JP7187530B2 - Medical two-way suturing device and its operating method - Google Patents

Description

TECHNICAL FIELD The present invention relates to a medical two-way suturing device capable of suturing an object in both directions from the proximal side to the distal side and from the distal side to the proximal side, and a method of operating the same.

Trans-Sphenoidal Surgery (TSS) is often performed to remove tumors in the pituitary gland. TSS is generally performed by the following procedures. First, the operator advances along the patient's nasal septum while detaching the nasal mucosa, opens the sphenoid bone and opens the dura mater to reach the pituitary gland. Next, the pituitary tumor is removed, and finally the dura is sutured to reconstruct the sphenoid bone and nasal mucosa. In a device for suturing the dura mater, it has been proposed to pass the suture thread in two directions, from the distal side to the proximal side of the dura mater and from the proximal side to the distal side (Patent Documents 1 to 10). .

Japanese Patent Publication No. 2012-515636 WO2010/085793 Japanese Patent Publication No. 2014-528768 WO2013/024466 Japanese Patent Publication No. 2011-509121 WO2009/089101 JP 2011-72790 A Japanese Patent Publication No. 2004-519299 JP 2014-236995 A WO2017/163600

However, in the threading devices described in Patent Documents 1 and 2, there is a problem that it is physically difficult to move the suture thread from the notch of the needle into the groove of the distal boom arm housing. In addition, since the suture needle must be moved while being in close contact with the boom arm housing, there is a risk that the suture thread will rub against the boom arm housing during movement, resulting in breakage or deformation of the suture thread.

The devices described in US Pat.

In order to reciprocate the needle in both directions in the suture holders described in Patent Documents 5 and 6, it is necessary to re-grip the needle and change the holding position each time. There is a possibility that the tissue may be damaged carelessly, and troublesome work may occur to search for the needle that has fallen off.

The endoscopic suturing machine described in US Pat. No. 5,300,001 manually feeds an object to be sutured while rotationally moving a looper along a multi-dimensional motion trajectory to reciprocate a thread loop formed by a needle. need to do In addition, since the purpose is to overlap two sheets of body tissue and overlock the edges, dura suturing in TSS cannot be performed.

The suturing device described in Patent Literature 9 needs to grasp the tissue portion, which is the object to be sutured, by the suture clasp arms when suturing, and thus there is a possibility of damaging the tissue portion. Since suturing cannot be performed unless the two sheets of living tissue are in a position where they can be grasped by the clasp arms, it is necessary to arrange the living tissue at appropriate positions before suturing.

In the suturing device described in Patent Document 10, the inner cylinder member is arranged inside the needle member, for example, in order to provide the needle member with a thread gripping and releasing mechanism. It requires sophisticated design and manufacturing, which can lead to low yields and high production costs.

SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to provide a medical two-way suturing apparatus that can perform suturing on the human body with simple operation and minimally invasiveness and that is more suitable for industrial production.

The two-way medical suturing device of the present invention, which has solved the above problems, has a housing extending in the far-near direction, and a first needle member and a second needle member provided in the housing. , the first needle member is arranged more proximal than the second needle member, the first needle member and the second needle member each extend in the near-field direction, and the first needle member has a tip facing distally, and the second needle member has a tip facing proximally. According to the two-way suturing device for medical use of the present invention, the first needle member is used when feeding the thread from the proximal side to the distal side, and the second needle member is used when feeding the thread from the distal side to the proximal side. By using it, it is possible to reliably suture in both directions. Moreover, since each needle member needs only to be able to send out the yarn in the advancing direction, it is possible to suppress an increase in production cost due to excessively complicated shape of the needle member. Furthermore, since it is possible to reduce the outer diameter of the needle member, it is possible to suture the human body in a minimally invasive manner.

In the medical two-way suturing device, the first needle member and the second needle member are preferably movable in the distance direction.

In the above two-way medical suturing device, it is preferable that the first needle member and the second needle member overlap each other when viewed from near and far.

In the above two-way suturing device for medical use, it is preferable that the tip of the first needle member or the second needle member is bifurcated into at least a first end portion and a second end portion.

In the above-described bidirectional medical suturing device, the housing extends from the center of gravity of the bidirectional medical suturing device to the central axis of the first needle member in a cross section perpendicular to the direction of distance between the first needle member and the second needle member. and a downward direction from the central axis to the center of gravity, and the first end and the second end are preferably spaced apart in the vertical direction.

The bidirectional medical suturing device further comprises a first thread holding mechanism disposed distally of the first needle member, and a thread holding mechanism between the tip of the second needle member and the distal end of the first thread holding mechanism. and a second thread holding mechanism located at the .

The two-way suturing device for medical use includes a first thread holding mechanism arranged proximal to the distal end of the first needle member, and a tip of the second needle member and a distal end of the first thread holding mechanism. and a second thread retention mechanism positioned between the and a moving mechanism.

In the above-described bidirectional medical suturing device, the housing extends from the center of gravity of the bidirectional medical suturing device to the central axis of the first needle member in a cross section perpendicular to the direction of distance between the first needle member and the second needle member. and a downward direction from the central axis to the center of gravity, and the first thread holding mechanism or the second thread holding mechanism preferably rotates about the first direction other than the vertical direction.

In the above bidirectional medical suturing device, the first direction is preferably a perspective direction or a direction perpendicular to both the vertical direction and the perspective direction.

