JP5832216B2 - Medical suture tool - Google Patents

Description

  TECHNICAL FIELD The present invention relates to a medical suturing device used when a suture for holding a visceral wall of an organ such as a stomach or a bladder from the outside of the body to the body surface such as an abdominal wall is introduced into the internal organ or pulled out from the internal organ. .

  Conventionally, enteral nutritional administration that supplies liquid foods, nutrients, etc. using a fistula catheter to people who have the ability to ingest food by mouth due to aging or illness (hereinafter referred to as patients) has been Has been done. For example, in the case of using percutaneous endoscopic gastrostomy (PEG), a through-hole (for example, a fistula such as a gastrostoma) penetrating the patient's abdominal wall and visceral wall (gastric wall) is created. Then, a fistula catheter is attached to the through hole, and liquid food or the like is supplied to the patient through the fistula catheter.

  When constructing a through hole, in order to easily form the through hole, the visceral wall and the abdominal wall which are easy to move are usually sutured and fixed percutaneously using sutures. Various types of medical suturing tools have been proposed that are used for securing the visceral wall and the abdominal wall together.

  As such, “inside the case body, it is housed in the inside of the puncture needle 30 for feeding and the sending mechanism for sequentially sending the sutures inserted from the proximal end of the puncture needle 20 for inserting the suture in the distal direction. A medical device that houses a protruding mechanism that causes the annular member of the stylet to protrude from the distal end of the puncture needle 30 for grasping a suture thread is disclosed (for example, see Patent Documents 1 and 2). This medical instrument is designed so that ligation in a living body can be carried out efficiently and safely by only one operator or two operators and an assistant.

JP 2009-213763 (for example, FIG. 5 and FIG. 6) JP 2009-213764 A (for example, FIG. 5 and FIG. 6)

  In a medical instrument as described in Patent Documents 1 and 2, an operator has to insert a suture into the medical instrument, which increases the labor of the operator. In addition, the work related to the insertion of the suture is often complicated, and the workability is low. Further, in the medical instruments described in Patent Documents 1 and 2, in order to form the annular member in an annular shape after puncturing the suture insertion puncture needle and the suture grasping puncture needle from the abdominal wall into the stomach. The operation that pushes the stylet into the stomach, the operation of turning the operation roller to insert the suture into the stomach, and the operation of pressing the release button to grip the suture with the annular member are required, and the operability is low It was.

  In addition, in the medical instruments described in Patent Documents 1 and 2, two needles (a suture insertion puncture needle and a suture grasping puncture needle) are punctured simultaneously. Compared with the case of puncturing one needle, the resistance at the time of puncturing was large.

  The present invention has been made to solve the above-described problems, and provides a medical suturing tool that greatly improves workability and operability and reduces puncture resistance. is there.

A medical suturing device according to the present invention includes a first housing, a second housing disposed opposite to the first housing, a moving mechanism for sliding the first housing and the second housing in the front-rear direction, and the first housing. A loop introduction needle provided on the distal end side of the first housing, a suture introduction needle provided on the distal end side of the second housing substantially parallel with a predetermined distance from the loop introduction needle, and containing a suture, A loop forming portion having a loop formed at the tip and movably inserted inside the loop introduction needle, a loop feed-back mechanism provided in the first housing and moving the loop forming portion, and in the second housing A suture feed mechanism that feeds the suture, and a loop feed-back mechanism and a suture feed mechanism that operate in the first housing and project from the first housing. Comprising an operation unit that, the operation unit is provided movably in the front-rear direction on the first housing, the loop feed back mechanism, the movement of the front of the operation unit is transmitted, the tip of the needle loop loop introduction feeding the suture feed mechanism, the motion is transmitted to the front side of the operation unit, feeding the suture from the distal end of the suture thread introduction needle, maintaining the suture in a state of delivery from the tip end of the suture thread introduction needle In this state, the loop is accommodated in the loop introduction needle, whereby the suture is gripped by the tip of the loop introduction needle.

  According to the medical suturing device of the present invention, the first housing and the second housing are configured to be slidable, and the loop introduction needle and the suture introduction needle can be punctured with a time difference. Not only can the workability and the operability be greatly improved, but also the puncture resistance can be reduced as compared with the case where two needles are punctured simultaneously.

It is a schematic external view which shows one of the structural examples of the medical suturing device which concerns on embodiment of this invention. It is a schematic perspective view which shows the external appearance structure of the medical suturing tool which concerns on embodiment of this invention. It is a schematic internal block diagram which shows one of the internal structural examples of the medical suturing tool which concerns on embodiment of this invention. It is a schematic external view which shows the state which looked at the medical suture tool which concerns on embodiment of this invention from the opposite side to FIG. 1 is a schematic external view showing a state in which a medical suturing device according to an embodiment of the present invention is viewed from a suture insertion side. It is explanatory drawing for demonstrating the relative movement of the 1st housing and 2nd housing of the medical suturing tool which concerns on embodiment of this invention. It is a schematic external view which shows the state which slid the 1st housing of the medical suture tool which concerns on embodiment of this invention to the front side. It is a schematic sectional drawing which shows the cross section of the state which slid the 1st housing of the medical suturing device which concerns on embodiment of this invention to the front side. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is explanatory drawing for demonstrating the effect | action of the medical suturing tool which concerns on embodiment of this invention. It is explanatory drawing for demonstrating the effect | action of the medical suturing tool which concerns on embodiment of this invention.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a schematic external view showing one configuration example of a medical suturing device (hereinafter simply referred to as a suturing device 100) according to an embodiment of the present invention. FIG. 2 is a schematic perspective view showing an external configuration of the suturing tool 100. FIG. 3 is a schematic internal configuration diagram showing one internal configuration example of the suturing tool 100. The configuration and operation of the suturing tool 100 will be described with reference to FIGS. In order to facilitate the formation of a fistula into which a fistula catheter is inserted, the suturing tool 100 introduces a suture thread that holds and holds the visceral wall of an organ such as the stomach or bladder from the outside of the body to the body surface side such as the abdominal wall. It is used when. In addition, in the following drawings including FIG. 1, the relationship of the size of each component may be different from the actual one.

[Overall Configuration of Suture 100]
The appearance of the suturing tool 100 is a predetermined distance from the housing 50, the operation unit 10 operated by the operator, the loop introduction needle 60 provided on the distal end side of the housing 50, and the loop introduction needle 60. And a suture introduction needle 70 provided on the distal end side of the housing 50 substantially parallel to each other. In addition, the suture tool 100 includes a loop feed-back mechanism 30 that operates in conjunction with the movement of the operation unit 10 and a suture feed mechanism 40 that operates in conjunction with the movement of the operation unit 10 in the housing 50. ing. Furthermore, the suturing tool 100 includes a loop forming portion 80 that is movably inserted inside the loop introduction needle 60.

  1 to 3 also illustrate the suture 1 that is fed from the distal end (blade edge) of the suture introduction needle 70 by the suture feed mechanism 40. Moreover, the distal end side refers to the side (patient side) inserted into the patient, and the proximal end side refers to the side operated by the operator (operating side). In the following description, the distal end side may be referred to as the front direction and the proximal end side may be referred to as the rear direction. Furthermore, the suture thread 1 has a length that can be secured by a plurality of times.

(Suture 1)
Although the suture thread 1 does not constitute the suture tool 100, it functions as an organ fixing tool and will be briefly described. The suture thread 1 is made of a material (for example, nylon thread or the like) having a flexibility that can be bent along a living tissue when inserted into a living body and a tensile strength that can lift an organ. Configure. The suture 1 is cut when it is attached to or removed from the patient. For this reason, it is preferable that the suture thread 1 is composed of a material and a diameter dimension that can be cut with a tool provided at a medical site such as scissors. In addition, the suture instrument 100 is punctured into the patient with the suture thread 1 inserted to the tip of the suture thread introduction needle 70.

(Housing 50)
The housing 50 is composed of two separated housings (a first housing 50a and a second housing 50b), and the two housings are relatively movable in the front-rear direction. In the following description, the state in which the base end surface of the first housing 50a and the base end surface of the second housing 50b are aligned, that is, the state in which the one side faces each other and is arranged in parallel is referred to as the normal state of the suturing tool 100. Shall be called. 4 to 8, the suturing tool 100 includes a moving mechanism capable of moving the first housing 50a and the second housing 50b relative to each other, and includes the first housing 50a and the second housing 50b. Is configured to be slidable in the front-rear direction.

  The first housing 50a and the second housing 50b are both hollow and have a substantially rectangular parallelepiped shape in which the longitudinal direction is the longitudinal direction. As shown in FIG. 3, the first housing 50a stores the loop feed-back mechanism 30 and the second housing 50b stores the suture feed mechanism 40, respectively. Since the first housing 50a and the second housing 50b are arranged in parallel, the loop feed-back mechanism 30 and the suture feed mechanism 40 are also arranged substantially in parallel. The loop feed back mechanism 30 is movable in the front-rear direction within the first housing 50a. The suture feed mechanism 40 is movable in the front-rear direction within the second housing 50b.

  The housing 50 unitizes the entire suturing tool 100 and also serves as a portion that is actually gripped by the operator. In addition, the 1st housing 50a and the 2nd housing 50b may not be a substantially rectangular parallelepiped shape, and an external shape is not specifically limited. Further, the first housing 50a and the second housing 50b may be configured with only a framework. That is, the 1st housing 50a and the 2nd housing 50b should just be the structure which can function the other structure demonstrated below.

  A loop introduction needle 60 is attached to the distal end side of the first housing 50a, and a suture introduction needle 70 is attached to the distal end side of the second housing 50b so as to be substantially parallel with a predetermined distance therebetween. ing. For example, as shown in FIG. 3, a support portion 52a is provided on the distal end side of the first housing 50a, the base end portion of the loop introduction needle 60 is inserted into the support portion 52a, and the loop introduction needle 60 is detachable. It is good to support. Similarly, a support portion 52b may be provided on the distal end side of the second housing 50b, and the proximal end portion of the suture thread introduction needle 70 may be inserted into the support portion 52b to detachably support the suture thread introduction needle 70. The support part 52a and the support part 52b are good to shape | mold materials, such as a synthetic resin, in a rectangular parallelepiped, for example. The support part 52a may protrude toward the distal end side of the first housing 50a. Similarly, the support part 52b may protrude toward the distal end side of the second housing 50b.

  The proximal end portions of the loop introduction needle 60 and the suture introduction needle 70 are previously supported by support members, and these support members are detachable from the distal ends of the first housing 50a and the second housing 50b, respectively. You may make it attach to. Further, the loop introduction needle 60 and the suture introduction needle 70 may be fixed in advance to the first housing 50a and the second housing 50b, respectively. Furthermore, the loop introduction needle 60 and the suture thread introduction needle 70 do not need to be attached to the forefront of the first housing 50a and the second housing 50b, respectively, and the tips of the first housing 50a and the second housing 50b, respectively. It only has to be attached to the side. That is, the proximal end sides of the loop introduction needle 60 and the suture introduction needle 70 may extend inside the first housing 50a and the second housing 50b, respectively.

