the cutting board 6-2 protrudes out of the end face of the top end seat 6-1; the surface of the chopping board 6-2 is arc-shaped, and the arc-shaped surface of the chopping board 6-2 is matched with the side part of the rigid section 4; a plurality of groups of titanium nail bending guide grooves are distributed on the surface of the cutting board 6-2, and each group of titanium nail bending guide grooves comprises two parallel bending guide grooves; the positions of the titanium nail bending guide grooves of each group are in one-to-one correspondence with the titanium nail accommodating grooves 4-3-1 of the nail bin seat 4-3; in the process that the titanium nails 4-4 leave the titanium nail accommodating grooves 4-3-1, the nail legs of the titanium nails 4-4 contact the surface of the chopping board 6-2, the chopping board 6-2 provides bending reaction force for the titanium nails 4-4, and the nail legs are guided by the bottoms of the bending guide grooves, so that the two nail legs of the same titanium nail 4-4 are bent, and the titanium nails 4-4 are deformed into a nailing shape, so that the nailing action is completed.
In another embodiment, the nail bin seat assembly comprises a nail bin seat 4-3, the nail bin seat 4-3 is provided with a titanium nail accommodating groove 4-3-1, and the titanium nail accommodating groove 4-3-1 is communicated in the radial direction, so that a titanium nail firing member 4-7 positioned at the inner side of the nail bin seat 4-3 can contact with a propeller 4-6 in the titanium nail accommodating groove 4-3-1; an end positioning pin 11 is movably arranged in the top end part 6, the end positioning pin 11 is connected with the top end seat 6-1 through threads, the end positioning pin 11 is fixedly connected with a positioning pin driving motor, and the positioning pin driving motor can drive the end positioning pin 11 to rotate so that the end positioning pin 11 extends outwards or retracts from the top end part 6; the nail bin seat 4-3 is provided with a positioning pin hole 4-3-3 matched with the end positioning pin 11, and the hole depth of the positioning pin hole 4-3-3 is smaller than the length of the end positioning pin 11 extending out of the top end 6; when the end locating pin 11 extends outwards from the top end 6, the tip end of the end locating pin 11 extends into the locating pin hole 4-3-3 of the cartridge seat 4-3, so that the relative positioning between the top end 6 and the rigid section 4 is realized.
In another embodiment, two ends of the chopping board 6-2 are respectively provided with a chopping board screw penetrating hole 6-2-1, chopping board screws 6-3 are movably arranged in the chopping board screw penetrating holes 6-2-1, and the chopping board screws 6-3 are connected with a chopping board screw driving mechanism; the chopping board screw driving mechanism can enable the chopping board screw 6-3 to extend outwards or retract from the chopping board 6-2; two chopping board screw matching holes 4-3-4 corresponding to the chopping board screws 6-3 are formed in the nail bin seat 4-3; the depth of the matching holes 4-3-4 of the chopping board screw is smaller than the length of the chopping board screw 6-3 extending out of the chopping board 6-2; when the chopping board screw 6-3 extends outwards from the chopping board 6-2, the tip of the chopping board screw 6-3 extends into the chopping board screw matching hole 4-3-4 of the cartridge seat 4-3, so that the relative positioning between the top end part 6 and the rigid section 4 is realized.
In another embodiment, when the end positioning pin 11 is extended to the position, a first interval H1 is formed between the end surface of the top end part 6 and the side surface of the rigid section 4, and the first interval H1 is the thickness of two layers of tissues; when the chopping board screw 6-3 stretches out in place, a second interval H2 is formed between the end face of the top end part (6) and the side face of the rigid section 4, and the second interval H2 is the nailing thickness of the titanium nail 4-4; the first pitch H1 > the first pitch H2.
In another embodiment, the anvil screw drive mechanism comprises: a chopping block drive shaft 6-4 which is rotatable under power; a driving gear is arranged on the chopping board driving shaft 6-4; a driven gear 6-5 engaged with the driving gear; chopping board screws 6-3 fixedly connected with the driven gears 6-5; the chopping board screw 6-3 is movably arranged in the chopping board screw penetrating hole 6-2-1 of the chopping board 6-2 in a penetrating way; the chopping board screw guide seat 6-6 is fixedly arranged at the bottom of the chopping board 6-2; the chopping board screw guide seat 6-6 is connected with the chopping board screw 6-3 through threads.
In another embodiment, the titanium nail firing member 4-7 comprises N firing plates 4-7-1 arranged in parallel; the firing plate 4-7-1 is provided with a first plane 4-7-11, a pushing inclined plane 4-7-12 and a second plane 4-7-13, the second plane 4-7-13 is higher than the first plane 4-7-11, and a height difference is formed between the second plane 4-7-13 and the first plane 4-7-11; one end of the titanium nail firing piece 4-7 forms a steel wire connecting part 4-7-2; in the initial state, the titanium nail firing part 4-7 is positioned at the rear end of the nail bin seat groove 4-1, and the titanium nail 4-4 and the propeller 4-6 in the titanium nail accommodating groove 4-3-1 are positioned above the first plane 4-7-11 of the firing plate 4-7-1; when in firing, the transmitting steel wire 4-8 is pulled to drive the titanium nail firing part 4-7 to move forward for a certain stroke along the nail bin seat groove 4-1-1; during the forward movement of the titanium nail firing member 4-7, the pushing inclined surface 4-7-12 of the titanium nail firing member 4-7 contacts the pusher 4-6, thereby pushing the titanium nail 4-4 to move outwards through the pusher 4-6; when the titanium nail firing member 4-7 moves to the front end of the nail bin seat groove 4-1-1, the second plane 4-7-13 of the titanium nail firing member 4-7 contacts the pusher 4-6, and the titanium nail 4-4 completes the firing stroke; at the moment, the titanium nail firing part 4-7 pushes the pusher 4-6 to the top of the titanium nail accommodating groove 4-3-1, and the pusher 4-6 pushes the titanium nail 4-4 out of the titanium nail accommodating groove 4-3-1, so that the firing of the titanium nail 4-4 is realized.
In another embodiment, in the initial state, a gap is formed between the propeller 4-6 and the first plane 4-7-11.
In another embodiment, the bending angle of the bending part (5) ranges from 0 DEG to 270 deg.
In another embodiment, the bottom of the propeller 4-6 is provided with a chute 4-6-2, the rear part of the propeller 4-6 forms a guiding part 4-6-3, and the bottom of the guiding part 4-6-3 forms a guiding inclined plane 4-6-12; the front part of the propeller 4-6 is provided with a limit part 4-6-4; the bottom surface of the limiting part 4-6-4 is matched with the second plane 4-7-13 of the titanium nail firing part 4-7; the inclination of the guide inclined plane 4-6-12 is matched with the pushing inclined plane 4-7-12 of the firing plate 4-7-1; the titanium nail firing member 4-7 can push the titanium nail pusher to move outwards through the cooperation between the pushing inclined plane 4-7-12 and the guiding inclined plane 4-6-12 during the movement process.