The medical two-way suturing device has an operation part on the proximal side, and the first thread holding mechanism is provided on one side of the rotating shaft centered in the first direction and on either side of the rotating shaft, It is preferable to have a fixed portion that is directly or indirectly fixed to the operation portion, and a thread abutting portion that is provided on the other side of the rotating shaft and abuts against the thread.

In the above bidirectional medical suturing device, it is preferable that the first thread holding mechanism or the second thread holding mechanism can protrude toward the axial center of the first needle member or the second needle member.

In the medical two-way suturing device, it is preferable that at least one of the first thread holding mechanism and the second thread holding mechanism is movable in the distance direction.

The bidirectional suturing device for medical use is further provided with a first tubular member enclosing the first needle member and a second tubular member enclosing the second needle member. At least one of the members is preferably movable along the perspective direction.

In the above bidirectional medical suturing device, at least one of a configuration in which the first thread holding mechanism is provided on the first tubular member and a configuration in which the second thread holding mechanism is provided on the second tubular member. It is preferable to have

In the above two-way medical suturing device, it is preferable that the distal end surface of the first tubular member and the proximal end surface of the second tubular member face each other.

One embodiment of the operating method of the two-way medical suturing device of the present invention, which has solved the above problems, comprises a housing extending in the far-near direction; and two needle members, the first needle member being disposed proximal to the second needle member, the first needle member and the second needle member each extending in the distal and proximal directions. providing a two-way medical suturing device in which the first needle member has a distally pointing tip and the second needle member has a proximally pointing tip; and a second needle member; moving the first needle member distally to place a portion of the thread distal to the suturing object; moving one needle member proximally; moving the device such that the second needle member is at a different position than the first needle member was at when the first needle member was moved distally; The gist of the method is that it includes the steps of: moving two needle members proximally to dispose a portion of the thread proximal to the object to be sutured; and moving the second needle member distally. have. According to the operating method of the medical two-way suturing device of the present invention, the first needle member is used when feeding the thread from the proximal side to the distal side, and the second needle member is used when feeding the thread from the distal side to the proximal side. By using a needle member, it is possible to reliably perform suturing in both directions. Moreover, since each needle member needs only to be able to send out the yarn in the advancing direction, it is possible to suppress an increase in production cost due to excessively complicated shape of the needle member. Furthermore, since it is possible to reduce the outer diameter of the needle member, it is possible to suture the human body in a minimally invasive manner.

In the above operating method, in the step of preparing the two-way medical suturing device, the two-way medical suturing device further comprises a first thread holding mechanism disposed distally of the first needle member and a second needle. a second thread retaining mechanism disposed between the distal end of the member and the distal end of the first thread retaining mechanism, wherein the thread is retained by the first thread retaining mechanism after the steps of providing the bi-directional medical suturing device; After performing the step of holding and placing the object to be sutured between the first needle member and the second needle member, the first thread holding mechanism extends from the first needle member when viewed from the perspective direction of the suturing device. moving the first thread holding mechanism so that the second thread holding mechanism is radially outwardly positioned; after moving the first needle member proximally, holding the thread with the second thread holding mechanism; After the step of moving the suturing device so that the second needle member is positioned at a position different from the position when the first needle member was moved distally, the suturing device is viewed from the near and far directions, Preferably, the step of moving the second thread holding mechanism so that the second thread holding mechanism is positioned radially outwardly of the second needle member is performed.

Before the step of moving either the first needle member or the second needle member to move the portion of the thread proximally or distally of the object to be sutured, the first moving the other of the needle member or the second needle member to a distal side or a proximal side relative to the object to be sutured; moving proximally or distally.

According to the two-way suturing device for medical use and the operating method thereof of the present invention, the first needle member is used when feeding the thread from the proximal side to the distal side, and the second needle member is used when feeding the thread from the distal side to the proximal side. Bi-directional suturing can be ensured by using two-needle members. Moreover, since each needle member needs only to be able to send out the yarn in the advancing direction, it is possible to suppress an increase in production cost due to excessively complicated shape of the needle member. Furthermore, since it is possible to reduce the outer diameter of the needle member, it is possible to suture the human body in a minimally invasive manner.