  The front end side inner wall surface of the first housing 50a (hereinafter simply referred to as the inner wall surface 54a) comes into contact with, ie, hits, the front end (a front end portion 31a described later) of the loop feed back portion 31 constituting the loop feed back mechanism 30. It has become. The loop feed-back portion 31 constituting the loop feed-back mechanism 30 does not move further forward when the tip end portion 31a hits the inner wall surface 54a of the first housing 50a.

  The distal end side inner wall surface of the second housing 50b (hereinafter simply referred to as the inner wall surface 54b) is configured such that the distal end of the second hollow member 42 constituting the suture feed mechanism 40 comes into contact with, that is, abuts against. When the tip of the second hollow member 42 constituting the suture feed mechanism 40 hits the inner wall surface 54b of the second housing 50b, the second hollow member 42 does not move further forward.

  Further, a stopper 51a and a stopper 51b are formed on a part of the inner wall side surface of the second housing 50b. The stopper 51a and the stopper 51b are formed by projecting a part of the inner wall side surface of the second housing 50b toward the inside of the second housing 50b or providing a step on a part of the inner wall surface of the second housing 50b. Good. The stopper 51a and the stopper 51b have a function of restricting movement of the movement restricting member 47 fixed to the second hollow member 42 in the front-rear direction. However, the tip of the second hollow member 42 abuts on the inner wall surface 54 b of the second housing 50 b, a part of the inner wall of the third hollow member 43, or the movement restricting member 47 of the third hollow member 43. The stopper 51a is not essential when the forward movement of the second hollow member 42 is restricted by contacting the base end.

  Similarly, the proximal end of the second hollow member 42 abuts on the outer wall of the first hollow member 41, or the distal end of the second hollow member 42 abuts on the proximal end (inside) of the third hollow member 43. When the backward movement of the second hollow member 42 is restricted, the stopper 51b is not essential. Further, when the distal end of the second hollow member 42 is brought into contact with the proximal end (inner side) of the third hollow member 43, the distal end of the second hollow member 42 is protruded radially outward, and the third hollow member 42 The rearward movement of the second hollow member 42 may be restricted by projecting the proximal end of 43 toward the inside in the radial direction and locking them.

  Further, a guide hole 55 through which the operation unit 10 can move in the front-rear direction is formed on the side surface of the first housing 50 a along the longitudinal direction of the first housing 50 a. The guide hole 55 penetrates the side surface of the first housing 50a and is formed with a predetermined length. The constituent materials of the first housing 50a and the second housing 50b are not particularly limited, and may be configured using, for example, a polyolefin such as polypropylene or polyethylene, a synthetic resin such as vinyl chloride or polycarbonate. The first housing 50a and the second housing 50b may be made of the same material or different materials.

  A flange portion 56a is provided on the outer wall of the front end of the first housing 50a so as to protrude radially outward. The collar portion 56a is not provided on the outer wall of the first housing 50a facing the second housing 50b. In addition, a flange portion 56b that protrudes radially outward is provided on the outer wall at the front end of the second housing 50b. The flange portion 56b is not provided on the outer wall of the second housing 50b facing the first housing 50a. The collar portion 56a and the collar portion 56b are for assisting the puncture operation.

(Operation unit 10)
The operation unit 10 is operated by the operator when the organ fixing tool is introduced into the internal organs using the suture tool 100. The operation unit 10 transmits the force applied by the operator to the loop feed back mechanism 30 and the suture feed mechanism 40. The operation unit 10 is installed between the base end portion 32 a of the first elastic member 32 constituting the loop feed back mechanism 30 and the base end portion 31 b of the loop feed back portion 31. A part of the operation unit 10 is provided in the guide hole 55 of the first housing 50a so as to protrude into the first housing 50a or from a part of the side surface of the first housing 50a. The operation unit 10 is movable in the front-rear direction along the guide hole 55. 1 to 3 show an example in which a part of the operation unit 10 is formed so as to protrude from the guide hole 55.

  In addition, the constituent material of the operation part 10 is not specifically limited, You may comprise with the synthetic resin similar to the 1st housing 50a, and you may comprise with a different constituent material from the 1st housing 50a. Further, the shape of the operation unit 10 is not particularly limited as long as it is a shape that can receive an operator's operation and transmit the operator's operation to the loop feed-back mechanism 30 and the suture feed mechanism 40. Further, a guide (for example, a groove 22 as shown in FIG. 3) for moving the operation unit 10 straight back and forth may be formed in the first housing 50a.

  1-3, the operation part 10 of the shape protruded toward the outer side from the side surface of the 1st housing 50a in the direction orthogonal to the advancing direction is shown as an example. By adopting such a shape, the operator's finger is easily caught and the operability is improved. However, the shape of the operation unit 10 is not limited to the shape shown in FIGS. 1 to 3. For example, the base end of the operation unit 10 extends backward and protrudes from the base end side of the first housing 50 a. A rod may be provided, and this rod may be used as the operation portion 10 so that it can be taken in and out of the first housing 50a. A button or the like may be provided at the base end of the rod to improve operability. Further, when the operation unit 10 is provided in the first housing 50a, a finger may be inserted through the guide hole 55 and the operation unit 10 may be operated.

(Loop feed back mechanism 30)
The loop feed-back mechanism 30 sends the loop forming portion 80, which is movably inserted into the loop introduction needle 60, to the tip side of the loop introduction needle 60 in conjunction with the movement of the operation portion 10, 1 to return to the inside of the housing 50a. The loop feed back mechanism 30 includes a loop feed back portion 31 and a first elastic member 32.

  The loop feed-back portion 31 includes a distal end portion 31 a, a proximal end portion 31 b, a side wall portion 31 c, a first abutting portion 33, and a housing portion 34, and the first housing according to the movement of the operation portion 10. It is possible to move in the front-rear direction within 50a. The loop feed-back portion 31 only needs to be formed with an accommodating portion 34 in which the first elastic member 32 can be installed and movable in the front-rear direction. For example, a hollow cylindrical member (cylindrical member) A prismatic member (square tube member) or the like can be used. In addition, a slit (or a cut) may be formed in the side wall portion 31c of the loop feed back portion 31 so that the accommodating portion 34 and the outside communicate with each other. FIG. 3 shows an example of the loop feed-back portion 31 that releases the suture feed mechanism 40 side.

  The distal end portion 31a constitutes the distal end side portion of the loop sending back portion 31 and the proximal end side fixing portion 83 of the loop forming portion 80 is fixed. The tip portion 31a regulates the movement of the loop sending back portion 31 in the forward direction. That is, when the tip portion 31a hits the inner wall surface 54a of the first housing 50a, the loop feed-back portion 31 cannot move further forward. The base end portion 31 b constitutes a base end side portion of the loop sending back portion 31, and the operation unit 10 is installed on the housing portion 34 side. The base end portion 31 b regulates the backward movement of the loop sending back portion 31. That is, when the base end portion 31b hits the base end side inner wall surface (hereinafter, simply referred to as the inner wall surface 57a) of the first housing 50a, the loop feed-back portion 31 can no longer move backward. In addition, since the base end side inner wall surface of the 2nd housing 50b differs in a position from the base end side inner wall surface of the 1st housing 50a, the base end side inner wall surface of the 2nd housing 50b shall be called the inner wall surface 57b.

  The side wall part 31c connects the front end part 31a and the base end part 31b, and slidably contacts the inner wall side surface in the first housing 50a. However, the side wall portion 31c does not need to cover the entire storage portion 34, and a slit (or a cut) may be formed so that the storage portion 34 and the outside communicate with each other.

  The first abutting portion 33 abuts the distal end surface of the second abutting portion 45a formed on the suture feeding portion 45 constituting the suture feeding mechanism 40 on the base end surface, and moves the suture feeding portion 45 in the backward direction. To move to. For example, the first contact portion 33 may be formed in a protruding shape that protrudes from a part of the side wall portion 31 c located on the suture feed mechanism 40 side of the loop feed-back portion 31. The first contact portion 33 is not limited to the protrusion shape, and may be any shape that can transmit a backward force to the suture thread feeding portion 45.

  The accommodating portion 34 is a space surrounded by the distal end portion 31a, the proximal end portion 31b, and the side wall portion 31c of the loop feed-back portion 31, and the first elastic member 32 is accommodated in an extendable manner.

  The first elastic member 32 is configured by a member (for example, a spring (coil spring, air spring, etc.), rubber, or the like) that has elasticity and expands and contracts in the front-rear direction. The first elastic member 32 is accommodated in the accommodating portion 34 in a compressed state in which a force greater than the frictional force of the loop 82 accommodated in the loop introduction needle 60 is applied. In other words, the first elastic member 32 is not deformed unless a force equal to or greater than the frictional force of the loop 82 is applied in the state of being accommodated in the accommodating portion 34. Therefore, in a state where the first elastic member 32 is housed in the housing portion 34, that is, in a state where the operation unit 10 is located between the first elastic member 32 and the base end portion 31 b, It can be moved back and forth.

  In addition, it is good to form the guide (for example, groove | channel which the loop feedback part 31 fits) for moving the loop feedback part 31 straight back and forth in the 1st housing 50a.

(Suture feed mechanism 40)
The suture feed mechanism 40 links a suture thread (the suture thread 1 shown in FIGS. 1 to 3) that is movably inserted into the suture introduction needle 70 in conjunction with the movement of the operation unit 10. The feed needle 70 is fed from the tip (blade edge). The suture feed mechanism 40 includes a first hollow member 41, a second hollow member 42, a third hollow member 43, a suture fastening member 44, a suture feed portion 45, and a second elastic member 46. And a restricting member 47.

  The first hollow member 41 is formed in a hollow shape, and is fixed to the proximal end side of the second housing 50b. The second hollow member 42 is formed in a hollow shape, and is movable in the front-rear direction in the second housing 50 b according to the movement of the operation unit 10. The 3rd hollow member 43 is formed in the hollow shape, and is being fixed to the front end side of the 2nd housing 50b. The suture 1 is inserted into the first hollow member 41, the second hollow member 42, and the third hollow member 43 from the outside of the second housing 50b.

  In particular, the third hollow member 43 also functions as a means for preventing the suture 1 from being bent. However, the suture 1 may be exposed in the second housing 50b without providing the third hollow member 43. If the third hollow member 43 is provided, the third hollow member 43 is interposed between the suture thread introduction needle 70 and the second hollow member 42, and the first hollow member 41 and the second hollow member 42 are connected. The suture thread 1 sent through the needle is fed into the suture thread introduction needle 70 in a substantially straight state. As described above, when the third hollow member 43 is provided, when the suture 1 is inserted into the suture instrument 100, the inserted suture 1 is guided to the suture introduction needle 70 in a substantially straight state without being bent. It becomes possible. Therefore, the operator can send the suture 1 to the suture introduction needle 70 in a substantially straight state simply by inserting the suture 1 from the first hollow member 41, and easily attach the suture 1 to the suture tool. 100 can be set.