In another embodiment, the bottom of the bending guide groove is arc-shaped with high ends and low middle; the length of the bending guide groove is smaller than the length of the nail leg of the titanium nail 4-4; the length difference between the nail leg and the bending guide groove is the nailing thickness of the titanium nail.
The invention has the following technical effects:
the invention ensures that part of the fundus is folded outside the lower esophageal segment by controlling the movement of the top end part, and the fundus and the lower esophageal segment are stapled and fixed together, thereby forming a new acute His angle around the esophagus, strengthening the cardiac anti-reflux barrier and preventing gastroesophageal reflux. The invention is suitable for treating moderate to severe gastroesophageal reflux disease.
The invention determines the positions of the nail bin and the top end of the endoscope through the ultrasonic detector for positioning, thereby accurately determining the nailing position of the fundus and the esophagus. Therefore, the invention can restore the His angle and the gastroesophageal flap valve without folding and stapling the whole fundus to the esophagus, and only three positions are selected to fold and staple the fundus and the esophagus, thereby establishing an effective barrier for preventing gastroesophageal reflux and playing a role in resisting reflux of gastric contents. Therefore, the partial fundoplication performed by the invention can achieve the therapeutic effect of the whole fundoplication of the prior art.
The invention can be used for endoscopic surgical fundus folding minimally invasive stapling operation, can be used for treating gastroesophageal reflux disease, does not need to cut abdominal cavity or any body surface incision in the whole use process, is similar to conventional gastroscopy, selects a stitching position from oral cavity to fundus through esophagus, enters a scope to the fundus, utilizes a visualized internal camera to determine the positions of a staple box and the top end of the endoscope through an ultrasonic detector, and then staples the fundus to the lower esophageal section at more than 2 positions to perform anterior angle fundus folding operation.
Drawings
It will be appreciated by those skilled in the art that the following description is merely illustrative of the principles of the invention, which can be applied in numerous ways to implement many different alternative embodiments. These descriptions are only intended to illustrate the general principles of the teachings of the present invention and are not meant to limit the inventive concepts disclosed herein.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description given above and the detailed description of the drawings given below, serve to explain the principles of the invention.
The invention is described in further detail below with reference to the attached drawings and detailed description:
FIG. 1 is a schematic view of an endoscopic stapling device for performing a fundoplication procedure in accordance with the present invention;
FIGS. 2 to 8 are schematic views of the operation of the present invention;
FIG. 9 is a schematic view of the titanium staple of the present invention, the titanium staple being shown in an original state;
FIG. 10 is a schematic view of the titanium staple of the present invention, shown in a stapled state;
FIG. 11 is a schematic view of a rigid segment of the present invention;
FIG. 12 is an exploded schematic view of the rigid segment assembly of the present invention;
FIG. 13 is a schematic cross-sectional view of the rigid segment assembly of the present invention with the titanium staple firing mechanism in an unfired state;
FIG. 14 is a schematic view of a titanium staple firing member of the present invention;
FIG. 15 is an exploded schematic view of the cartridge seat assembly of the present invention;
FIG. 16 is a schematic view of a cartridge housing of the present invention;
FIG. 17 is a schematic view of a propeller of the present invention;
FIG. 18 is a schematic illustration of the relative positions of the titanium staple firing mechanism of the present invention and the titanium staple in an unfired state;
FIG. 19 is a schematic view of the titanium staple firing mechanism of the present invention in an unfired state with the titanium staples and the pusher in the cartridge receptacle;
FIG. 20 is a schematic view of the titanium staple firing mechanism of the present invention in a firing process;
FIG. 21 is a schematic view of the titanium staple firing mechanism of the present invention and one of the titanium staples during firing;
FIG. 22 is a schematic cross-sectional view of a rigid section of the present invention with the titanium staple firing mechanism in a fired state with the titanium staples exiting the cartridge bay;
FIG. 23 is a schematic view of the relative positions of the titanium staple firing mechanism of the present invention and the titanium staple in the fired state
FIG. 24 is a schematic illustration of the relative positions of a titanium staple and pusher and a cartridge seat of the titanium staple firing mechanism of the present invention in a fired state;
FIG. 25 is a schematic view of the tip portion of the present invention;
FIG. 26 is an end view of the tip portion of the present invention;
FIG. 27 is a schematic view in section A-A of FIG. 26;
FIG. 28 is a schematic view of the anvil of the present invention;
FIG. 29 is a schematic view of an anvil of the present invention at another angle;
FIG. 30 is an exploded view of the tip portion of the present invention;
FIG. 31 is a schematic cross-sectional view of the tip portion of the present invention;
FIG. 32 is an exploded view of the anvil screw drive mechanism of the present invention;
FIG. 33 is a schematic view of the tip seat of the present invention;
FIG. 34 is a schematic side view of the tip seat of the present invention;
fig. 35 is a schematic view in section B-B of fig. 34.
The reference numerals in the drawings illustrate:
100 is an endoscopic stitching device, and,
1 is a handle, 2 is a conical protective sleeve,
3 is an insertion tube, 4 is a rigid section,
5 is a bending part, 6 is a top part,
7 is an angle tracking sensor, 8 is a miniature camera,
9 is an LED lamp, 10 is an ultrasonic detector,
reference numeral 11 denotes an end portion positioning pin,
4-1 is a rigid section shell, 4-2 is a sensor positioning disk,
4-3 is a nail bin seat, 4-4 is a titanium nail,
4-5 is an ultrasonic reflector,
4-2-1 is a sensor positioning groove,
4-3-1 is a titanium pin accommodating groove, 4-3-2 is a reflector accommodating groove,
4-3-3 is a positioning pin hole, 4-3-4 is a cutting board screw matching hole,
4-6-1 is the main body of the propeller, 4-6-2 is the chute,
4-6-3 is a guiding part, 4-6-4 is a limiting part,
4-6-11 is a limit surface of the titanium nail, 4-6-12 is a guide inclined surface,
4-7-1 is a firing plate, 4-7-2 is a steel wire connecting part,
4-7-11 is a first plane, 4-7-12 is an inclined plane,
4-7-13 is a second plane,
6-1 is a top end seat, 6-2 is a cutting board,
6-3 is a chopping board screw, 6-4 is a chopping board driving shaft,
6-5 is driven gear, 6-6 is cutting board screw guide seat,
6-7 is driven gear locating pin, 6-8 is chopping block locating pin,
6-1-1 is a top seat body, 6-1-2 is a positioning groove of the chopping board,
6-1-3 is a cutting board driving shaft penetrating hole, 6-1-4 is a driven gear shaft penetrating hole,
6-1-5 is LED lamp positioning hole, 6-1-6 is miniature camera positioning hole,
6-1-7 is an ultrasonic detector mounting hole, 6-1-8 is an end locating pin accommodating hole,
6-1-9 is a hole for passing through a driven gear locating pin, 6-1-10 is a limiting boss,
6-2-0 is the chopping block body, 6-2-1 is the chopping block screw penetrating hole,
6-2-2, 6-2-3, 6-2-4, 6-2-5 and 6-2-6 are bending guide grooves of titanium nails,
6-2-7 is a first blocking lug, 6-2-8 is a second blocking lug,
7-1 is an angle tracking sensor signal line,
9-1 is an LED lampshade,
201 is the esophagus and 202 is the stomach.