FIG. 2 shows a side view (partially cross-sectional view) of the two-way medical suturing device of the present invention. FIG. 3 depicts a perspective view of the interior of the distal side of the bi-directional medical suturing device of the present invention. FIG. 2 shows a cross-sectional view (partial side view) of the distal side of the bi-directional medical suturing device of the present invention. FIG. 4 depicts a side view with an enlarged distal side of the first needle member shown in FIGS. 1 to 3; FIG. Fig. 5 shows a modification of the side view of the first needle member shown in Fig. 4; Fig. 5 shows another modification of the side view of the first needle member shown in Fig. 4; FIG. 2 shows an illustration of a bi-directional medical suturing device with a rotating thread holding mechanism; FIG. 2 shows an illustration of a bi-directional medical suturing device with a rotating thread holding mechanism; FIG. 4 shows an explanatory view of a medical two-way suturing device having a suture holding mechanism that can protrude from the axis of a needle member; FIG. 10 shows a modification of the explanatory diagram of the bidirectional medical suturing device shown in FIG. 9 ; FIG. FIG. 10 is an explanatory diagram of a thread holding mechanism that pinches a thread; FIG. 12 shows an explanatory view of the medical two-way suturing device having the thread holding mechanism shown in FIG. 11; FIG. 4 is an explanatory diagram of steps S2 and S3 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S4 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S5 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S6 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S7 of the operating method of the two-way medical suturing device of the present invention; FIG. 10 is an explanatory diagram of step S8 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S9 of the operating method of the bidirectional medical suturing device of the present invention; FIG. 10 is an explanatory diagram of step S10 of the operating method of the two-way medical suturing device of the present invention; FIG. 10 is an explanatory diagram when the device is rotated after step S10 of the operation method of the medical two-way suturing device of the present invention; FIG. 4 is an explanatory diagram of step S11 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S12 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S13 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S14 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S15 of the operating method of the two-way medical suturing device of the present invention; FIG. 10 is an explanatory diagram of step S16 of the operating method of the medical two-way suturing device of the present invention; FIG. 10 is an explanatory diagram of step S17 of the operating method of the medical two-way suturing device of the present invention; FIG. 4 is an explanatory diagram of an object to be sutured to which the operating method of the two-way medical suturing device of the present invention is applied; FIG. 10 is an explanatory diagram of step S104 of another operating method of the two-way medical suturing device of the present invention; FIG. 10 is an explanatory diagram of step S105 of another operating method of the two-way medical suturing device of the present invention; FIG. 10 is an explanatory diagram of step S106 of another operating method of the two-way suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S107 of another operating method of the two-way suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S108 of another operating method of the two-way medical suturing device of the present invention; FIG. 10 is an explanatory diagram of step S109 of another method of operating the bidirectional suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S111 of another operating method of the two-way suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S112 of another method of operating the bidirectional suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S113 of another operating method of the two-way suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S114 of another method of operating the bidirectional suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S115 of another method of operating the bidirectional suturing device for medical use of the present invention; FIG. 10 is an explanatory diagram of step S116 of another method of operating the bidirectional suturing device for medical use of the present invention; FIG.

Hereinafter, the present invention will be described in more detail based on the following embodiments, but the present invention is not limited by the following embodiments, and can be modified appropriately within the scope of the above and later descriptions. It is of course possible to carry out in addition, and all of them are included in the technical scope of the present invention. In each drawing, for the sake of convenience, hatching, member numbers, etc. may be omitted. In such cases, the specification and other drawings shall be referred to. In addition, the dimensions of various members in the drawings may differ from the actual dimensions, since priority is given to helping to understand the features of the present invention.

1. Medical two-way suturing device A two-way medical suturing device of the present invention has a housing extending in the near and far direction, and a first needle member and a second needle member provided on the housing. The first needle member is arranged proximally relative to the second needle member, the first needle member and the second needle member each extend in the near-field direction, and the first needle member , the tip points distally and the second needle member points proximally. According to the two-way suturing device for medical use of the present invention, the first needle member is used when feeding the thread from the proximal side to the distal side, and the second needle member is used when feeding the thread from the distal side to the proximal side. By using it, it is possible to reliably suture in both directions. Moreover, since each needle member needs only to be able to send out the yarn in the advancing direction, it is possible to suppress an increase in production cost due to excessively complicated shape of the needle member. Furthermore, since it is possible to reduce the outer diameter of the needle member, it is possible to suture the human body in a minimally invasive manner.

A two-way suturing device for medical use, for example, applies a thread to an object to be sutured, such as a living tissue, from one side to the other side and from the other side to the other side under visual observation, a microscope, or an endoscopic image. It is a treatment tool that can pass through. It may be referred to herein simply as a "device" or "suture device."

The thread is a suture used for medical purposes, and may be a single thread or a knitted thread, and the outer diameter can be appropriately selected as long as it is a diameter commonly used for sutures. Also, the thread material may be a degradable material. The length of the thread is desirably long enough not to interfere with surgery, preferably 20 cm or more and 200 cm or less. For example, in TSS, a length that allows the suture to travel back and forth from outside the body to the dura plus a length sufficient for a physician to knot the suture outside the patient's body is preferred, and preferred in TSS. Specifically, the length of the thread is 40 cm or more and 150 cm or less.

First, the overall configuration of the apparatus will be described with reference to FIGS. 1 to 3. FIG. FIG. 1 is a side view (partial cross-sectional view) of the suturing device of the present invention, and FIGS. 2 and 3 are a perspective view and a cross-sectional view (partial side view) of the interior of the distal side. In addition, in FIG. 2, the outer shape of the housing is indicated by a dashed line in order to facilitate understanding of the internal structure of the housing. The same applies to subsequent perspective views. The device 1 according to the invention comprises a housing 10 , a first needle member 21 and a second needle member 22 . Hereinafter, the first needle member 21 and the second needle member 22 may be collectively referred to as "the needle member 20". In each figure, an arrow x indicates a far-near direction of the housing 10, and an arrow y indicates a vertical direction, which will be described later.

The housing 10 prevents members other than the needle member 20, the thread holding mechanism 30 described later, and the tubular member 40 from coming into contact with living tissue. The housing 10 extends in the perspective direction x. In the present invention, the proximal side of the housing 10 refers to the direction toward the hand side of the user, and the distal side refers to the direction opposite to the proximal side (that is, the direction toward the treatment target).