  The second hollow member 42 has an inner diameter larger than the outer diameter of the first hollow member 41 and an outer diameter smaller than the inner diameter of the third hollow member 43. And the 2nd hollow member 42 moves to the front-back direction in the state inserted in the hollow part of the 3rd hollow member 43 at the front end side. The second hollow member 42 is configured such that the first hollow member 41 is inserted into the hollow portion on the proximal end side according to the position. Furthermore, the axial lengths of the first hollow member 41, the second hollow member 42, and the third hollow member 43 are the size of the second housing 50b and the suture thread that is desired to protrude from the distal end of the suture thread introduction needle 70. The length is determined in consideration of the length of 1, and the length is not particularly limited.

  A movement restricting member 47 is fixed to the outer periphery on the proximal end side of the second hollow member 42. The movement restricting member 47 restricts the movement of the second hollow member 42 in the front-rear direction. That is, the second hollow member 42 moves in the front-rear direction while the movement restricting member 47 contacts the stopper 51a and the stopper 51b formed on the inner wall side surface of the second housing 50b. The front end of the second hollow member 42 abuts against the inner wall surface 54b or the movement restricting member 47 abuts against the stopper 51a to restrict the forward movement of the second hollow member 42, and the movement restricting member 47 contacts the stopper 51b. The case where the rearward movement of the second hollow member 42 is formed by hitting will be described below as an example.

  However, when the forward movement of the second hollow member 42 is restricted by the outer peripheral surface on the front end side of the second hollow member 42 being in contact with a part of the inner wall of the third hollow member 43, the movement restricting member 47. Restricts only the backward movement of the second hollow member 42. In addition, the proximal end side inner peripheral surface of the second hollow member 42 abuts on the outer wall of the first hollow member 41, or the distal end of the second hollow member 42 abuts on the proximal end (inside) of the third hollow member 43. Thus, when restricting the backward movement of the second hollow member 42, the movement restricting member 47 restricts only the forward movement of the second hollow member 42. That is, the movement restricting member 47 is not indispensable, and it is only necessary to determine whether or not the movement restricting member 47 is installed according to the configuration of the first hollow member 41, the second hollow member 42, the third hollow member 43, the stopper 51a, and the stopper 51b.

  Moreover, since the 1st hollow member 41, the 2nd hollow member 42, and the 3rd hollow member 43 allow the suture thread 1 to be inserted through the inside, the inner diameter thereof is set to such an extent that the suture thread 1 can be inserted. Further, the first hollow member 41 and the second hollow member 42 can be inserted into a suture fastening member 44 described later. Therefore, the outer diameters of the first hollow member 41 and the second hollow member 42 need to be set so as to be able to be inserted into the cut line of the suture thread fastening member 44.

  Furthermore, although the internal diameter is enlarged here in order of the 1st hollow member 41, the 2nd hollow member 42, and the 3rd hollow member 43, the magnitude | size of these internal diameters is not specifically limited. However, by increasing the inner diameter in the order of the first hollow member 41, the second hollow member 42, and the third hollow member 43, a step does not occur in a portion where they are connected as viewed from the base end side. Therefore, if the inner diameter is increased in the order of the first hollow member 41, the second hollow member 42, and the third hollow member 43, the suture 1 can be inserted more smoothly when the suture 1 is passed from the proximal end side. it can.

  When the forward movement of the second hollow member 42 is stopped at a part of the inner wall of the third hollow member 43, the tapered shape is such that the inner diameter of the third hollow member 43 is reduced toward the tip side. Or a protrusion or the like may be formed in the inner cavity of the third hollow member 43. Similarly, when the backward movement of the second hollow member 42 is stopped at a part of the outer wall of the first hollow member 41, the outer diameter of the first hollow member 41 increases toward the proximal end. What is necessary is just to make it a taper shape or to form a projection part etc. in the outer periphery of the 1st hollow member 41. Further, when the backward movement of the second hollow member 42 is stopped at the proximal end (inside) of the third hollow member 43, the distal end of the second hollow member 42 is radially outward. The base end of the third hollow member 43 is protruded inward in the radial direction, and these can be locked.

  In addition, it is good to make the base end part of the 1st hollow member 41 protrude outside the 2nd housing 50b. By doing so, it is possible to reduce the burden of the operation of inserting the suture thread 1. However, as shown in FIGS. 1 to 3, the base end portion of the first hollow member 41 may not protrude outside the second housing 50 b. If the base end side of the first hollow member 41 is formed in a funnel shape (a shape in which the wall surface is gradually expanded in diameter toward the base end), the suture thread 1 is easily inserted. Further, the first hollow member 41 may be configured to have a length up to the proximal end of the second housing 50 b, and a funnel-shaped member having a lumen may be attached to the proximal end of the first hollow member 41. Further, the first hollow member 41, the second hollow member 42, and the third hollow member 43 only have to be hollow inside, and for example, a hollow columnar member (cylindrical member) or a prismatic member (square tube member). ) And the like. Further, even if slits (or cuts) are formed in a part of the first hollow member 41, the second hollow member 42, and the third hollow member 43 so that the hollow portion and the outside communicate with each other. Good.

  Further, the third hollow member 43 also has a function of guiding the movement of the second hollow member 42 in the front-rear direction. Therefore, the axial length of the third hollow member 43 may be determined in consideration of the length of the second hollow member 42 as well as the length of the suture 1 to be fed from the distal end of the suture introduction needle 70. . That is, the axial length of the third hollow member 43 is such that a part of the second hollow member 42 is located in the hollow portion of the third hollow member 43 even when the second hollow member 42 is moved most backward. It is configured to a length of about.

  The suture fastening member 44 has a cut that penetrates in the front-rear direction, for example, at the center. The suture fastening member 44 is movable in the front-rear direction by the second hollow member 42. The suture thread fastening member 44 can tighten the first hollow member 41, the suture thread 1 or the second hollow member 42 at the cut. That is, the suture fastening member 44 is configured to fasten any one of the first hollow member 41, the suture thread 1, and the second hollow member 42 according to a position that changes according to the movement of the operation unit 10.

  The suture fastening member 44 is moved in the front-rear direction while being accommodated in the suture feed unit 45. The second abutting portion 45a of the suture thread feeding portion 45 can move forward until the second abutting portion 45a hits the first abutting portion 33 of the loop feed back portion 31, and the proximal end surface of the suture thread feeding portion 45 is the first one. 2 The rearward movement is possible until it hits the inner wall surface 57b on the base end side of the housing 50b. The suture 1 is sent out by being fastened to the suture fastening member 44. Therefore, the suture thread 1 is fastened to the suture fastening member 44 and sent out until the suture fastening member 44 is detached from the first hollow member 41 and the second hollow member 42 is fastened.

  The suture fastening member 44 may be formed of an elastic body such as natural rubber or synthetic rubber, or a relatively soft metal ring such as copper. If the suture fastening member 44 is formed of an elastic body, the suture 1 can be fastened using the elastic force. If the suture fastening member 44 is formed of a metal ring or the like, the suture 1 can be tightened by being plastically deformed at the same time as it is detached from the first hollow member 41. Further, the cut formed in the suture fastening member 44 includes not only a simple cut but also a slit shape, a hole having an inner diameter smaller than the outer diameter of the suture thread 1 and the like.

  The suture thread feeding portion 45 includes a second contact portion 45a, a side wall extending portion 45b, a main body portion 45c, and a mounting portion 45d. The suture thread feeding portion 45 moves back and forth in the second housing 50b according to the movement of the operation portion 10. It can move in the direction. The suture thread feed section 45 only needs to have a mounting portion 45d in which the suture thread fastening member 44 is mounted, for example, a hollow cylindrical member (cylindrical member) or a prismatic member (square tube member). Or the like. A guide for moving the suture feed portion 45 straight back and forth (for example, a groove in which the suture feed portion 45 fits) may be formed in the second housing 50b. At this time, it is preferable that the formed guide does not generate a frictional resistance against the movement of the suture thread feeding portion 45.

  The second contact portion 45a is provided at the tip of the side wall extending portion 45b, for example, and is formed in a protruding shape that protrudes toward the loop feed-back mechanism 30 side. The second contact portion 45a is in contact with the distal end surface of the operation unit 10 whose base end surface has moved in the forward direction, so that the movement from the operation unit 10 is transmitted. And the 2nd contact part 45a receives the force of the front, and the suture feed part 45 moves to the front. Further, the forward movement of the second contact portion 45 a is restricted by the front end surface coming into contact with the base end surface of the first contact portion 33 formed in the loop feed-back portion 31.

  On the other hand, the rearward movement of the second contact portion 45a is performed by pushing the distal end surface against the proximal end surface of the first contact portion 33 formed on the loop feed-back portion 31, so that the suture feed portion 45 is It will also move backwards. However, the suture thread feeding portion 45 can be automatically moved backward by a repulsive force of a second elastic member 46 described later. The second contact portion 45a is not limited to the protrusion shape, and may be any shape that can contact the first contact portion 33 and the operation portion 10. Further, the movement of the second contact portion 45 a in the front-rear direction is guided by the groove 22 that guides the movement of the operation unit 10.

  The side wall extending portion 45b extends a part of the outer wall of the main body portion 45c toward the distal end side. The side wall extending portion 45b is located on the loop feed back mechanism 30 side. The axial length of the side wall extending portion 45b is determined in consideration of the size of the second housing 50b and the length of the suture thread 1 that is desired to protrude from the distal end of the suture thread introduction needle 70. It does not limit the length. Further, the side wall extending portion 45b only needs to have a strength sufficient to withstand the force applied to the second contact portion 45a, and the thickness is not particularly limited.

  The main body 45c has a mounting portion 45d formed therein and a through-hole through which the suture thread 1 is inserted back and forth through the mounting portion 45d. The main body 45c is installed in the second housing 50b so as to be movable in the front-rear direction. As described above, if the guide for moving the suture feed portion 45 straight back and forth is formed in the second housing 50b, the main body portion 45c may be installed on this guide. Further, the suture thread feeding portion 45 is moved backward until the proximal end surface of the main body portion 45c contacts the inner wall surface 57b of the second housing 50b.

  The attachment portion 45d is formed in the main body portion 45c, and the suture fastening member 44 is attached to the attachment portion 45d. The suture fastening member 44 is attached to the attachment portion 45d and its movement is restricted. The mounting portion 45d is not particularly limited in size as long as the suture fastening member 44 can be mounted on the mounting portion 45d.