Detailed Description
In order to make the objects, technical solutions and advantages of the embodiments of the present invention more clear, the technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings of the embodiments of the present invention. It will be apparent that the described embodiments are some, but not all, embodiments of the invention. All other embodiments, which can be made by a person skilled in the art without creative efforts, based on the described embodiments of the present invention fall within the protection scope of the present invention. Unless otherwise defined, technical or scientific terms used herein should be given the ordinary meaning as understood by one of ordinary skill in the art to which this invention belongs. The terms "first," "second," and the like, as used herein, do not denote any order, quantity, or importance, but rather are used to distinguish one element from another. The word "comprising" and the like means that elements or items preceding the word are included in the element or item listed after the word and equivalents thereof without precluding other elements or items. "upper", "lower", "left", "right", etc. are used merely to indicate relative positional relationships, which may also be changed when the absolute position of the object to be described is changed.
As shown in fig. 1, the endoscopic stitching device 100 for performing a fundoplication according to the present invention includes a handle 1, a taper sleeve 2, an insertion tube 3, a rigid section 4, a bent portion 5, and a tip portion 6, wherein the front end of the handle 1 is fixedly connected to the insertion tube 3 through the taper sleeve 2, and the front end of the insertion tube 3 is fixedly connected to the rigid section 4, the bent portion 5, and the tip portion 6 in this order; the side surface of the rigid section 4 and the end surface of the top end part 6 form a nailing mechanism;
the outer diameter of the insertion tube 3, the rigid section 4, the bent portion 5, the distal end portion 6 is smaller than the inner diameter of the esophagus 201, so that the distal end of the endoscopic stitching device can be inserted into the stomach 202 through the esophagus 201 through the oral cavity;
the handle 1 is provided with an angle control mechanism, the angle control mechanism can control the bending angle of the bending part 5, so that the included angle between the top end parts 6 at the two ends of the bending part 5 and the rigid section 4 is changed within the range of 0-270 degrees, and the end face of the top end part 6 is driven to move relative to the side face of the rigid section 4;
in the initial state, the bending angle of the bending part 5 is 0 degrees, and the top end part 6, the bending part 5 and the rigid section 4 are positioned on the same straight line; the distal end of the endoscopic stitching device 100 (i.e., the distal end portion 6, the bent portion 5 and the rigid section 4) is inserted into the stomach 202 through the mouth and the esophagus 201, and at this time, the internal condition (such as a mucosal structure) of the stomach 202 can be observed by the micro camera 8 of the distal end portion 6, as shown in fig. 2;
As shown in fig. 3, when the rigid segment 4 is positioned at the bottom of the esophagus 201, the bending angle control mechanism of the handle 1 is operated to gradually bend the bending part 5 so as to move the tip end part 6 relative to the rigid segment 4, thereby changing the relative position between the end face of the tip end part 6 and the side face of the rigid segment 4;
when the bending angle of the bending part 5 reaches 180 degrees, the end face of the top end part 6 is abutted against the inner wall of part of the fundus; when the bending angle of the bending part 5 is increased from 180 degrees to 270 degrees, the part of the fundus is pushed to move towards the esophagus direction by the end surface of the tip part 6, as shown in fig. 4;
as shown in fig. 5, when the bending angle of the bending portion 5 is 270 °, the partial fundus is pushed by the end face of the tip portion 6 to overlap with the lower section of the esophagus, thereby achieving folding of the partial fundus and the esophagus; at this time, the side surface of the rigid section 4 is opposite to the end surface of the distal end portion 6, the ultrasonic mirror 4-5 of the rigid section 4 can reflect all ultrasonic signals emitted by the ultrasonic probe 10 of the distal end portion 6 and send the reflected ultrasonic signals to the ultrasonic probe 10, and then the bending portion 5 is bent in place, and the distal end portion 6 is in the stapled state, as shown in fig. 6;
the end locating pin 11 is driven by the locating pin driving motor to extend outwards, so that the tip end of the end locating pin 11 of the top end part 6 penetrates through the stomach fundus and esophagus two-layer tissue to extend into the locating pin hole 4-3-3 of the rigid section 4, and the top end part 6 is kept in a nailing state, so that the position location between the top end part 6 and the rigid section 4 is realized; because the depth of the positioning pin holes 4-3-3 is smaller than the extending length of the end positioning pins 11, when the end positioning pins 11 extend in place, a distance H1 is formed between the end face of the top end part 6 and the side face of the rigid section 4, and the distance H1 is the thickness of two layers of tissues;
Then the two chopping board screws 6-3 are driven to extend outwards through the chopping board screw driving mechanism, so that the tips of the chopping board screws 6-3 at the top end part 6 penetrate through two layers of tissues and are screwed into the chopping board screw matching holes 4-3-4 of the nail bin seat 4-3 of the rigid section 4; in the process of screwing the chopping board screws 6-3 inwards, the two chopping board screws 6-3 respectively penetrate through two layers of tissues along the thickness direction and jointly squeeze the two layers of tissues; because the hole depth of the chopping board screw matching hole 4-3-4 is smaller than the extension length of the chopping board screw 6-3, when the chopping board screw 6-3 extends in place, a space H2 is formed between the end face of the top end part 6 and the side face of the rigid section 4, and the space H2 is the nailing thickness of the titanium nail 4-4; h1 > H2; after the chopping board screw 6-3 is extended into place, the end locating pin 11 can be retracted;
the titanium nail firing mechanism is started, five titanium nails 4-4 (at the moment, the titanium nails 4-4 are in the shape shown in fig. 9, the nail legs of the titanium nails 4-4 are outwards) of the nail bin seat assembly are simultaneously ejected, the titanium nails 4-4 sequentially penetrate through the lower esophageal section and partial stomach fundus tissue after being ejected, and are subjected to the reaction force of the chopping board 6-2 on the end face of the top end part 6, so that the two nail legs of the titanium nails 4-4 are inwards bent to form a B shape shown in fig. 10, and at the moment, the titanium nails 4-4 can stitch the lower esophageal section and partial stomach fundus two-layer tissues together to form a folding stitching part 200, as shown in fig. 7, and therefore stitching fixation is realized on the part;
The new nail bin seat assembly is replaced, then the handle 1 is rotated around the axial direction for a certain angle, so that the end face of the top end part 6 contacts the inner wall of the other stomach fundus, and the folding and nailing of the other stomach fundus and the lower esophageal segment can be realized, as shown in fig. 8; according to the actual situation, a plurality of (such as three) folds and nails are carried out around the circumference of the esophagus, so that the His angle alpha of one circle around the esophagus is restored to an acute angle, the gastroesophageal flap valve is restored, and an effective barrier for preventing gastroesophageal reflux is established.