As shown in FIG. 1, the housing 10 preferably has a handle 50 on the proximal side that is manually grasped by the user. Although the details will be described later, it is more preferable that the handle 50 is provided with an operating portion for moving the first needle member 21 and the second needle member 22 . The length from the distal end of the housing 10 to the handle 50 (that is, the length of the portion of the housing 10 extending in the far-near direction x) is the distance from the operator's hand side to the suturing position as a guideline. , for example, 5 cm or more and 80 cm or less. The TSS may be set with reference to the distance from the pituitary gland to the nostrils, and is preferably 20 cm or more and 50 cm or less, for example. For ease of operation by the operator, the grip portion of the handle 50 preferably extends in a direction perpendicular to the far-near direction x of the housing 10 (more preferably downward direction y2, which will be described later).

The first needle member 21 and the second needle member 22 are members used to pass the thread 60 through a biological tissue such as the dura mater, which is the object 70 to be sutured. A part of the thread 60 is moved from the proximal side to the distal side or from the distal side to the proximal side across the sutured object 70 by piercing the sutured object 70 with the needle member 20 on which the thread 60 is hung. be able to.

The first needle member 21 and the second needle member 22 are provided on the housing 10 . The needle member 20 may be provided on the surface of the housing 10, but the housing 10 has a hollow portion as shown in FIGS. It is preferably provided in the part. Specifically, it is preferable that the first needle member 21 and the second needle member 22 are arranged in a portion of the housing 10 that extends in the distance direction x. As a result, the needle member 20 is less likely to be exposed from the housing 10 when suturing is not performed, and thus the needle member 20 is less likely to come into contact with portions other than the suture object 70 . A portion of the housing 10 extending in the perspective direction x can be formed in a cylindrical shape, an elliptical cylindrical shape, or a polygonal cylindrical shape.

As shown in FIG. 3, the housing 10 has a cross-section perpendicular to the perspective direction x between the first needle member 21 and the second needle member 22, and the center axis of the first needle member 21 from the center of gravity of the apparatus. It may have a direction y1 and a downward direction y2 from the central axis toward the center of gravity. In that case, as will be described later, it is preferable that the first end and the second end of the needle member 20 are spaced apart in the vertical direction y. The first end and the second end are the ends of the distal end of the needle member that are divided into at least the first end and the second end, respectively. For example, in FIG. 4, the tip 21A of the first needle member 21 is bifurcated into a first end 21B and a second end 21C. As a result, the thread 60 can easily extend along the perspective direction x in areas other than the portion where the needle member 20 is hooked, and each member of the device 1 can be smoothly operated without the thread 60 becoming an obstacle. .

It is preferable that the housing 10 is provided with a recess 11 for arranging the object 70 to be sutured. It is preferable that the recessed portion 11 is formed by cutting out a part of the housing 10 in the circumferential direction. In the initial position of the first needle member 21 and the second needle member 22, that is, the position in which the first needle member 21 and the second needle member 22 are not moved as shown in FIGS. It is preferably provided between needle member 21 and second needle member 22 . Thus, the object to be sewn 70 is placed between the first needle member 21 and the second needle member 22, and the object to be sewn is moved by moving the first needle member 21 and the second needle member 22 in parallel along the distance direction. It becomes easier to puncture the needle member 20 into 70 . In order to make it easier to confirm the stitching position, it is preferable that the concave portion 11 is arranged on the upper side in the vertical direction y, which is the side opposite to the grip portion of the handle 50 .

Although not shown, the housing 10 may be provided with a protective lid that covers the recess 11 . This prevents the tip of the needle member 20 from being exposed from the concave portion 11 when the housing 10 is moved inside the body before and after suturing. It is preferable that the protective lid is attached so as to be movable in the perspective direction x. In addition, it is preferable that opening and closing of the protective lid can be operated by an operation section on the hand side. As a result, the protective lid can be moved to expose the concave portion 11 during suturing, and the concave portion 11 can be covered with the protective lid during non-suturing.

The outer diameter of the portion of the housing 10 that is inserted into the body can be, for example, 1.5 mm or more, 2 mm or more, or 3 mm or more, or can be 20 mm or less, 10 mm or less, or 8 mm or less.

As shown in FIGS. 1 to 3, the first needle member 21 is arranged proximally relative to the second needle member 22, and the first needle member 21 and the second needle member 22 each extend in the distance direction x. The first needle member 21 has a tip 21A facing distally and the second needle member 22 has a tip 22A facing proximally. The first needle member 21 is used for suturing from the proximal side to the distal side, and the second needle member 22 is used for suturing from the distal side to the proximal side. The thread 60 passed from the proximal side through the object to be sutured 70 by the first needle member 21 and sent to the distal side is passed to the second needle member 22 and passed through the object to be sutured from the distal side by the second needle member 22 . Thread 60 passed proximally through object 70 is passed over first needle member 21 . As a result, the thread 60 can be moved in the distance direction x, and the suturing object 70 can be sutured. At least a portion of the needle member 20 needs to extend in the perspective direction x, and the needle member 20 as a whole may extend in the perspective direction x. In addition, it is preferable that the tip 22A (proximal end) of the second needle member 22 be arranged on the distal side of the tip 21A (distal end) of the first needle member 21 .