  The second elastic member 46 has an elastic force and is configured by a member (for example, a spring (coil spring, air spring, etc.) or rubber) that expands and contracts in the front-rear direction. The second elastic member 46 is installed between the inner wall surface 54 b and the movement restricting member 47 fixed to the second hollow member 42, and extends and contracts between the inner wall surface 54 b and the movement restricting member 47. ing. The second elastic member 46 moves the suture thread feeding portion 45 in the backward direction by pushing the movement restricting member 47 using a repulsive force. When the second elastic member 46 is constituted by a spring, the second elastic member 46 may be installed so as to wind the outer peripheral portions of the third hollow member 43 and the second hollow member 42.

(Loop introduction needle 60)
The loop introduction needle 60 has a lumen, and accommodates the loop forming portion 80 in the lumen so as to be movable in the front-rear direction. When the loop introduction needle 60 is attached to the first housing 50a, the base end portion opens into the first housing 50a and communicates with the inside of the first housing 50a. The loop introduction needle 60 is attached to the distal end side of the first housing 50 a so that its axis coincides with the axis of the loop feed back mechanism 30. If the loop introduction needle 60 is attached to the first housing 50a in this way, the loop forming portion 80 can be fed back linearly. The loop introduction needle 60 may be formed of a metal such as stainless steel.

  The loop introduction needle 60 has a blade surface for puncturing the skin at the tip. The blade surface may be formed by cutting along a plane that obliquely intersects the axis of the loop introduction needle 60. The distal end opening of the loop introduction needle 60 may be directed toward the suture introduction needle 70 in order to ensure that a loop 82 of the loop forming portion 80 described later extends in the direction of the suture introduction needle 70. .

  The loop introduction needle 60 is not particularly limited in shape as long as it can puncture the skin and insert the loop forming portion 80. For example, as the loop introduction needle 60, a needle having an outer diameter of about 21 to 17G (preferably 20 to 18G) and a length of about 70 to 120 mm (preferably 80 to 100 mm) may be used. Further, a chamfered portion may be formed at the tip of the loop introduction needle 60 so that the grasped suture thread 1 is not broken. Furthermore, it is preferable that the position of the tip of the loop introduction needle 60 (relative position with respect to the fed suture thread 1) can be adjusted by the position of the support portion 52a.

(Suture introduction needle 70)
The suture thread introduction needle 70 has a lumen, and the suture thread 1 is inserted into the lumen so as to be movable in the front-rear direction. When the suture thread introduction needle 70 is attached to the second housing 50 b, the proximal end portion communicates with the hollow portion of the third hollow member 43. The suture introduction needle 70 is attached to the distal end side of the second housing 50b such that its axis coincides with the axis of the suture feed mechanism 40. If the suture introduction needle 70 is attached to the second housing 50b in this manner, the suture 1 can be fed out linearly. The suture thread introduction needle 70 may be formed of a metal such as stainless steel. The proximal end portion of the suture thread introduction needle 70 may function as the third hollow member 43.

  The suture thread introduction needle 70 has a blade surface for puncturing the skin at the tip. The blade surface may be formed by cutting along a plane that obliquely intersects the axis of the suture introduction needle 70. The direction of the distal end opening of the suture thread introduction needle 70 is not particularly limited, but is preferably directed toward the loop introduction needle 60.

  The suture thread introduction needle 70 is not particularly limited in shape as long as it can puncture the skin and insert the suture thread 1. For example, as the suture thread introduction needle 70, one having an outer diameter of about 21 to 17G (preferably 20 to 18G) and a length of about 70 to 120 mm (preferably 80 to 100 mm) may be used. Further, it is preferable that the position of the tip of the loop introduction needle 60 (relative position with the fed loop 82) can be adjusted by the position of the support portion 52b.

  As described above, the loop introduction needle 60 and the suture thread introduction needle 70 are supported on the distal ends of the first housing 50a and the second housing 50b in parallel with a predetermined distance from each other. The distance between the loop introduction needle 60 and the suture introduction needle 70 is preferably set to a length (for example, about 10 to 30 mm) at which the suture 1 fixes the patient's abdominal wall and visceral wall. . If the distance between the loop introduction needle 60 and the suture introduction needle 70 is within this range, the patient's abdominal wall and visceral wall can be sufficiently fixed by the suture 1.

(Loop formation part 80)
The loop forming portion 80 is inserted into the loop introduction needle 60 so as to be movable in the front-rear direction. The loop forming portion 80 has a proximal end side fixed portion 83 fixed to the distal end portion of the loop sending back portion 31, a loop 82 fixed to the distal end, and an outer diameter smaller than the inner diameter of the loop introduction needle 60, It is comprised by the rod-shaped axial part 81 which connects the base end side fixing | fixed part 83 and the loop 82. As shown in FIG. The loop 82 is formed of an elastic material, and in a state where the loop 82 is fed from the tip of the loop introduction needle 60 (a state where no external force is applied), the loop 82 is restored to an annular shape and is fed from the tip of the loop introduction needle 60. In the absence, it changes almost linearly and can be stored inside the loop introduction needle 60.

  In the state where the loop 82 is delivered from the distal end of the loop introduction needle 60, the suture thread 1 fed from the distal end of the suture introduction needle 70 passes through the loop 82 so that the suture thread 1 delivered from the distal end of the suture introduction needle 70. It extends in the direction. For example, the loop 82 may be fixed to the distal end of the rod-shaped shaft portion 81 at a predetermined angle and formed in a curved shape in a state where the loop 82 is fed from the distal end of the loop introduction needle 60. The curved shape may be a shape in which, for example, the apex portion of the curved portion protrudes in the forward direction when the loop 82 is viewed from the side. If the loop 82 is formed in such a shape, the suture thread 1 can be positioned inside the loop 82 more reliably. Further, when the center of the loop 82 comes on the extension of the suture thread introduction needle 70, the suture thread 1 can be positioned in the loop 82 more reliably when the suture thread 1 is straightly extended.

  Further, although the tip shape of the loop 82 is not particularly limited, the loop 82 has a substantially V shape or a substantially U shape centered on the tip, and a portion for gripping the suture thread 1 (a substantially V shape or a substantially U shape). It is good to narrow the distance of the part. In this way, the suture thread 1 fed from the distal end of the suture thread introduction needle 70 can be gripped more reliably. The loop 82 only needs to be made of a deformable member, for example, a stainless steel wire (high-strength stainless steel for springs), a piano wire (a piano wire with nickel plating or chrome plating), or a superelastic alloy wire. (Alloys of titanium and nickel, alloys of copper and zinc (or alloys including beryllium, silicon, tin, aluminum, gallium, etc.) and alloys of nickel and aluminum).

  The rod-shaped shaft portion 81 can be configured using a metal (for example, stainless steel), a synthetic resin (for example, a polyolefin such as polypropylene or polyethylene, a fluororesin such as PTFE or ETFE), or the like. The rod-shaped shaft portion 81 can be configured using a stylet or the like. Moreover, the base end side fixing | fixed part 83 should just be fixed to the front-end | tip part of the loop sending back part 31, and the method of fixing is not specifically limited. For example, it may be fixed using an adhesive or the like, or a notch or the like may be provided at the tip of the loop feed-back portion 31 and fixed so as to be fitted into the notch. In the case where the loop 82 is made of a relatively rigid material, the rod-shaped shaft portion 81 and the loop 82 may be made of the same material. In this case, the rod-shaped shaft portion 81 and the loop 82 may be formed integrally or separately.

[Relative movement of first housing 50a and second housing 50b]
FIG. 4 is a schematic external view showing a state in which the suture instrument 100 is viewed from the side opposite to FIG. FIG. 5 is a schematic external view showing the suture tool 100 as seen from the insertion side of the suture thread 1. FIG. 6 is an explanatory diagram for explaining the relative movement between the first housing 50a and the second housing 50b. FIG. 7 is a schematic external view showing a state in which the first housing 50a is slid to the front side. FIG. 8 is a schematic cross-sectional view showing a cross-section in a state where the first housing 50a is slid forward. The relative movement between the first housing 50a and the second housing 50b by the moving mechanism will be described in detail with reference to FIGS. 6A is a schematic view showing a state in which the first housing 50a is slid forward, and FIG. 6B is a schematic cross-sectional view taken along line AA in FIG. 6A. However, in FIG.6 (b), illustration is abbreviate | omitted about the internal structure of the 2nd housing 50b.

  The suturing tool 100 includes a moving mechanism 90. The moving mechanism 90 allows the first housing 50a and the second housing 50b to slide relative to each other in the front-rear direction. The moving mechanism 90 includes a slide receiving portion 91 and a slide protrusion 92. The state shown in FIGS. 6 and 7, that is, the state in which the first housing 50 a is slid forward is referred to as the initial state of the suturing tool 100. “Sliding movement” means that the first housing 50a moves along one side surface of the second housing 50b.

  The slide receiving portion 91 is installed on a part of each side surface of the first housing 50a and the second housing 50b constituting one side surface of the housing 50. The slide receiving portion 91 has a function of connecting the first housing 50a and the second housing 50b. In other words, the first housing 50a and the second housing 50b are integrated by the slide receiving portion 91, and the housing 50 is configured. The slide receiving portion 91 may be formed integrally with the first housing 50a, or may be fixed to the first housing 50a using an adhesive or the like as a separate body.

  However, the slide receiving portion 91 is fixed only to the first housing 50a and is not fixed to the second housing 50b. Thereby, the relative movement of the 1st housing 50a and the 2nd housing 50b is attained. That is, when the first housing 50a is moved in the front-rear direction, the slide receiving portion 91 fixed to the first housing 50a also moves in the front-rear direction, but the second housing is not fixed to the slide receiving portion 91. 50b does not move in the front-rear direction. Note that a slide groove 93 extending in the front-rear direction is formed in the slide receiver 91 (see FIG. 6B).

  The slide protrusion 92 is formed on the installation surface of the slide receiver 91 of the second housing 50b. The slide protrusion 92 is formed to extend in the front-rear direction longer than the length of the slide receiver 91 in the front-rear direction. By mounting the slide projection 92 in the slide groove 93 formed in the slide receiver 91, the slide receiver 91 is installed in the second housing 50b. In other words, the slide receiving portion 91 can connect the first housing 50a and the second housing 50b by the action of the slide protrusion 92 and the slide groove 93. Here, the case where the slide protrusion 92 is formed longer than the length of the slide receiver 91 is shown as an example, but the present invention is not limited to this, and the slide protrusion 92 and the slide receiver 91 have the same length. Alternatively, the slide receiving portion 91 may be longer than the length of the slide projection portion 92.

  By providing the slide protrusion 92 and the slide groove 93, the first housing fixed to the slide receiving portion 91 along the slide protrusion 92 attached to the slide groove 93 without moving the second housing 50b. 50a moves in the front-rear direction. The lengths of the slide protrusion 92 and the slide groove 93 may be determined by how much the first housing 50a and the second housing 50b are moved in the front-rear direction.

  Since the slide protrusion 92 is formed longer than the slide receiver 91, the slide receiver 91 slides in the front-rear direction along the slide protrusion 92 when the slide protrusion 92 is mounted in the slide groove 93. You can move. As the slide receiving portion 91 slides, the first housing 50a fixed to the slide receiving portion 91 also slides back and forth (the state shown in FIGS. 6A and 7).