The invention realizes the relative position positioning between the top end part 6 and the rigid section 4 before the stapling by the end part positioning pin 11, thereby realizing the preliminary positioning of the tissue to be stapled, avoiding or reducing the deviation of the positioning position of the tissue in the stapling process and improving the operation precision.
According to the invention, the tissue to be stapled is extruded and positioned through the chopping board screw 6-3, so that the titanium nail 4-4 can tightly fix the two layers of tissue together without separation after the nail leg of the titanium nail 4-4 is bent in the stapling process, and the newly formed His angle (gastroesophageal angle) can be ensured not to change for a long time. In addition, the invention determines the nailing thickness of the titanium nails 4-4 through the chopping board screws 6-3, thereby ensuring that the titanium nails 4-4 can be accurately emitted to the titanium nail bending guide grooves of the chopping board 6-2, enabling the device to be suitable for different crowds, and avoiding the phenomena of unstable nailing and reduced operation effect even if the thicknesses of the two layers of tissues of the stomach bottom and the esophagus of an individual are different due to different physique.
According to the invention, the extending stroke of the chopping board screw 6-3 is accurately controlled through the chopping board screw driving mechanism, so that the thickness of two layers of tissues between the end face of the top end part 6 and the side face of the rigid section 4 is gradually reduced and reaches the nailing thickness of the titanium nail 4-4 capable of implementing nailing; the thickness variation of the two layers of tissue can be monitored by the ultrasonic probe 10 to precisely control the thickness of the staple.
The bending angle control mechanism for controlling the bending portion 5 in the present invention is a prior art, and will not be described herein.
As shown in fig. 11 to 13, the rigid section 4 comprises a rigid section shell 4-1, one end of the rigid section shell 4-1 is fixedly connected with a sensor positioning disk 4-2, a sensor positioning groove 4-2-1 is formed in the side part of the sensor positioning disk 4-2, and an angle tracking sensor 7 is fixedly arranged in the sensor positioning groove 4-2-1; the angle tracking sensor 7 is connected with one end of the angle tracking sensor signal wire 7-1, and the other end of the angle tracking sensor signal wire 7-1 is connected with the main board so as to realize synchronous transmission and feedback of signals;
the side part of the rigid section shell 4-1 is provided with a nail bin seat groove 4-1-1 extending along the axial direction, a titanium nail firing part 4-7 is movably arranged in the nail bin seat groove 4-1-1, and the length of the titanium nail firing part 4-7 is smaller than that of the nail bin seat groove 4-1-1; one end of the titanium nail firing piece 4-7 is fixedly connected with one end of the transmitting steel wire 4-8, and the other end of the transmitting steel wire 4-8 is connected with the handle 1; the transmitting steel wire 4-8 can be pulled by controlling the handle 1, so that the titanium nail firing part 4-7 is driven to move back and forth along the nail bin seat groove 4-1-1;
A nail bin seat assembly is arranged in the nail bin seat groove 4-1-1, and five titanium nail accommodating grooves 4-3-1 are formed in the nail bin seat assembly, and the titanium nail accommodating grooves 4-3-1 are used for accommodating the titanium nails 4-4 and the propeller 4-6; the propeller 4-6 is propped against the bottom of the titanium nail 4-4;
as shown in fig. 14, the titanium nail firing member 4-7 includes three firing plates 4-7-1 arranged in parallel, the three firing plates 4-7-1 corresponding to the five titanium nails 4-4 so that the five titanium nails 4-4 can simultaneously contact the titanium nail firing member 4-7;
the firing plate 4-7-1 is provided with a first plane 4-7-11, a pushing inclined plane 4-7-12 and a second plane 4-7-13, the second plane 4-7-13 is higher than the first plane 4-7-11, and the height difference between the second plane 4-7-13 and the first plane 4-7-11 is the firing stroke of the titanium nails 4-4;
one end of the titanium nail firing member 4-7 forms a steel wire connecting part 4-7-2, and the titanium nail firing member 4-7 is fixedly connected with one end of the transmitting steel wire 4-8 through the steel wire connecting part 4-7-2.
As shown in fig. 15, the cartridge seat assembly includes a cartridge seat 4-3, the surface of the cartridge seat 4-3 being a partial circumference of the rigid section housing 4-1 (i.e., the arcuate surface of the cartridge seat 4-3 being a partial circumference of the rigid section housing 4-1);
as shown in fig. 16, five titanium nail accommodating grooves 4-3-1 are formed in the nail bin seat 4-3, and the titanium nails 4-4 and the thrusters 4-6 are arranged in the titanium nail accommodating grooves 4-3-1; the propeller 4-6 is positioned at the bottom of the titanium nail 4-4;
The nail bin seat 4-3 is also provided with a reflector accommodating groove 4-3-2, an ultrasonic reflector 4-5 is arranged in the reflector accommodating groove 4-3-2, and the ultrasonic reflector 4-5 is used for receiving ultrasonic signals sent by the ultrasonic detector 10 and reflecting the received ultrasonic signals to the ultrasonic detector 10;
the nail bin seat 4-3 is also provided with a positioning pin hole 4-3-3 corresponding to the end positioning pin 11 and two chopping board screw matching holes 4-3-4 corresponding to the chopping board screws 6-3; the depth of the positioning pin hole 4-3-3 is smaller than the extending length of the end positioning pin 11, and the depth of the chopping board screw matching hole 4-3-4 is smaller than the extending length of the chopping board screw 6-3.