The first needle member 21 and the second needle member 22 are preferably movable along the perspective direction x, and more preferably parallelly movable along the perspective direction x. Specifically, when the second needle member 22 is moved to the most distal side, the first needle member 21 can move to a position closer to the proximal side than the tip of the second needle member 22. It is preferable that the second needle member 22 can move to a position distal to the tip of the first needle member 21 when the first needle member 21 is moved to the most proximal side. The first needle member 21 is movable to a position proximal to the tip of the second needle member 22 and distal to the distal end of the recess 11 of the housing 10 . can be configured to be movable to a position distal to the tip of the first needle member 21 and proximal to the proximal end of the concave portion 11 of the housing 10 . Thus, the first needle member 21 can feed the thread 60 from the proximal side to the distal side, and the second needle member 22 can feed the thread 60 from the distal side to the proximal side.

It is preferable that the first needle member 21 and the second needle member 22 overlap each other when viewed in the perspective direction x, and the axial center of the first needle member 21 and the axial center of the second needle member 22 are aligned. more preferably match. When viewed in the perspective direction x, the first needle member 21 and the second needle member 22 overlapping each other means that the first needle member 21 and the second needle member 22 are on the same straight line in the perspective direction x. means that In this case, the entire first needle member 21 and the entire second needle member 22 do not have to be on the same straight line, but the tip of the first needle member 21 and the tip of the second needle member 22 are on the same straight line. preferably in It can also be said that this is a state in which the tip of the first needle member 21 and the tip of the second needle member 22 face each other. By arranging the needle members 20 in this way, the thread 60 moved distally by the first needle member 21 is more likely to be arranged in the vicinity of the tip of the second needle member 22 , and is moved proximally by the second needle member 22 . The thread 60 that has moved to the side is more likely to be arranged near the tip of the first needle member 21 . Therefore, it becomes easier to transfer the thread 60 between the first needle member 21 and the second needle member 22 .

The needle member 20 preferably has biocompatibility and also has strength enough to pierce an object such as a living tissue, and is made of, for example, a metal material such as stainless steel or a resin material. is preferable, and stainless steel is particularly preferable from the viewpoint of rust resistance and ease of processing.

The needle member 20 may be straight, curved, or a combination thereof. Needle member 20 may have a bent portion. FIG. 1 shows an example in which the second needle member 22 is provided with a bent portion. By providing the bent portion, the second needle member 22 and the operating portion can be connected. Although not shown, the needle member 20 is not provided with a bent portion, and a connection member extending in a direction perpendicular to the far-near direction x of the housing 10 is provided at the distal end of the second needle member 22 . provided, and the second needle member 22 may be connected to the operating portion via a connecting member.

The needle member 20 is preferably hollow or solid, and more preferably solid from the viewpoint of ease of manufacture of the needle member 20 and increased strength.

The length of the needle member 20 can be set to 1.5 mm or more and 40 cm or less, which is the distance from the nasal cavity to the pituitary gland in a TSS device, for example. If the length of the needle member 20 is shorter than the length of the portion of the housing 10 that is to be inserted into the body, the needle member 20 can be connected to the operating portion via one or more connecting members. The lengths of the first needle member 21 and the second needle member 22 in the distal direction x may be the same or different. Member 22 is preferably shorter than first needle member 21 .

The outer diameter of the needle member 20 is not particularly limited as long as it is a diameter used for a general suture needle, but is preferably 0.05 mm or more and 1.5 mm or less, for example. The thickness of the hollow needle member 20 is preferably, for example, 0.01 mm or more and 0.5 mm or less.

The tip shapes of the first needle member 21 and the second needle member 22 will be described with reference to FIGS. 4 to 6. FIG. 4 shows an enlarged side view of the distal side of the first needle member 21 shown in FIGS. 1 to 3, and FIGS. 5 and 6 are modifications of the side views of the first needle member 21 shown in FIG. represents 4 to 6, the first needle member 21 is used for explanation, but the second needle member 22 can be similarly constructed.

As shown in FIG. 4, it is preferable that a puncture section 23 is provided at the distal end of the needle member 20 . The sharp puncturing portion 23 easily punctures the object 70 to be sutured. Puncture section 23 may be provided with one or a plurality of sharp tips pointed toward the tip side. For example, the cross-sectional area of the first needle member 21 decreases toward the distal side, and the cross-sectional area of the second needle member 22 decreases toward the proximal side. 23. The inclined surface forming puncture portion 23 may be arranged on the outer surface side of needle member 20 or may be formed on the inner surface side. In the case where the inclined surface that constitutes the puncture portion 23 is arranged on the inner surface side, the outer diameter of the needle member 20 may be constant at the puncture portion 23 .

The needle member 20 is preferably provided with a portion on which the thread 60 is hooked. For example, as shown in FIG. 4, it is preferable that the needle member 20 is provided with a through hole 24 penetrating in a direction perpendicular to the perspective direction x. Above all, it is preferable that the through-hole 24 is provided in a portion including the tip of the needle member 20 (hereinafter referred to as “tip portion”). Moreover, it is more preferable that the through hole 24 extends along the distance direction x of the needle member 20 . As a result, the thread 60 can be hooked to the tip of the needle member 20 through the through hole 24 . A through hole 24 can be provided by bifurcating the needle member 20 .