  As described above, the suturing tool 100 can change the state from the normal state to the initial state by providing the moving mechanism 90.

  Note that a distal end side stopper 94 that stops the sliding movement of the front side of the slide receiving portion 91 is formed at the distal end portion of the slide projection portion 92. The distal end stopper 94 is formed in a shape larger than the shape of the slide groove 93 by causing the distal end portion of the slide projection portion 92 to protrude outward, and comes into contact with the distal end surface of the slide receiving portion 91 so as to contact the slide receiving portion 91. The slide movement of the front side of is stopped.

  Similarly, a base end side stopper 95 that stops the slide movement on the rear side of the slide receiving portion 91 is formed at the base end portion of the slide projection portion 92. The base end side stopper 95 is formed in a shape larger than the shape of the slide groove 93 by projecting the base end portion of the slide projection 92 toward the outside, and is brought into contact with the base end surface of the slide receiving portion 91 so as to receive the slide receiver. The slide movement on the rear side of the portion 91 is stopped. The distal end side stopper 94 and the proximal end side stopper 95 correspond to the stopper of the present invention.

  When the proximal end surface of the slide receiving portion 91 contacts the proximal end side stopper 95, the first housing 50a and the second housing 50b are arranged in parallel, and the distal end surface of the slide receiving portion 91 contacts the distal end side stopper 94. When in contact, the first housing 50a is slid to the front side of the second housing 50b. Then, in the suture instrument 100, when the first housing 50a and the second housing 50b are arranged in parallel, the second contact portion 45a contacts the first contact portion 33 as shown in FIG. In a state in which the first housing 50a is slid forward from the second housing 50b, the second contact portion 45a is in contact with the operation portion 10 as shown in FIG. That is, even if the first housing 50a is slid, the loop feed back mechanism 30 and the suture feed mechanism 40 are not driven.

  The configuration of the slide protrusion 92 and the slide groove 93 is not particularly limited as long as the slide receiver 91 does not come off the second housing 50b and the slide receiver 91 can slide in the front-rear direction. . For example, as shown in FIG. 6B, the cross-sectional shape of the slide groove 93 is a groove shape, and the cross-sectional shape of the slide projection 92 is a shape in which the diameter is increased toward the slide receiver 91. The slide receiving portion 91 is prevented from being detached from the slide projection portion 92 and can be slid. A slide protrusion 92 may be formed on the slide receiver 91, and a slide groove 93 may be formed on the second housing 50b.

  Further, a lock mechanism for maintaining the state in which the first housing 50a and the second housing 50b are arranged in parallel may be provided in the first housing 50a and the second housing 50b. For example, a locking projection is provided on one of the facing surface of the first housing 50a or the facing surface of the second housing 50b, and a locking receiving portion is provided on the other. The first housing 50a and the second housing 50b are parallel to each other. The locking mechanism can be configured such that the locking protrusion fits into the locking receiving portion in the disposed state. In addition, a hook portion is provided on either one of the outer wall of the first housing 50a or a part of the outer wall of the second housing 50b, and a hook locking portion is provided on the other, and the first housing 50a and the second housing 50b are provided. The lock mechanism can be configured by hooking the hook portion to the hook engaging portion in a state where the two are arranged in parallel.

  Although the case where the slide receiving portion 91 is fixed to the first housing 50a has been described as an example here, the slide receiving portion 91 may be fixed to the second housing 50b. In this case, the slide protrusion 92, the slide groove 93, the distal end side stopper 94, and the proximal end side stopper 95 are formed on the first housing 50a side. Further, the shape and size of the slide receiving portion 91 are not particularly limited. For example, the slide receiving portion 91 may be shaped to cover the first housing 50a and the second housing 50b in a circumferential shape, and may be circular, elliptical, oval, etc. in a state in which the slide receiving portion 91 is viewed in plan. . Further, the constituent material of the slide receiving portion 91 is not particularly limited.

  Furthermore, although the case where the slide receiving portion 91 is installed on a part of each side surface of the first housing 50a and the second housing 50b constituting one side surface of the housing 50 is shown here as an example, the present invention is limited to this. Instead, a part of the opposing surface of the first housing 50 a or the second housing 50 b may function as the slide receiving portion 91. In this case, the slide protrusion 92 is also formed on a part of the facing surface of the first housing 50a or the second housing 50b. By doing so, the suturing tool 100 can be made more compact.

  However, since the loop feed-back mechanism 30 and the suture feed mechanism 40 interact with each other on the opposing surface side of the first housing 50a and the second housing 50b, the design is made in consideration of these mechanisms. There is a need. For example, the slide protrusion 92 and the slide groove 93 are formed on a part of the surface excluding the part where the loop feed back mechanism 30 and the suture feed mechanism 40 interact, and the loop feed is performed by the sliding movement of the first housing 50a. The return mechanism 30 and the suture feed mechanism 40 must be prevented from being driven.

[Operation of Suture 100]
In the suture instrument 100, the operation unit 10, the loop feed-back mechanism 30, and the suture feed mechanism 40 are not connected. In addition, the loop feed back mechanism 30 and the suture feed mechanism 40 are not connected. That is, the operation unit 10, the loop feed back mechanism 30, and the suture feed mechanism 40 are independent from each other. However, the suturing tool 100 can provide a time difference between the delivery timing of the loop 82 and the delivery timing of the suture 1 with a simple operation without requiring an excessive operation burden on the operator. The suture thread 1 can be put through the visceral wall and the abdominal wall. The mechanism will be described in detail.

  As a preliminary operation of the suture tool 100, the surgeon first inserts the suture 1 into the first hollow member 41 of the suture feed mechanism 40. At this time, the surgeon feeds the suture 1 into the suture introduction needle 70 with such a length that the suture 1 does not protrude from the tip of the suture introduction needle 70. Note that the operator may use the suture thread 1 that is set in the suture tool 100 in advance.

  Thereafter, the surgeon performs a puncturing operation for the loop introduction needle 60 and the suture introduction needle 70. At this time, the operator grasps the suture tool 100 in a state where the first housing 50a is slid forward, and first punctures the patient with the loop introduction needle 60. Then, the operator punctures the patient with the suture introduction needle 70 while sliding the first housing 50a rearward, that is, sliding the second housing 50b forward. Thus, since the suture instrument 100 can move relatively between the first housing 50a and the second housing 50b, the loop introduction needle 60 and the suture introduction needle 70 can be punctured separately with a time difference. it can. Therefore, the puncture resistance can be reduced as compared with the case where the loop introduction needle 60 and the suture introduction needle 70 are punctured simultaneously.

  Then, the operator operates the operation unit 10 with two loop introduction needles 60 and suture introduction needles 70 punctured. That is, the surgeon punctures the loop introduction needle 60 and the suture introduction needle 70 of the suture instrument 100 into the internal organs, and in this state, moves the operation unit 10 forward. Then, the forward movement of the operation unit 10 is first transmitted to the loop feed-back mechanism 30 and then to the suture feed mechanism 40. The following explanation regarding (the operation of the loop feed back mechanism 30) and (the operation of the suture feed mechanism 40) is based on the assumption that the loop introduction needle 60 and the suture introduction needle 70 have been punctured. Yes.

(Operation of loop feed back mechanism 30)
In the initial state where the operation unit 10 is not operated (or the state before the second and subsequent operations), on the loop feed back mechanism 30 side, the base end portion 31b of the loop feed back portion 31 is the inner wall surface 57a of the first housing 50a. It is in the state which contact | abutted. At this time, the first elastic member 32 in a compressed state to which a predetermined force is applied is accommodated in the accommodating portion 34. In addition, the operation unit 10 is sandwiched between the first elastic member 32 and the base end portion 31 b of the loop feed-back unit 31.

  When the operation unit 10 is moved forward by the operator, the force is transmitted to the first elastic member 32. Since the first elastic member 32 is compressed with a predetermined force, the distal end portion 31 a of the loop feed-back portion 31 is pushed on the distal end side of the first elastic member 32. That is, the operation unit 10, the loop feed-back unit 31, and the first elastic member 32 move in the forward direction while maintaining their respective positions. Then, the loop forming portion 80 fixed to the tip end portion 31 a of the loop sending back portion 31 also moves in the forward direction, and the loop 82 positioned at the tip end of the loop forming portion 80 moves from the tip of the loop introduction needle 60. It pops out and opens in a ring.

  Further, when the operation unit 10 is moved in the forward direction, the tip 31a of the loop feed-back unit 31 comes into contact with the inner wall surface 54a of the first housing 50a. In this state, when a force larger than the force applied to the first elastic member 32 is transmitted to the first elastic member 32 via the operation unit 10, the first elastic member 32 is further compressed. become. That is, the loop 82 fed from the tip of the loop introduction needle 60 can be held in an open state. With such a configuration, it is possible to delay the delivery timing of the suture thread 1 from the delivery timing of the loop 82. That is, the loop shape of the loop 82 can be maintained while continuing to move the operation unit 10 in the forward direction.

  Next, when the operation toward the distal end side of the operation unit 10 is released, the compressive force of the first elastic member 32 is released, and the loop feed-back unit 31 starts moving backward. That is, the operation unit 10 moves backward by the repulsive force of the first elastic member 32 until it comes into contact with the proximal end portion 31 b of the loop feed-back unit 31. When the operator further moves the operation unit 10 in the backward direction, the force in the backward direction of the operation unit 10 that is in contact with the proximal end portion 31 b of the loop feed-back unit 31 is transmitted to the loop feed-back unit 31. The As a result, the base end portion 31b of the loop feed-back portion 31 is pushed backward, and the loop feed-back portion 31 moves backward.

  In addition to the first elastic member 32, another elastic body such as a spring or rubber may be provided, and the operation unit 10 may be moved backward using the repulsive force of the elastic body. If such an elastic body is provided, the operation when moving the operation unit 10 in the backward direction is simplified, and the operation burden on the operator is further reduced. That is, it is not necessary for the operator to perform a return operation, which will be described later, and the suture thread 1 can be passed through the visceral wall and the abdominal wall with a substantially one-touch operation.

  When the loop sending back portion 31 moves backward, the loop 82 also starts moving backward. At this time, the suture thread 1 delivered from the distal end of the suture thread introduction needle 70 is penetrated through the loop 82. Therefore, when the loop 82 starts moving backward, the loop shape of the loop 82 gradually decreases, and the suture 1 is gripped by the loop 82. Further, when the loop 82 moves in the backward direction, the suture thread 1 is gripped by the tip of the loop introduction needle 60.

(Operation of suture thread feeding mechanism 40)
In the initial state in which the operation unit 10 is not operated (or the state before the second and subsequent operations), the suture fastening member 44 rides on the first hollow member 41 on the suture feed mechanism 40 side, that is, The first hollow member 41 is in a fastened state, and the suture 1 is not fastened by the suture fastening member 44 and is free to move (the suture 1 is fastened to the suture fastening member 44). Is not).