As shown in fig. 17, the pusher 4-6 includes a pusher body 4-6-1, a chute 4-6-2 is provided at the bottom of the pusher body 4-6-1, and the width of the chute 4-6-2 matches the thickness of the firing plate 4-7-1, so that the pusher 4-6 can ride on the firing plate 4-7-1, thereby realizing the relative sliding between the pusher 4-6 and the firing plate 4-7-1; the rear part of the pusher body 4-6-1 forms a guide part 4-6-3, the bottom of the guide part 4-6-3 forms a guide inclined plane 4-6-12, the inclination of the guide inclined plane 4-6-12 is matched with the pushing inclined plane 4-7-12 of the firing plate 4-7-1, and the titanium nail firing member 4-7 can push the pusher 4-6 to move outwards through the pushing inclined plane 4-7-12 in the moving process;
The front part of the propeller main body 4-6-1 forms a limit part 4-6-4; when the titanium nail firing member 4-7 moves to the second plane 4-7-13 to contact the pusher 4-6, the second plane 4-7-13 of the titanium nail firing member 4-7 contacts the bottom surface of the limit portion 4-6-4 at this time.
The titanium nail firing mechanism is composed of a titanium nail firing part 4-7, a transmitting steel wire 4-8 and a propeller 4-6; in the initial state, the titanium nail firing part 4-7 is positioned at the rear end of the nail bin seat groove 4-1-1; at this time, the titanium nails 4-4 and the pusher 4-6 in the nail bin seat 4-3 are positioned above the first plane 4-7-11 of the firing plate 4-7-1; to avoid false firing, a gap is formed between the pusher 4-6 and the first plane 4-7-11, as shown in fig. 13 and 18; at this time, the titanium nails 4-4 are positioned in the titanium nail accommodating grooves 4-3-1, and the pusher 4-6 is positioned at the bottom of the titanium nail accommodating grooves 4-3-1, as shown in FIG. 19;
when in firing, the transmitting steel wire 4-8 is pulled to drive the titanium nail firing part 4-7 to move forward for a certain stroke along the nail bin seat groove 4-1-1; during the forward movement of the titanium staple firing member 4-7, the pushing inclined surface 4-7-12 of the titanium staple firing member 4-7 contacts the pusher 4-6, thereby pushing the titanium staples 4-4 outwardly through the pusher 4-6, as shown in fig. 20, 21; when the titanium nail firing member 4-7 moves to the front end of the nail cartridge seat groove 4-1-1, the second plane 4-7-13 of the titanium nail firing member 4-7 contacts the pusher 4-6, and the titanium nail 4-4 completes the firing stroke, as shown in fig. 22 and 23; at this time, the titanium nail firing member 4-7 pushes the pusher 4-6 to the top of the titanium nail accommodating groove 4-3-1, the pusher 4-6 pushes the titanium nails 4-4 out of the titanium nail accommodating groove 4-3-1, and as shown in fig. 24, five titanium nails 4-4 are ejected at the same time;
In the process that the titanium nails 4-4 leave the titanium nail accommodating grooves 4-3-1, the nail legs of the titanium nails 4-4 contact the surface of the chopping board 6-2, the chopping board 6-2 provides bending reaction force for the titanium nails 4-4, the nail legs are guided by the bottoms of the bending guide grooves, two nail legs of the same titanium nail 4-4 are bent inwards twice, the titanium nails 4-4 are deformed into a nailing shape shown in fig. 10, and at the moment, the titanium nails 4-4 can tightly fix two layers of tissues together, so that a new acute His angle alpha is formed.
According to the invention, the titanium nail firing part 4-7 is driven to move forwards along the nail bin seat groove 4-1-1 by the transmitting steel wire 4-8, and in the process of moving forwards of the titanium nail firing part 4-7, the titanium nail 4-4 is driven to move outwards by the pusher 4-6 by means of the inclined plane cooperation formed by the titanium nail firing part 4-7 and the guide part 4-6-3 of the pusher 4-6, so that the firing of the titanium nail 4-4 is realized. Because the firing stroke of the titanium nails 4-4 is determined by the inclined plane height of the titanium nail firing piece 4-7, even if the force pulling the transmitting steel wire 4-8 is too large, the firing stroke of the titanium nails 4-4 is not influenced, so the invention can accurately control the firing stroke of the titanium nails 4-4 and does not influence the nailing effect due to different forces of different operators.
According to the invention, the ultrasonic reflector 4-5 is arranged near the titanium nail accommodating groove 4-3-1, the ultrasonic detector 10 is arranged on the end face of the top end part 6, and the nailing point can be accurately determined under the assistance of the ultrasonic detector 10, so that the operation precision of the fundoplication can be greatly improved.
According to the invention, the angle tracking sensor 7 is arranged on the rigid section 4, when the handle 1 rotates around the axial direction, the rigid section 4 deflects along with the axial direction, the angle tracking sensor 7 transmits a deflection angle signal to the main board in real time, and the main board receives the deflection angle signal and finally intuitively displays the deflection angle signal in a display picture. The invention can accurately determine the relative position of the top end part 6 and the esophagus through the angle tracking sensor 7 so as to determine the specific position of the fundus at the other position, and provide accurate and visual guidance for fundus folding operation.
As shown in fig. 25 to 27, the tip portion 6 includes a tip seat 6-1, the end face of the tip seat 6-1 is provided with a cutting board 6-2, a micro camera 8, an LED lamp 9, an ultrasonic probe 10 and a tip positioning pin 11, the cutting board 6-2 is fixedly provided in the middle of the end face, the length of the cutting board 6-2 extends in the longitudinal direction, and the surface of the cutting board 6-2 protrudes from the end face of the tip seat 6-1, so that a bending force can be provided for the titanium nails 4-4; the miniature camera 8 and the LED lamp 9 are positioned on one side of the chopping board 6-2, and the ultrasonic detector 10 and the end positioning pin 11 are positioned on the other side of the chopping board 6-2; the LED lamp 9 is used for providing an illumination light source, and the miniature camera 8 is used for collecting images; the ultrasonic detector 10 is used for transmitting and receiving ultrasonic signals; the ultrasonic detector 10 is matched with the ultrasonic reflector 4-5 of the rigid section 4, the ultrasonic detector 10 transmits ultrasonic signals, the ultrasonic signals are reflected back to the ultrasonic detector 10 through the ultrasonic reflector 4-5, and the ultrasonic detector 10 judges whether the top end 6 is well matched with the position of the nail bin seat 4-3 of the rigid section 4 according to the strength change condition of the received signals; when the ultrasonic signal is stable, the end positioning pin 11 extends outwards and is matched with the positioning pin hole 4-3-3 of the rigid section 4, so that the tissue is positioned;
The middle part of the end positioning pin 11 is provided with an external thread 11-1, and the end positioning pin 11 is connected with the top end seat 6-1 through threads; the free end of the end positioning pin 11 is a tip, and the fixed end of the end positioning pin 11 is connected with a positioning pin driving motor; the end positioning pin 11 is driven to rotate by the positioning pin driving motor, so that the end positioning pin 11 can realize telescopic movement relative to the top end seat 6-1; the free end of the end locating pin 11 is matched with the locating pin hole 4-3-3 of the rigid section 4, so that tissue locating can be performed, and the deviation of the locating position of the tissue in the operation process is avoided or reduced.