As a result of arranging the through hole 24 at the tip of the needle member 20, the tip of the first needle member 21 or the second needle member 22 is divided into at least a first end and a second end. Preferably, the distal end 21A of the first needle member 21 is bifurcated into at least a first end portion 21B and a second end portion 21C, and the distal end portion 22A of the second needle member 22 is bifurcated into at least the first end portion 22B and the second end portion 21C. More preferably, it is divided into two ends 22C. As a result, both the ease of manufacture of the needle member 20 and the ease of movement of the thread 60 can be achieved. FIG. 4 shows an example in which the tip 21A of the first needle member 21 is bifurcated into a first end portion 21B and a second end portion 21C. Although not shown, the distal ends 21A and 22A of the first needle member 21 and the second needle member 22 may be divided into three or more or four or more. In this case, it can be said that there are a plurality of through holes 24 . This makes it easier for the thread 60 to get caught on the tip of the needle member 20 .

The first end and the second end are preferably provided on or inside the outer periphery of the needle member 20 when the needle member 20 is viewed from the perspective direction x. are preferably provided on the outer periphery of the needle member 20 at opposing positions across the center of the shaft. By arranging the first end portion and the second end portion in this way, the thread 60 is hung so as to cross the outer periphery of the needle member 20 , so that the thread 60 is less likely to come off the needle member 20 .

When viewed from the direction perpendicular to the central axis of the needle member 20, the bifurcated portion of the first end and the second end may be V-shaped (FIG. 4) or U-shaped. It may be in the shape (FIGS. 5 and 6). For example, it may be uneven, wavy, or non-symmetrical. It is preferable that the height in the vertical direction y at the base end portion 21</b>D of the bifurcated portion is smaller than the outer diameter of the thread 60 . As a result, the thread 60 can be pinched by the base end portion 21D, so that the needle member 20 can easily hold the thread 60. As shown in FIG. On the other hand, the height of the base end portion 21D in the vertical direction y may be larger than the outer diameter of the thread 60. As shown in FIG. This prevents the thread 60 from being deformed by being pinched by the base end portion 21D. The first end and the second end of the needle member 20 may have the same or different positions on the distal side in the far-near direction x. Lengthening either the first end or the second end makes it easier to puncture the object 70 to be sutured.

As another embodiment of the portion of the needle member 20 on which the thread 60 is hooked, the through hole 24 may be provided closer to the proximal end than the distal end of the needle member 20 . In that case, the through hole 24 preferably extends along the radial direction of the needle member 20 . The thread 60 can also be hung on the needle member 20 by providing the through hole 24 at such a position. The through hole 24 may be formed along the circumferential direction of the needle member 20 . In addition, in the present invention, the lumen penetrating along the perspective direction x, which does not appear on the outer peripheral surface of the hollow needle member 20, is not defined as the through hole 24.

The shape of the through hole 24 when the needle member 20 is viewed from the outer peripheral surface is not particularly limited, and can be linear, curved, or a combination thereof, for example.

It is preferable that the first needle member 21 and the second needle member 22 are arranged above the center of gravity of the device 1 in the direction y1 in a cross section perpendicular to the perspective direction x of the housing 10 . By arranging the needle members 20 in the vertical direction y in this way, it becomes easier to visually recognize the stitching position. In addition, since the suture thread 60 can be passed through a position farther from the periphery of the opening of the sutured object 70, it is possible to prevent the thread from coming off due to cutting of the periphery of the opening of the sutured object 70. Further, in order to effectively utilize the space in the housing 10, it is preferable that a member for moving the second needle member 22 is arranged in the downward direction y2 relative to the center of gravity of the device 1. FIG.

Although not shown, the needle member 20 may be provided with the functions of holding and releasing the thread 60 by being combined with other members. For example, the needle member 20 may have a through hole 24, and an outer cylinder member may be provided through which the needle member 20 is inserted through the lumen. As another aspect, the hollow needle member 20 may have a through hole 24 and an insertion member may be arranged in the lumen of the needle member 20 . Both the outer cylinder member and the insertion member are members extending along the distance direction x of the needle member 20 . Since the thread 60 hooked on the through-hole 24 can be held by the outer cylindrical member or the inserting member, the thread 60 can be prevented from falling out of the needle member 20 . It is also possible to release the thread 60 from the needle member 20 by pushing out the thread 60 hooked on the through-hole 24 with an outer cylindrical member or an inserting member.

The suturing device 1 includes a first thread holding mechanism 31 arranged distally of the first needle member 21 , and arranged between the tip of the second needle member 22 and the distal end of the first thread holding mechanism 31 . and a second thread holding mechanism 32, wherein at least a part of the suturing device 1 is arranged movably distally of the first needle member 21, and the second needle A first thread holding mechanism 31 arranged proximal to the member 22 and a first thread holding mechanism 31 arranged at least partially between the tip of the second needle member 22 and the distal end of the first thread holding mechanism 31 . It is more preferable to have two thread holding mechanisms 32 . Hereinafter, the first thread holding mechanism 31 and the second thread holding mechanism 32 may be collectively referred to as the "thread holding mechanism 30". The first thread retaining mechanism 31 retains the thread 60 distal to at least a portion of the first needle member 21 and the second thread retaining mechanism 32 proximal to at least a portion of the second needle member 22 . Provided to hold thread 60 . Accordingly, since the thread 60 is held by the thread holding mechanism 30 , the thread 60 can be prevented from slipping out of the object to be sewn 70 or detached from the device 1 when the device 1 is moved.