  Even if the operation unit 10 is moved forward by the operator, the operation is not immediately started on the suture feed mechanism 40 side. Furthermore, the operating portion 10 is moved in the forward direction and comes into contact with the second contact portion 45a, whereby the suture thread feeding portion 45 starts moving in the forward direction. That is, the movement of the operation unit 10 is transmitted to the suture feed mechanism 40 side via the second contact portion 45a.

  When the suture feed section 45 moves in the forward direction, the suture fastening member 44 also moves in the forward direction. When the suture fastening member 44 moves by a predetermined distance, the first hollow member 41 comes out of the suture fastening member 44. Then, the suture thread 1 is inserted in the cut of the suture thread fastening member 44, that is, the suture thread fastening member 44 is tightening the suture thread 1. In this state, the fastening force of the suture thread fastening member 44 reaches the suture thread 1, and the suture thread 1 is held by the suture thread fastening member 44.

  At this time, the proximal end of the second hollow member 42 is in contact with the distal end of the suture fastening member 44. Then, the movement of the operation unit 10 is transmitted to the second hollow member 42 through the suture fastening member 44, and the second hollow member 42 is also moved forward by being pushed by the suture fastening member 44. As the second hollow member 42 moves in the forward direction, the second elastic member 46 is pushed by the movement restricting member 47 and is compressed in the forward direction.

  Since the suture thread 1 is gripped by the suture thread fastening member 44, the suture thread 1 is fed out from the distal end of the suture thread introduction needle 70 as the second hollow member 42 moves forward. That is, the suture thread 1 is sent out from the distal end of the suture introduction needle 70 at a timing later than the timing at which the loop 82 is fed out from the distal end of the loop introduction needle 60. Therefore, a time difference can be provided between the delivery timing of the loop 82 and the delivery timing of the suture 1, and the suture 1 can be easily inserted into the loop 82.

  That is, the delivery timing of the loop 82 and the delivery timing of the suture thread 1 can be adjusted. Thereby, in the suturing tool 100, a time difference can be provided between the feed timing of the loop 82 and the feed timing of the suture 1, or the feed timing of the loop 82 and the feed timing of the suture 1 can be made simultaneously. Since the suture 1 is sent to the suture introduction needle 70 in a substantially straight state by providing the third hollow member 43, the suture 1 is not bent in the second housing 50b.

  Further, when the operation unit 10 is moved forward, the tip of the second hollow member 42 hits the inner wall surface 54b, or the movement restricting member 47 hits the stopper 51a. As a result, the forward movement of the suture thread feeding portion 45 together with the second hollow member 42 stops. In this state, when a force larger than the force applied to the first elastic member 32 is transmitted to the first elastic member 32 via the operation unit 10 and the operation unit 10 is further moved forward, the suture thread The feed portion 45 moves in the forward direction, and the proximal end side of the second hollow member 42 pierces the suture fastening member 44. Then, the fastening to the suture thread 1 by the suture fastening member 44 is released, and the suture thread 1 becomes free. That is, the suture thread 1 does not move forward. Here, a case will be described as an example in which the movement of the second hollow member 42 is restricted by the movement restricting member 47 abutting against the stopper 51a, but this is not a limitation, as described above. Yes (see paragraph [0023]).

  Next, when the operation toward the distal end side of the operation unit 10 is released, the compressive force of the second elastic member 46 is released, and the suture thread feeding unit 45 moves backward to a position where the movement restricting member 47 hits the stopper 51b. Moving. However, the second hollow member 42 is stuck in the suture fastening member 44. Here, the movement of the second hollow member 42 is restricted by the movement restricting member 47 abutting against the stopper 51b. However, the movement restricting member 47 is not limited to this, as described above (paragraph [0024]). reference).

  When the operation unit 10 is further moved in the backward direction with the movement restricting member 47 in contact with the stopper 51b, the proximal end surface of the first contact portion 33 of the loop feed back portion 31 and the first end of the suture feed portion 45 are moved. 2 The front end surface of the abutting portion 45 a abuts, and the force of the operation portion 10 is transmitted to the suture thread feeding portion 45 via the loop feeding back portion 31. Since the movement of the second hollow member 42 is stopped by the stopper 51b, only the suture thread feeding portion 45 moves backward. Then, the second hollow member 42 comes out of the cut line of the suture fastening member 44, and the suture fastening member 44 fastens the first hollow member 41. That is, the fastening force of the suture thread fastening member 44 is applied from the second hollow member 42 to the first hollow member 41, and the initial state is restored.

  Through the series of operations described above, each unit (the operation unit 10, the loop feed back mechanism 30, and the suture feed mechanism 40) returns to the same position as in the initial state, but the loop 82 holds the suture 1. It has become. In this state, when the loop introduction needle 60 and the suture introduction needle 70 of the suture instrument 100 are pulled out from the internal organs toward the abdominal wall, the suture 1 is free, so the suture 1 is guided smoothly. Thus, the visceral wall and the abdominal wall are passed through a substantially U-shape. Finally, the suture thread 1 is cut with the cutting edge of the suture thread introduction needle 70 drawn out of the body or other cutting means (such as scissors or a cutter). Then, since the suture thread 1 is the same as the initial state in which the suture thread introduction needle 70 is inserted to the tip, the visceral wall can be fixed by the above procedure any number of times. When the suture thread 1 is cut out from the distal end side of the cutting edge of the suture introduction needle 70 after the suture thread 1 is cut, the suture thread 1 is pulled to the proximal end by hand and is in the same state as the initial state. It is good to.

(Feeding timing of loop 82 and suture 1)
According to the suturing tool 100, the forward movement of the operation unit 10 is first transmitted to the loop 82, and then the forward movement of the operation unit 10 can be transmitted to the suture thread 1. The delivery timing of the suture thread 1 can be delayed from the delivery timing of the loop 82. By doing so, the suture thread 1 can be surely inserted into the loop 82, and the suture thread 1 can be securely gripped.

  Specifically, when the operation unit 10 is moved to the distal end side, the loop sending back mechanism 30 starts to operate, and only the loop 82 is sent out first using the elastic force of the first elastic member 32. Then, the movement of the operation unit 10 is moved only to the first elastic member 32 on the loop feed-back mechanism 30 side so that the suture thread 1 is sent out in a state where the loop 82 is completely sent out and a state where the loop shape of the loop 82 is maintained. And the shape of the loop 82 can be maintained.

  On the other hand, the suture feed mechanism 40 starts operation with a delay from the operation of the loop feed back mechanism 30. Immediately after the movement starts, the suture feed mechanism 40 uses the state in which the suture fastening member 44 rides on the first hollow member 41 and keeps the suture 1 free. Next, on the side of the suture feed mechanism 40, the suture fastening member 44 comes out of the first hollow member 41, tightens the suture 1, and transmits the movement of the operation unit 10 to the suture 1.

  In this manner, in the suturing tool 100, it is possible to provide a time difference between the delivery timing of the loop 82 and the delivery timing of the suture thread 1. Specifically, in the suturing tool 100, the suture thread 1 can be fed out in a state where the loop 82 has been fed out first, and the suture thread 1 can be easily inserted into the loop 82 formed with an annular shape. It will be. Therefore, according to the suturing tool 100, the suture thread 1 can be delivered by adjusting the lengths of the loop feed-back portion 31, the first hollow member 41 and the second hollow member 42, and the positions of the stoppers 51a and 51b. The timing and the delivery timing of the loop 82 can be changed and corrected.

[Specific Operation Procedure of Suture 100]
9 to 12 are schematic cross-sectional views schematically showing the operation procedure of the suturing tool 100. FIG. A specific operation procedure of the suturing tool 100 will be described with reference to FIGS. In addition, in FIGS. 9-12, the suturing tool 100 which installed the support bar 20 and the flat plate part 21 is illustrated as an example. After the support rod 20 and the flat plate portion 21 are described, a specific operation procedure of the suturing tool 100 will be described. 9 shows the puncture operation of the loop introduction needle 60 (hereinafter referred to as puncture operation 1), FIG. 10 shows the puncture operation of the suture introduction needle 70 (hereinafter referred to as puncture operation 2), and FIG. FIG. 12 shows a forward movement operation (hereinafter referred to as push-in operation 1 (C1) to push-in operation 3 (C3)). ) To return operation 3 (D3)), and FIGS. 11 and 12 also show extracted views of the suture 1 and the loop 82.

  A support rod 20 and a flat plate portion 21 are installed in the suturing tool 100 shown in FIGS. The support bar 20 is attached to the distal end side of the second housing 50b so as to be aligned in parallel with the suture introduction needle 70. The flat plate portion 21 is attached to the distal end portion of the support bar 20 and is movable in the front-rear direction together with the support bar 20. A loop introduction needle 60 and a suture introduction needle 70 are arranged in the flat plate portion 21 in a state of being inserted therethrough.

  By moving the flat plate portion 21 toward the distal end side when the loop introduction needle 60 and the suture introduction needle 70 are punctured, a change in the distance between the loop introduction needle 60 and the suture introduction needle 70 is suppressed. Can do. By providing such a flat plate portion 21, it is possible to prevent the loop introduction needle 60 and the suture introduction needle 70 from being bent and their distances from being significantly changed. Further, since the flat plate portion 21 is movable in the front-rear direction with respect to the loop introduction needle 60 and the suture thread introduction needle 70 via the support bar 20, the flat plate portion 21 also obstructs the puncturing operation. Don't be.

  The planar shape of the flat plate portion 21 is not particularly limited, but may be a rectangular shape, a circular shape, or a polygonal shape, for example. Moreover, it is good to make the front end side surface (patient side surface) of the flat plate part 21 flat so as not to stimulate the patient's skin. When such a flat plate portion 21 is provided, it is preferable that the tips of the support bars 20 extending in parallel with the loop introduction needle 60 and the suture thread introduction needle 70 are fixed to the flat plate portion 21. By providing the support bar 20, the movement stability of the flat plate portion 21 is improved, and the force transmitted from the flat plate portion 21 to the loop introduction needle 60 and the suture introduction needle 70 can be reduced.

(A) Puncture operation 1 (represents the state of the puncture operation 1 of the suturing tool 100 that punctures the loop introduction needle 60, that is, the use state (including the second and subsequent use states))
First, the surgeon prepares the suture tool 100 in a state where the loop 82 of the loop forming portion 80 is accommodated in the loop introduction needle 60 and the suture 1 is accommodated in the suture introduction needle 70 ( (The state shown in FIG. 3). Then, as shown in FIG. 9, the first housing 50a is slid forward. At this time, the suture thread 1 is inserted into the suture thread introduction needle 70 so as not to protrude from the tip of the suture thread introduction needle 70. In addition, the suture fastening member 44 rides on the first hollow member 41, and the suture 1 is free, that is, does not move forward.