Since the side surface of the rigid segment 4 is opposite to the end surface of the distal end portion 6 in the stapled state, the angle of view of the micro-camera 8 located at the distal end portion 6 is blocked by the fundus tissue at this time, and thus image information cannot be acquired, resulting in a blind area in the entire stapled state. The invention is provided with the ultrasonic reflector 4-5 and the ultrasonic detector 10 respectively at the side surface of the rigid section 4 and the end surface of the top end part 6, so that the relative position between the rigid section 4 and the top end part 6 in the nailing process can be monitored, and an operator can still intuitively observe the position information between the rigid section 4 and the top end part 6 in the nailing state.
As shown in fig. 28 and 29, the chopping board 6-2 comprises a chopping board body 6-2-0 with an arc-shaped surface, and the arc-shaped surface of the chopping board body 6-2-0 is matched with the side part of the rigid section 4; the length direction of the chopping block body 6-2-0 corresponds to the circumferential direction (namely the arc length direction) of the cartridge seat 4-3; when the top end part 6 is in the nailing state, the surface of the chopping block body 6-2-0 is matched with the side part of the rigid section 4;
The two ends of the chopping block body 6-2-0 are respectively provided with a chopping block screw penetrating hole 6-2-1, chopping block screws 6-3 are movably arranged in the chopping block screw penetrating holes 6-2-1, and the chopping block screws 6-3 are connected with a chopping block screw driving mechanism which is internally provided with a top seat 6-1; the chopping board screw 6-3 can perform telescopic movement relative to the chopping board body 6-2-0 under the action of the chopping board screw driving mechanism;
five groups of titanium nail bending guide grooves 6-2-2, 6-2-3, 6-2-4, 6-2-5 and 6-2-6 are distributed on the surface of the chopping block body 6-2-0 (five different patterns are used for representing the bottoms of the five groups of titanium nail bending guide grooves respectively in the figure); each group of titanium nails bending guide grooves comprises two parallel bending guide grooves, and each bending guide groove corresponds to one nail leg of each titanium nail 4-4; the bottom of each bending guide groove is arc-shaped with high ends and low middle parts, and the arc-shaped bottoms of each group of titanium nail bending guide grooves are symmetrically arranged; the bending guide grooves can guide the bending direction of the nail legs of the titanium nails 4-4.
The side part of the chopping block body 6-2-0 is provided with two blocking lugs, and the first blocking lug 6-2-7 is positioned on the outer side above the LED lamp 9 and right above the water outlet hole; the second blocking lugs 6-2-8 are positioned on the outer side above the miniature camera 8 and right above the air outlet holes, as shown in fig. 25; the bottom surfaces of the two blocking lugs are respectively perpendicular to the water outlet hole and the air outlet hole; when the water outlet sprays water, the first blocking lugs 6-2-7 reflect water flow, so that the water flow is sprayed to the miniature camera 8 and the LED lamp 9, and the lens of the miniature camera 8 and the LED lamp 9 are washed; when the air outlet holes are exhausted, the second blocking lugs 6-2-8 reflect air flow, so that the air flow is sprayed to the miniature camera 8 and the LED lamp 9, and the lens of the miniature camera 8 and the LED lamp 9 are purged.
As shown in fig. 30 and 31, the chopping board screw driving mechanism comprises a chopping board driving shaft 6-4, and the chopping board driving shaft 6-4 can rotate under the power driving; a driving gear is arranged on the chopping board driving shaft 6-4, and two sides of the driving gear are respectively meshed with a driven gear 6-5; the two driven gears 6-5 are respectively and fixedly connected with the chopping board screws 6-3;
two chopping board screw guide seats 6-6 are fixedly arranged at the bottom of the chopping board 6-2, and the chopping board screw guide seats 6-6 are connected with chopping board screws 6-3 through threads; the chopping board screw guide seats 6-6 are in one-to-one correspondence with the driven gears 6-5 and are coaxially arranged;
the bottom of the driven gear 6-5 is provided with a driven gear positioning pin 6-7; the driven gear positioning pin 6-7 is longitudinally penetrated into the driven gear positioning pin hole 6-1-9 of the top end seat 6-1; the driven gear locating pin 6-7 can limit the driven gear 6-5, and prevent the driven gear 6-5 from axially displacing, so as to ensure the transmission precision of the chopping board screw driving mechanism;
the chopping board driving shaft 6-4 drives the two driven gears 6-5 to synchronously rotate, so that the chopping board screw 6-3 is driven to do telescopic motion relative to the chopping board 6-2; the chopping board screw guide seat 6-6 can guide the chopping board screw 6-3, so that the stroke of the chopping board screw 6-3 can be accurately controlled.
As shown in fig. 32 to 34, the top end seat 6-1 comprises a top end seat body 6-1-1, a cutting board positioning groove 6-1-2 extending longitudinally is formed in the middle of the end face of the top end seat body 6-1-1, the cutting board positioning groove 6-1-2 is matched with the bottom of the cutting board 6-2, and the cutting board 6-2 is fixedly arranged in the cutting board positioning groove 6-1-2; limiting bosses 6-1-10 are respectively formed at two ends of the chopping board positioning groove 6-1-2, and the width of the limiting bosses 6-1-10 is matched with the width of the chopping board 6-2, so that the limiting of the chopping board 6-2 is realized in the width direction (namely transversely);
a cutting board driving shaft penetrating hole 6-1-3 and two driven gear shaft penetrating holes 6-1-4 are formed in the cutting board positioning groove 6-1-2; the cutting board driving shaft penetrating holes 6-1-3 and the driven gear shaft penetrating holes 6-1-4 extend along the axial direction;
a miniature camera positioning hole 6-1-6 and an LED lamp positioning hole 6-1-5 are formed in one side of the top end seat body 6-1, a miniature camera 8 is fixedly arranged in the miniature camera positioning hole 6-1-6, an LED lamp cover 9-1 is fixedly arranged at the end part of the LED lamp positioning hole 6-1-5, and an LED lamp 9 is fixedly arranged in the LED lamp positioning hole 6-1-5;
the other side of the top end seat body 6-1-1 is provided with an end locating pin accommodating hole 6-1-8 and an ultrasonic detector mounting hole 6-1-7, and an ultrasonic detector 10 is fixedly arranged in the ultrasonic detector mounting hole 6-1-7; the lower part of the end locating pin accommodating hole 6-1-8 is provided with an internal threaded hole 6-1-8', and the lower internal threaded hole 6-1-8' of the end locating pin accommodating hole 6-1-8 is connected with an end locating pin 11 through threads;
The end surface of the top end seat 6-1 is longitudinally formed into an arc 6-20 which is matched with the side part of the rigid section 4; the end face of the top end seat 6-1 transversely forms a conical surface with a small upper part and a large lower part, so that a first inclined surface 6-31 and a second inclined surface 6-32 are formed on two sides of the end face, the miniature camera positioning hole 6-1-6 and the LED lamp positioning hole 6-1-5 are positioned on the first inclined surface 6-31, and the end positioning pin accommodating hole 6-1-8 and the ultrasonic detector mounting hole 6-1-7 are positioned on the second inclined surface 6-32;
the connecting parts of the top end seat 6-1 and the two ends of the chopping board 6-2 are provided with a chopping board positioning pin hole 6-11 along the transverse direction, and chopping board positioning pins 6-8 are penetrated in the chopping board positioning pin hole 6-11; the lengthwise (i.e. longitudinal) positioning between the anvil 6-2 and the tip seat 6-1 can be achieved by means of two anvil positioning pins 6-8.