The suturing device 1 is connected to the first thread holding mechanism 31 arranged proximal to the distal end of the first needle member 21 and the first thread holding mechanism 31 . and a moving mechanism (hereinafter referred to as “first moving mechanism”) that moves at least part of the distal end of the first needle member 21 to the distal side. Since the first moving mechanism can move the first thread holding mechanism 31 further to the distal side than the first needle member 21 , the thread 60 can be gripped by the first needle member 21 .

The suturing device 1 may include a moving mechanism (hereinafter referred to as a "second moving mechanism") that moves the second thread holding mechanism 32. As shown in FIG. When the second thread holding mechanism 32 is arranged proximally of the proximal end of the second needle member 22, the second moving mechanism is connected to the second thread holding mechanism 32 and the second thread holding mechanism At least a portion of mechanism 32 may be a mechanism that moves proximal to the proximal end of second needle member 32 and distal to the distal end of first needle member 31 . In addition, even when the second thread holding mechanism 32 is arranged distally of the proximal end of the second needle member 22, the second moving mechanism is connected to the second thread holding mechanism 32, At least part of the second thread holding mechanism 32 may be moved proximally of the proximal end of the second needle member 32 and distally of the distal end of the first needle member 31 . can.

The configuration of the first moving mechanism or the second moving mechanism is not particularly limited as long as it is connected to the operation section provided on the proximal side of the device 1, and may be composed of one or more members. It may be formed integrally with the thread holding mechanism 31 or the second thread holding mechanism 32 . The first moving mechanism or the second moving mechanism can be configured, for example, as a connecting member 36 to be described later.

The thread holding mechanism 30 may be composed of one member, or may be composed of a combination of a plurality of members. The housing 10 is configured to be able to hold the thread holding mechanism 30 . The thread holding mechanism 30 may be provided inside or outside the housing 10 , or may be provided in the recess 11 of the housing 10 .

The material of the thread holding mechanism 30 preferably has biocompatibility. For example, it is more preferable to use a metal material such as stainless steel or a resin material. is more preferable.

Embodiments of the thread holding mechanism 30 will be described below. Although the following drawings show an example in which the first thread holding mechanism 31 and the second thread holding mechanism 32 have the same aspect, they can of course have different aspects.

A mode of holding the thread 60 by rotating the thread holding mechanism 30 to hook or hold the thread 60 will be described with reference to FIGS. 7 and 8. FIG. Figures 7-8 represent illustrations of the device 1 with a rotating thread retention mechanism 30, Figures 7(a) and 8(a) represent perspective views of the distal interior of the device 1, 7(b) and 8(b) show a cross-sectional view (partial side view) of the distal side of the device 1. FIG.

Although the shape of the thread holding mechanism 30 is not particularly limited, for example, as shown in FIG. That is, the device 1 has an operation portion on the proximal side, and the first thread holding mechanism 31 is provided on one side of the rotating shaft 33 having the axis in the first direction and the rotating shaft 33 interposed therebetween, It is preferable to have a fixed portion 34 directly or indirectly fixed to the operation portion, and a thread contact portion 35 provided on the other side of the rotating shaft 33 and with which the thread 60 contacts. By rotating the first thread holding mechanism 31 , the thread 60 can be held in contact with the thread 60 on the proximal side of the suture object 70 . Similarly, the second thread holding mechanism 32 is provided on one side of a rotating shaft 33 whose axis is in the first direction, and on either side of the rotating shaft 33, and is fixed directly or indirectly to the operating portion. It is preferable to have a portion 34 and a thread contact portion 35 which is provided on the other side of the rotating shaft 33 and with which the thread 60 contacts. By rotating the second thread holding mechanism 32 , the thread 60 can be held in contact with the thread 60 on the distal side of the suture object 70 . Note that the fixing portion 34 is omitted in FIG. 7(a).

At least one of the first thread holding mechanism 31 and the second thread holding mechanism 32 is preferably movable along the perspective direction x. It is preferably movable along direction x. As a result, since the first thread holding mechanism 31 or the second thread holding mechanism 32 follows the movement of the needle member 20, the thread 60 near the tip of the needle member 20 can be easily held.

At least one of the first thread holding mechanism 31 and the second thread holding mechanism 32 may be fixed in the perspective direction x. For example, the first thread holding mechanism 31 can move along the perspective direction x, and the second thread holding mechanism 32 can be configured not to move along the perspective direction x. By limiting the movable range of the thread holding mechanism 30 in this way, it is possible to prevent the portion of the housing 10 on the distal side from the concave portion 11 from becoming excessively long.

The fixed part 34 is preferably connected to the proximal side operation part via one or more connecting members 36 . The connection member 36 can be arranged inside the housing 10 or outside the housing 10 , but is preferably arranged inside the housing 10 . The connection between the fixed part 34 and the connecting member 36 is achieved by, for example, mechanical fixing such as fitting, screwing, or caulking, welding using a laser or metal brazing, or an adhesive such as polyurethane, epoxy, cyano, or silicone. A method such as adhesion using a can be used. The shape and number of the connection members 36 are not particularly limited as long as the thread abutting portion 35 can be rotated, but the connection members 36 have a portion extending along the perspective direction x of the housing 10 . is preferred. This facilitates connection with the operation unit. The connecting member 36 may be in the form of a long plate, or in the form of a wire or rod. The connecting member 36 is preferably arranged below the needle member 20 in order to facilitate suturing.