  Further, since the first housing 50 a is slid forward, the proximal end surface of the second contact portion 45 a of the suture feed mechanism 40 is in contact with the distal end portion of the operation portion 10. However, since the operation part 10 is not operated yet, the base end part 31b of the loop sending-back part 31 is in contact with the inner wall surface 57a. In this state, the operator punctures the patient with the loop introduction needle 60 of the suturing tool 100.

(B) Puncturing operation 2 (represents the state (including the normal state) of the puncturing operation 2 of the suturing instrument 100 that punctures the suture introduction needle 70)
After the puncture of the loop introduction needle 60, the surgeon punctures the patient with the suture introduction needle 70 while sliding the second housing 50b forward. Then, as shown in FIG. 10, the base end surface of the first housing 50a and the base end surface of the second housing 50b are aligned, and the first housing 50a and the second housing 50b are arranged in parallel. In this state, the surgeon applies force to the operation unit 10. Thus, since the suture instrument 100 can move relatively between the first housing 50a and the second housing 50b, the loop introduction needle 60 and the suture introduction needle 70 can be punctured separately with a time difference. it can. Therefore, the puncture resistance can be reduced as compared with the case where the loop introduction needle 60 and the suture introduction needle 70 are punctured simultaneously.

(C1) Push-in operation 1 (from the start of feeding the loop 82 to the start of sending the suture 1)
When a forward force is applied to the operation unit 10 by the operator, the loop feed-back unit 31 starts moving in the forward direction via the first elastic member 32. When the loop feed-back unit 31 moves in the front-rear direction, the loop forming unit 80 also moves in the front-rear direction. The loop feed-back portion 31 can move in the forward direction until the tip portion 31a hits the inner wall surface 54a of the first housing 50a. When the distal end portion 31a of the loop sending back portion 31 moves forward until it abuts against the inner wall surface 54a of the first housing 50a, the loop forming portion 80 connected to the distal end portion 31a also moves the lumen of the loop introduction needle 60 to the distal end. And is fed out from the tip of the loop introduction needle 60. When the loop 82 is fed out from the tip of the loop introduction needle 60, no external force is applied, and the loop 82 is restored to an annular shape.

  The suture feed mechanism 40 does not move yet when the loop feed back mechanism 30 starts to move. In a state where the suture thread fastening member 44 rides on the first hollow member 41, the suture thread 1 remains free.

(C2) Push-in operation 2 (from the start of sending the suture 1 to the completion of sending the suture 1)
When the operator further moves the operation unit 10 in the forward direction, on the loop feed back mechanism 30 side, the loop feed back unit 31 hits the inner wall surface 54a and does not move further forward. Then, the movement of the operation unit 10 is transmitted only to the first elastic member 32, and the first elastic member 32 is compressed in the forward direction in the accommodating portion 34 of the loop sending back portion 31. Therefore, only the first elastic member 32 moves forward while maintaining the shape of the loop 82. At this time, due to the action of the first elastic member 32, a load is gradually applied to the operator's hand via the operation unit 10. Therefore, the operation unit 10 can be moved smoothly forward.

  On the other hand, the suture thread feeding mechanism 40 starts to move forward when the operation unit 10 abuts on the second abutting portion 45a of the suture thread feeding mechanism 40. When the second contact portion 45a is pushed forward by the operation portion 10, the suture thread feeding portion 45 starts moving in the forward direction. Since the suture fastening member 44 is attached to the suture feed unit 45, the suture fastening member 44 starts to move forward along the first hollow member 41 together with the suture feed unit 45. Note that the second elastic member 46 is compressed as the suture thread feeding portion 45 moves in the forward direction.

  On the suture feed mechanism 40 side, the suture feed portion 45 continues to move forward, and the suture fastening member 44 comes off the first hollow member 41 and tightens the suture 1. In this state, when the suture fastening member 44 further moves forward, the suture 1 fastened to the suture fastening member 44 also starts to move forward, and the suture is introduced from the distal end of the suture introduction needle 70. 1 begins to be sent out. Then, the suture thread 1 is penetrated into the loop 82 that has already been fed out. At this time, the second hollow member 42 is also pushed forward by the suture fastening member 44 and moved in the forward direction.

  Thereafter, the suture thread feeding portion 45 continues to move forward until the movement restricting member 47 hits the stopper 51a or the tip of the second hollow member 42 hits the inner wall surface 54b. At this time, the suture 1 of a necessary length is sent out from the distal end of the suture introduction needle 70.

  When the tip 31a of the loop feed back portion 31 hits the inner wall surface 54a of the first housing 50a, the forward movement of the loop feed back portion 31 is restricted, but the operation unit 10 is further moved forward. As a result, only the first elastic member 32 moves in the forward direction. The loop feed-back portion 31 can compress only the first elastic member 32 to the tip side without moving further to the tip side. By doing so, the shape of the loop 82 fed from the tip of the loop introduction needle 60 is maintained.

(C3) Push-in operation 3 (Release tightening on sent-out suture 1)
When the operation unit 10 is moved further forward by the operator, the compression of the first elastic member 32 and the forward movement of the suture thread feeding unit 45 are continued. However, the second hollow member 42 does not move forward because the movement restricting member 47 hits the stopper 51a or the tip of the second hollow member 42 hits the inner wall surface 54b. In this state, when the suture thread feeding portion 45 is further moved in the forward direction, the second hollow member 42 pierces the suture thread fastening member 44. Then, the tightening on the suture thread 1 is released, and the suture thread 1 becomes free again. That is, the suture thread 1 does not move forward. On the other hand, on the loop feed back mechanism 30 side, only the first elastic member 32 is compressed while maintaining the shape of the loop 82. Therefore, the state in which the suture thread 1 is penetrated inside the loop 82 is maintained.

(D1) Return operation 1 (start movement of each part in the backward direction)
When the surgeon releases the force applied to the operating portion 10 to the distal end side, the compressed state of the first elastic member 32 and the second elastic member 46 is released. When the compressed state of the first elastic member 32 is released, the operation unit 10 is pushed by the first elastic member 32 and moves backward. Then, the operation unit 10 comes into contact with the proximal end portion 31 b of the loop sending back portion 31. Since the second hollow member 42 is pierced into the suture fastening member 44, the second hollow member 42 is also moved backward together with the suture fastening member 44. Then, the suture fastening member 44 is temporarily stopped from moving backward together with the second hollow member 42 whose movement is restricted when the movement restricting member 47 hits the stopper 51b.

  In addition, although the figure has shown as an example the case where the suture thread feeding part 45 is moved backward by releasing the compressed state of the second elastic member 46, the second elastic member 46 will be described below. Even if there is not, the backward movement of the suture thread feeding portion 45 is possible. Hereinafter, description will be made assuming that the second elastic member 46 is not installed.

(D2) Return operation 2 (return start of loop 82)
When the operator further moves the operation unit 10 in the backward direction, the operation unit 10 pushes the proximal end portion 31b of the loop feed-back unit 31, and the loop feed-back unit 31 starts moving in the backward direction. As the loop feed-back portion 31 moves backward, the loop 82 starts to be accommodated in the loop introduction needle 60 so as to draw the suture 1 toward the tip of the loop introduction needle 60.

(D3) Return operation 3 (completion of grasping suture 1)
After a while after the loop feed-back portion 31 is moved, the first contact portion 33 of the loop feed-back portion 31 comes into contact with the second contact portion 45a of the suture feed portion 45. Then, the backward moving force of the loop feed back portion 31 is transmitted to the suture feed portion 45, and the suture feed portion 45 is also moved backward together.

  When the operation unit 10 is further moved backward from this state, the force is transmitted to the suture feed unit 45 via the first contact portion 33 of the loop feed back unit 31, and the suture feed unit 45 further moves. Move backwards. Then, the suture thread fastening member 44 comes out of the second hollow member 42 and rides on the first hollow member 41 as in the state of the puncture operation 2 (normal state). The suture 1 remains free. That is, the suture thread 1 does not move. On the other hand, the loop feed-back portion 31 moves backward until the backward movement of the suture feed portion 45 stops due to the force of the first elastic member 32 and the backward force applied to the operation portion 10. . When the suture fastening member 44 returns to the normal state, it returns to the normal state together. At this time, each part returns to the same position as in the normal state, but the loop 82 is holding the suture 1.

  When the suture tool 100 is removed in this state, the suture thread 1 is free, so that the suture thread 1 is smoothly guided and the visceral wall and abdominal wall are passed through a substantially U-shape. That is, the surgeon can make the suture thread 1 pass through the substantially visceral wall and the abdominal wall only by the pushing operation (pushing operations 1 to 3) and the returning operation (returning operations 1 to 3). Become. That is, according to the suturing tool 100, the suture 1 can be introduced into or removed from the internal organs simply by pushing and pulling the operation unit 10, so that the operation burden on the operator can be greatly reduced. The property will be remarkably improved. In addition, according to the suturing tool 100, the first housing 50a and the second housing 50b can be moved relative to each other in the front-rear direction. The puncture resistance to the patient can be reduced as compared with the case of puncturing two at the same time.

  Finally, if the suture thread 1 is cut by the cutting edge of the suture thread introduction needle 70 drawn out of the body or other cutting means, a series of operations for introduction and withdrawal of the suture thread 1 into the internal organs is completed. . Then, since the suture thread 1 becomes the same as the normal state in which the suture thread introduction needle 70 is inserted up to the tip, the visceral wall can be fixed by the above procedure any number of times. When the suture thread 1 is cut out from the distal end side of the cutting edge of the suture introduction needle 70 after the suture thread 1 is cut, the suture thread 1 is pulled to the proximal end by hand and is in the same state as the initial state. It is good to.

[Organ fixation technique using suture tool 100]
13 and 14 are explanatory views for explaining the operation of the suturing tool 100. FIG. Based on FIGS. 13 and 14, the operation of the suturing tool 100 will be described along the flow of a procedure using the suturing tool 100. Here, fixation of the patient's abdominal wall 101 and visceral wall 102 (for example, stomach wall) using the suturing tool 100 will be described.

  First, the operator inserts an endoscope into the internal organs (for example, the stomach) from the mouth or nose of the patient. Thereafter, the surgeon supplies a sufficient gas (for example, carbon dioxide) into the internal organs to expand the internal organs. Then, the visceral wall 102 is brought into close contact with the abdominal wall 101. Then, the skin 103 is sterilized including the portion to be punctured with the loop introduction needle 60 and the suture introduction needle 70. Then, the position of the viscera is confirmed by the light emitted from the endoscope, and local anesthesia is performed on this site.