According to the invention, the miniature camera 8, the LED lamp 9, the end locating pin 11 and the ultrasonic detector 10 which are positioned on the end face of the top end are arranged on the inclined planes on two sides of the chopping board 6-2, so that interference caused by nailing action is avoided, and whether equipment is in a nailing state or not, the miniature camera 8, the LED lamp 9, the end locating pin 11 and the ultrasonic detector 10 can ensure respective working states.
It will be apparent to those skilled in the art that various modifications and variations can be made to the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention also include such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.
Claims (10)
1. An endoscopic stitching device for performing a fundoplication is characterized by comprising a handle (1), a conical protective sleeve (2), an insertion tube (3), a rigid section (4), a bending part (5) and a top end part (6), wherein the front end of the handle (1) is fixedly connected with the insertion tube (3) through the conical protective sleeve (2), and the front end of the insertion tube (3) is sequentially and fixedly connected with the rigid section (4), the bending part (5) and the top end part (6); the side part of the rigid section (4) and the end part of the top end part (6) form a nailing mechanism; the bending angle of the bending part (5) is controlled by the handle (1), so that the end surface of the top end part (6) corresponds to the side surface of the rigid section (4), and the top end part (6) enters a nailing state;
the side surface of the rigid section (4) is provided with a nail bin seat assembly, and M titanium nail accommodating grooves (4-3-1) are formed in the nail bin seat assembly; an chopping board (6-2) is fixedly arranged on the end face of the top end part (6); when the top end part (6) is in a nailing state, the titanium nail containing groove (4-3-1) on the nail bin seat assembly corresponds to the chopping board (6-2) of the top end part (6);
the nail bin seat assembly comprises a nail bin seat (4-3), and the surface of the nail bin seat (4-3) is arc-shaped which is matched with the arc-shaped surface of the chopping board (6-2); the arc length direction of the nail bin seat (4-3) corresponds to the length direction of the chopping board (6-2); when the top end part (6) is in a nailing state, the side part of the rigid section is matched with the arc-shaped surface of the chopping board (6-2) through the nail bin seat (4-3) in an arc-shaped surface;
The rigid section (4) comprises a rigid section shell (4-1), a nail bin seat groove (4-1-1) extending along the axial direction is formed in the side part of the rigid section shell (4-1), and a titanium nail firing part (4-7) is movably arranged in the nail bin seat groove 4-1-1; one end of the titanium nail firing piece (4-7) is fixedly connected with one end of the transmitting steel wire (4-8), and the other end of the transmitting steel wire (4-8) is connected with the handle (1); a nail bin seat assembly is arranged in the nail bin seat groove (4-1-1), the titanium nail accommodating groove (4-3-1) is formed in the nail bin seat assembly, a titanium nail (4-4) and a propeller (4-6) are movably arranged in the titanium nail accommodating groove (4-3-1), and the propeller (4-6) is positioned at the inner side of the titanium nail (4-4); the nail bin seat assembly is positioned at the outer side of the titanium nail firing part (4-7); the handle (1) is used for pulling the transmitting steel wire (4-8) to drive the titanium nail firing part (4-7) to move forwards along the nail bin seat groove (4-1-1), and the titanium nail firing part (4-7) pushes the titanium nail (4-4) to move outwards and leave the titanium nail accommodating groove (4-3-1) through the propeller (4-6), so that the firing of the titanium nail (4-4) is realized;
the titanium nail firing piece (4-7) comprises N firing plates (4-7-1) which are arranged in parallel; the firing plate (4-7-1) is provided with a first plane (4-7-11), a pushing inclined plane (4-7-12) and a second plane (4-7-13), wherein the second plane (4-7-13) is higher than the first plane (4-7-11), and a height difference is formed between the second plane (4-7-13) and the first plane (4-7-11);
A sliding groove (4-6-2) is formed in the bottom of the propeller (4-6), and the propeller (4-6) rides on a firing plate (4-7-1) of the titanium nail firing piece (4-7) through the sliding groove (4-6-2); the rear part of the propeller (4-6) is provided with a guide part (4-6-3), and the bottom of the guide part (4-6-3) is provided with a guide inclined plane (4-6-12); the front part of the propeller (4-6) is provided with a limit part (4-6-4), and the bottom surface of the limit part (4-6-4) is matched with a second plane (4-7-13) of the titanium nail firing piece (4-7); the inclination of the guide inclined plane (4-6-12) is matched with the pushing inclined plane (4-7-12) of the firing plate (4-7-1); the top end part (6) comprises a top end seat (6-1), the chopping board (6-2) is fixedly arranged on the end face of the top end seat (6-1), and the surface of the chopping board (6-2) protrudes out of the end face of the top end seat (6-1); the surface of the chopping board (6-2) is arc-shaped, and the arc-shaped surface of the chopping board (6-2) is matched with the side part of the rigid section (4); a plurality of groups of titanium nail bending guide grooves are distributed on the surface of the cutting board (6-2), and each group of titanium nail bending guide grooves comprises two parallel bending guide grooves; the positions of the bending guide grooves of each group of titanium nails are in one-to-one correspondence with the titanium nail accommodating grooves (4-3-1) of the nail bin seat (4-3);
in the process that the titanium nails (4-4) leave the titanium nail accommodating grooves (4-3-1), the nail legs of the titanium nails (4-4) are contacted with the surface of the chopping board (6-2), the chopping board (6-2) provides bending reaction force for the titanium nails (4-4), the nail legs are guided by the bottoms of the bending guide grooves, so that the two nail legs of the same titanium nail (4-4) are bent, and the titanium nail (4-4) is deformed into a nailing shape, so that the nailing action is completed.