  Subsequently, the suture tool 100 is prepared in a state where the loop 82 of the loop forming portion 80 is accommodated in the loop introduction needle 60 and the suture 1 is accommodated in the suture introduction needle 70 (FIG. 3). As shown). At this time, the suture thread 1 is stored in the suture thread introduction needle 70 so as not to protrude from the tip of the suture thread introduction needle 70. Then, the first housing 50a is slid forward, the loop introduction needle 60 is punctured into the abdominal wall 101 of the patient, and the loop introduction needle 60 protrudes from the internal organs wall 102 into the internal organs (FIG. 13 (a)). . Next, the second housing 50b is slid forward, the suture introduction needle 70 is punctured into the abdominal wall 101 of the patient, and the suture introduction needle 70 protrudes from the internal organs wall 102 into the internal organs (FIG. 13 ( b)).

  After confirming this state with an endoscope, the surgeon moves the operation unit 10 forward. Then, the surgeon executes the series of operations shown in FIGS. 11 and 12 so that the suture thread 1 is exposed outside the body (FIG. 14C). That is, the suture thread 1 is in a state of passing the visceral wall 102 and the abdominal wall 101 in a substantially U shape. Finally, the surgeon cuts the suture 1 drawn out of the body and ligates both ends of the suture 1 (FIG. 14D). By this ligation, the visceral wall 102 and the abdominal wall 101 are fixed.

  Furthermore, the suture instrument 100 is punctured again substantially parallel to a position separated from the ligated portion by a predetermined distance, for example, about 20 to 30 mm, and the visceral wall 102 and the abdominal wall 101 are fixed. That is, when the suture thread 1 functions as an organ fixing tool, the visceral wall 102 and the abdominal wall 101 are fixed, and a fistula used when a fistula catheter is inserted can be easily formed. At this time, if the length of the suture thread 1 is set to a plurality of times, the suture tool 100 can be used continuously.

[Effects of Suture 100]
According to the suture instrument 100, it is not necessary to insert the suture thread 1 into the suture instrument 100 each time, and the organ can be fixed any number of times until the suture thread 1 is eliminated. Further, according to the suture instrument 100, the loop introduction needle 60 and the suture introduction needle 70 can be punctured with a time difference, and the puncture resistance to the patient can be reduced as compared with the case where two needles are punctured simultaneously. It becomes possible. Furthermore, according to the suturing tool 100, the suture thread 1 is attached to the visceral wall 102 and the abdominal wall 101 only by pushing and pulling operations (pushing operation (pushing operations 1 to 3) and returning operation (returning operations 1 to 3)) of the operation unit 10. Can be passed through a substantially U-shape. Specifically, the surgeon only performs the operation of moving the operation unit 10 in the forward direction and the operation of moving the operation unit 10 to the initial position, and the suture 1 is applied to the visceral wall 102 and the abdominal wall 101. Since it can be passed, the procedure required by the operator can be greatly simplified. Furthermore, since the suture thread 1 is fed out after the loop 82 is in an annularly open state, the suture thread 1 can be reliably inserted into the loop 82.

  Therefore, the operation burden on the operator can be greatly reduced, and the workability is remarkably improved. Further, since the procedure itself can be executed very simply, not only the workability but also the operability is remarkably improved. Furthermore, since the suture 1 can be reliably grasped while being a simple technique, it is possible to reduce the number of punctures as much as possible, and not only the burden on the operator but also the burden on the patient. Can also contribute. In addition, the operation of the first elastic member 32 allows the pushing operation to be performed smoothly, and the stability during the treatment is further improved.

  In addition, since the suture instrument 100 can relatively move the first housing 50a and the second housing 50b, even if the target site cannot be punctured, the puncture is performed again in units of one. Therefore, not only the burden on the operator but also the burden on the patient can be further reduced.

  In the above embodiment, the case where the suturing tool 100 is used repeatedly has been described as an example. However, the suturing tool 100 is not necessarily used repeatedly. That is, the suture thread 1 having a length corresponding to one procedure may be inserted so that the suture tool 100 is not repeatedly used. In the suture instrument 100, if the first housing 50a and the second housing 50b are placed at the same position, the loop introduction needle 60 and the suture introduction needle 70 can be punctured simultaneously.

  DESCRIPTION OF SYMBOLS 1 Suture thread, 10 Operation part, 20 Support rod, 21 Flat plate part, 22 Groove, 30 Loop feed back mechanism, 31 Loop feed back part, 31a Tip part, 31b Base end part, 31c Side wall part, 32 1st elastic member, 32a Base end portion, 33 First contact portion, 34 receiving portion, 40 Suture feed mechanism, 41 First hollow member, 42 Second hollow member, 43 Third hollow member, 44 Suture fastening member, 45 Suture feed Part, 45a second contact part, 45b side wall extension part, 45c body part, 45d mounting part, 46 second elastic member, 47 movement restricting member, 50 housing, 50a first housing, 50b second housing, 51a stopper, 51b stopper, 52a support portion, 52b support portion, 54a tip side inner wall surface, 54b tip side inner wall surface, 55 guide hole, 56a collar portion, 56b collar Portion, 57a proximal inner wall surface, 57b proximal inner wall surface, 60 loop introduction needle, 70 suture introduction needle, 80 loop forming portion, 81 rod-shaped shaft portion, 82 loop, 83 proximal end fixing portion, 90 Movement mechanism, 91 slide receiving part, 92 slide projection part, 93 slide groove, 94 distal end side stopper, 95 proximal end side stopper, 100 suture tool, 101 abdominal wall, 102 visceral wall, 103 skin.

Claims (6)

A first housing;
A second housing disposed opposite to the first housing;
A moving mechanism for slidingly moving the first housing and the second housing in the front-rear direction;
A loop introduction needle provided on a distal end side of the first housing;
A suture introduction needle that is provided on the distal end side of the second housing at a predetermined distance from the loop introduction needle and that accommodates the suture;
A loop is formed at the tip, and a loop forming portion inserted movably into the loop introduction needle;
A loop feed back mechanism that is provided in the first housing and moves the loop forming portion;
A suture feed mechanism provided in the second housing for feeding out the suture;
An operation unit provided in the first housing or projecting from the first housing and operating the loop feed-back mechanism and the suture feed mechanism;
With
The operation unit is
The first housing is provided to be movable in the front-rear direction,
The loop feed back mechanism is
The movement of the operation unit to the front side is transmitted, and the loop is sent out from the tip of the loop introduction needle,
The suture feed mechanism is
The motion to the front side of the operation unit is transmitted, feeding the suture from the distal end of the needle wherein the suture introduction,
The loop is accommodated in the loop introduction needle while the suture is maintained in a state where the suture is fed from the distal end of the suture introduction needle, so that the suture is grasped by the distal end of the loop introduction needle. A medical suturing device. A first housing;
A second housing disposed opposite to the first housing;
A moving mechanism for slidingly moving the first housing and the second housing in the front-rear direction;
A loop introduction needle provided on a distal end side of the first housing;
A suture introduction needle that is provided on the distal end side of the second housing at a predetermined distance from the loop introduction needle and that accommodates the suture;
A loop is formed at the tip, and a loop forming portion inserted movably into the loop introduction needle;
A loop feed back mechanism that is provided in the first housing and moves the loop forming portion;
A suture feed mechanism provided in the second housing for feeding out the suture;
An operation unit provided in the first housing or projecting from the first housing and operating the loop feed-back mechanism and the suture feed mechanism;
With
The moving mechanism is
A slide receiver fixed to one side surface of the first housing or the second housing;
A slide protrusion formed on the other side surface of the first housing or the second housing and extending in the front-rear direction;
A slide groove formed on the slide receiving portion and fitted with the slide projection,
When the slide protrusion is mounted in the slide groove, the first housing and the second housing are connected to be slidable in the front-rear direction via the slide receiver ,
The loop feed back mechanism is
The movement of the operation unit to the front side is transmitted, and the loop is sent out from the tip of the loop introduction needle,
The suture feed mechanism is
The movement of the operation part to the front side is transmitted, and the suture is sent out from the tip of the suture introduction needle,
The loop is accommodated in the loop introduction needle while the suture is maintained in a state where the suture is fed from the distal end of the suture introduction needle, so that the suture is grasped by the distal end of the loop introduction needle. A medical suturing device. A first housing;
A second housing disposed opposite to the first housing;
A moving mechanism for slidingly moving the first housing and the second housing in the front-rear direction;
A loop introduction needle provided on a distal end side of the first housing;
A suture introduction needle that is provided on the distal end side of the second housing at a predetermined distance from the loop introduction needle and that accommodates the suture;
A loop is formed at the tip, and a loop forming portion inserted movably into the loop introduction needle;
A loop feed back mechanism that is provided in the first housing and moves the loop forming portion;
A suture feed mechanism provided in the second housing for feeding out the suture;
An operation unit provided in the first housing or projecting from the first housing and operating the loop feed-back mechanism and the suture feed mechanism;
With
The moving mechanism is
In a state where the first housing and the second housing are arranged to face each other , provided on the side surface or the facing surface that are in the same direction,
The loop feed back mechanism is
The movement of the operation unit to the front side is transmitted, and the loop is sent out from the tip of the loop introduction needle,
The suture feed mechanism is
The movement of the operation part to the front side is transmitted, and the suture is sent out from the tip of the suture introduction needle,
The loop is accommodated in the loop introduction needle while the suture is maintained in a state where the suture is fed from the distal end of the suture introduction needle, so that the suture is grasped by the distal end of the loop introduction needle.
A medical suturing device. The moving mechanism is
A slide receiver fixed to one side surface of the first housing or the second housing;
A slide protrusion formed on the other side surface of the first housing or the second housing and extending in the front-rear direction;
A slide groove formed on the slide receiving portion and fitted with the slide projection,
When the slide protrusion is mounted in the slide groove, the first housing and the second housing are coupled to be slidable in the front-rear direction via the slide receiver.
The medical suturing device according to claim 1 or 3, wherein The medical suturing device according to claim 2 or 4 , wherein stoppers are formed at both ends of the slide projection. A first housing;
A second housing disposed opposite to the first housing;
A moving mechanism for slidingly moving the first housing and the second housing in the front-rear direction;
A loop introduction needle provided on a distal end side of the first housing;
A suture introduction needle that is provided on the distal end side of the second housing at a predetermined distance from the loop introduction needle and that accommodates the suture;
A loop is formed at the tip, and a loop forming portion inserted movably into the loop introduction needle;
A loop feed back mechanism that is provided in the first housing and moves the loop forming portion;
A suture feed mechanism provided in the second housing for feeding out the suture;
An operation unit provided in the first housing or projecting from the first housing and operating the loop feed-back mechanism and the suture feed mechanism;
With
In a state where the first housing and the second housing are arranged to face each other,
The loop feed back mechanism is
The movement of the operation unit to the front side is transmitted, and the loop is sent out from the tip of the loop introduction needle,
The suture feed mechanism is
The movement to the front side of the operation portion is transmitted after the loop starts to be sent out from the loop introduction needle , and the suture is sent out from the tip of the suture introduction needle.
The loop is accommodated in the loop introduction needle while the suture is maintained in a state where the suture is fed from the distal end of the suture introduction needle, so that the suture is grasped by the distal end of the loop introduction needle.
A medical suturing device.

Images