2. An endoscopic stitching device according to claim 1, wherein the cartridge seat (4-3) is provided with the titanium staple receiving slots (4-3-1), the titanium staple receiving slots (4-3-1) being in radial communication so that the titanium staple firing member (4-7) located inside the cartridge seat (4-3) may contact the pusher (4-6) within the titanium staple receiving slots (4-3-1);
an end locating pin (11) is movably arranged in the top end part (6), the end locating pin (11) is connected with the top end seat (6-1) through threads, the end locating pin (11) is fixedly connected with a locating pin driving motor, and the locating pin driving motor can drive the end locating pin (11) to rotate, so that the end locating pin (11) extends outwards or retracts from the top end part (6); a positioning pin hole (4-3-3) matched with the end positioning pin (11) is formed in the nail bin seat (4-3), and the depth of the positioning pin hole (4-3-3) is smaller than the length of the end positioning pin (11) extending out of the top end (6); when the end locating pin (11) extends outwards from the top end part (6), the tip end of the end locating pin (11) extends into the locating pin hole (4-3-3) of the nail bin seat (4-3), so that the relative positioning between the top end part (6) and the rigid section (4) is realized.
3. An endoscopic stitching device for performing a fundoplication according to claim 2, wherein two ends of the anvil (6-2) are provided with anvil screw insertion holes (6-2-1), respectively, anvil screws (6-3) are movably provided in the anvil screw insertion holes (6-2-1), and the anvil screws (6-3) are connected with an anvil screw driving mechanism; the chopping board screw driving mechanism can enable the chopping board screw (6-3) to extend outwards or retract from the chopping board (6-2);
Two chopping board screw matching holes (4-3-4) corresponding to the chopping board screws (6-3) are formed in the nail bin seat (4-3); the depth of the matching hole (4-3-4) of the chopping board screw is smaller than the length of the chopping board screw (6-3) extending out of the chopping board (6-2); when the chopping board screw (6-3) extends outwards from the chopping board (6-2), the tip of the chopping board screw (6-3) extends into the chopping board screw matching hole (4-3-4) of the nail bin seat (4-3), so that the relative positioning between the top end part (6) and the rigid section (4) is realized.
4. An endoscopic stitching device according to claim 3, wherein, when the end locating pin (11) is extended into position, a first spacing (H1) is provided between the end face of the tip portion (6) and the side face of the rigid section (4), the first spacing (H1) being the thickness of two layers of tissue; when the chopping board screw (6-3) stretches out in place, a second interval (H2) is formed between the end face of the top end part (6) and the side face of the rigid section (4), and the second interval (H2) is the nailing thickness of the titanium nail (4-4); first pitch (H1) > second pitch (H2).
5. A rigid section of an endoscopic stapling device for performing fundoplication according to claim 3, wherein said anvil screw drive mechanism comprises:
A chopping block drive shaft (6-4) which is rotatable under power; a driving gear is arranged on the chopping board driving shaft (6-4);
a driven gear (6-5) meshing with the driving gear;
a cutting board screw (6-3) fixedly connected with the driven gear (6-5); the chopping board screw (6-3) is movably arranged in the chopping board screw penetrating hole (6-2-1) of the chopping board (6-2) in a penetrating way; and
the chopping board screw guide seat (6-6) is fixedly arranged at the bottom of the chopping board (6-2); the chopping board screw guide seat (6-6) is connected with the chopping board screw (6-3) through threads.
6. Endoscopic stitching device according to claim 1, characterized in that one end of the titanium staple firing member (4-7) forms a wire connection (4-7-2);
in an initial state, the titanium nail firing part (4-7) is positioned at the rear end of the nail bin seat groove (4-1-1), and the titanium nails (4-4) and the propeller (4-6) in the titanium nail accommodating groove (4-3-1) are positioned above the first plane (4-7-11) of the firing plate (4-7-1);
when in firing, the transmitting steel wire (4-8) is pulled to drive the titanium nail firing part (4-7) to move forwards for a certain stroke along the nail bin seat groove (4-1-1); in the forward movement process of the titanium nail firing member (4-7), the pushing inclined plane (4-7-12) of the titanium nail firing member (4-7) contacts the pusher (4-6), so that the titanium nail (4-4) is pushed to move outwards by the pusher (4-6);
When the titanium nail firing piece (4-7) moves to the front end of the nail bin seat groove (4-1-1), the second plane (4-7-13) of the titanium nail firing piece (4-7) contacts the propeller (4-6), and the titanium nail (4-4) completes the firing stroke; at the moment, the titanium nail firing part (4-7) pushes the propeller (4-6) to the top of the titanium nail accommodating groove (4-3-1), and the propeller (4-6) pushes the titanium nail (4-4) out of the titanium nail accommodating groove (4-3-1), so that the firing of the titanium nail (4-4) is realized.
7. Endoscopic stitching device according to claim 6, wherein in the initial state a gap is formed between the pusher (4-6) and the first plane (4-7-11).
8. Endoscopic stitching device according to claim 1, wherein the bending angle of the bending portion (5) is in the range 0 ° to 270 °.
9. Endoscopic stitching device according to claim 6, wherein the titanium staple firing member (4-7) is capable of pushing the pusher (4-6) outwardly during movement by cooperation between the pushing ramp (4-7-12) and the guiding ramp (4-6-12).
10. An endoscopic stitching device according to claim 1, wherein the bottom of the curved guide groove is arcuate with high ends and low middle; the length of the bending guide groove is smaller than the length of the nail leg of the titanium nail (4-4); the length difference between the nail leg and the bending guide groove is the nailing thickness of the titanium nail.
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| Application Number | Priority Date | Filing Date | Title |
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| CN202010533229.7A CN111671480B (en) | 2020-06-12 | 2020-06-12 | Endoscopic stapling device for performing fundoplication |
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| Application Number | Priority Date | Filing Date | Title |
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| CN202010533229.7A CN111671480B (en) | 2020-06-12 | 2020-06-12 | Endoscopic stapling device for performing fundoplication |
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| CN111671480A CN111671480A (en) | 2020-09-18 |
| CN111671480B true CN111671480B (en) | 2023-09-22 |
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| CN111990951B (en) * | 2020-09-25 | 2024-03-22 | 妙思医疗科技(上海)有限公司 | Endoscopic device, system for treating gastroesophageal reflux disease and control method thereof |
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| CN1462180A (en) * | 2000-09-22 | 2003-12-17 | 波士顿科技有限公司 | Methods and devices for folding and securing tissue |
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| CN111671480A (en) | 2020-09-18 |
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