The thread contact portion 35 can be formed in a plate shape, a block shape, or a rod shape, for example, but the plate shape or rod shape is preferable from the viewpoint of weight reduction. The thread abutting portion 35 has a first main surface 35A that easily contacts the thread 60, a second main surface 35B on the opposite side, and a side surface 35C. The outer surface of the thread abutting portion 35 may be flat or uneven. In order to prevent the thread 60 from falling off, it is preferable that at least one of the first main surface 35A and the side surface 35C of the thread contact portion 35 is provided with unevenness. The thread abutting portion 35 may be provided with grooves or protrusions for facilitating gripping of the thread 60 .

When holding the thread 60, as shown in FIG. 7, the first main surface 35A of the thread contact portion 35 of the first thread holding mechanism 31 faces the proximal side, and the second main surface 35B faces the far side. It is preferably facing the position side. As a result, the thread 60 near the tip of the needle member 20 can be held by the thread holding mechanism 30 . Similarly, when holding the thread 60, the first principal surface 35A of the thread contact portion 35 of the second thread holding mechanism 32 faces distally, and the second principal surface 35B faces proximally. preferably.

The thread 60 can be released as follows. As shown in FIG. 8(b), when the connecting member 36 connected to the fixing portion 34 of the second thread holding mechanism 32 is moved distally, the second thread holding mechanism 32 moves toward the rotation shaft 33. A fixing portion 34 is arranged on the distal side, and a thread contact portion 35 is arranged on the proximal side. At this time, the first principal surface 35A of the thread contact portion 35 faces upward, and the second principal surface 35B faces downward. Similarly, when the connection member 36 connected to the fixed portion 34 of the first thread holding mechanism 31 is moved proximally, the fixed portion 34 is moved proximally of the rotating shaft 33 in the first thread holding mechanism 31 . is arranged, and the thread contact part 35 is arranged on the distal side. At this time, the first principal surface 35A of the thread contact portion 35 faces upward, and the second principal surface 35B faces downward.

The rotation direction of the thread holding mechanism 30 is not particularly limited. In a cross section perpendicular to the perspective direction x between the first needle member 21 and the second needle member 22, the housing 10 has an upward direction y1 from the center of gravity of the device 1 toward the central axis of the first needle member 21 and a center The first thread holding mechanism 31 or the second thread holding mechanism 32 preferably rotates about the first direction other than the vertical direction y. By setting the rotation axis direction of the thread holding mechanism 30 in this manner, the thread 60 is easily caught by the thread holding mechanism 30 .

Preferably, the first direction is the perspective direction x, or a direction perpendicular to both the up-down direction y and the perspective direction x. By setting the rotation axis direction of the thread holding mechanism 30 in the first direction, the thread 60 can be easily gripped. 7 and 8 show examples in which the first direction is perpendicular to both the vertical direction y and the perspective direction x.

Although not shown, as a modification of FIGS. 7 and 8, the thread holding mechanism 30 has a thread contact portion 35 with which the thread 60 abuts, and a rotary shaft 33 for rotating the thread contact portion 35. The contact portion 35 may have a fixed portion 34 directly or indirectly connected to the operating portion. In this case, it is preferable that the thread contact portion 35 is plate-shaped, and the fixing portion 34 for fixing the distal end portion of the connecting member 36 is provided on the second main surface 35B of the thread contact portion 35 .

Although not shown, the thread abutting portion 35 of the first thread holding mechanism 31 may have a through hole through which the first needle member 21 can be inserted. Similarly, the thread abutment portion 35 of the second thread holding mechanism 32 may have a through hole through which the second needle member 22 can be inserted. In that case, the depth direction of the through-hole preferably extends along the perspective direction x of the needle member 20 . By providing the through hole in the thread holding mechanism 30 in this way, even if the thread holding mechanism 30 faces the tip of the needle member 20, the needle member 20 can be moved in the distance direction.

Next, another aspect of the thread holding mechanism 30 will be described with reference to FIGS. 9 to 10. FIG. 9 to 10 are explanatory diagrams of the device 1 having the thread holding mechanism 30 projecting toward the axial center of the needle member 20. FIGS. 9(b) and 10(b) show perspective views of the distal side of the device 1 with the needle member 20 and rod member 37 not overlapping.

The first thread holding mechanism 31 or the second thread holding mechanism 32 can also be configured to protrude toward the axial center of the first needle member 21 or the second needle member 22 . Even in this mode, the thread 60 at the tip of the first needle member 21 or the second needle member 22 can be retained by the first thread holding mechanism 31 or the second thread holding mechanism 32 .

As shown in FIG. 9, the thread holding mechanism 30 may have a fixed portion 34 directly or indirectly fixed to the operating portion, and a thread contact portion 35 with which the thread 60 contacts. Since it is not necessary to provide a rotating mechanism, it is possible to suppress the occurrence of malfunctions in the movable portion of the thread holding mechanism 30 .

The thread contact portion 35 is preferably movable along the first direction, and more preferably movable along the vertical direction y. This makes it easier to hook the thread 60 on the thread contact portion 35 . For example, it is preferable that the first needle member 21 is arranged inside a first cylindrical member 41, which will be described later, that an opening is provided in the inner wall of the first cylindrical member 41, and that the thread contact portion 35 is exposed through the opening. . Although the position where the opening is provided is not particularly limited, it can be provided below the housing 10 in the vertical direction y, for example.

As a specific configuration of the thread holding mechanism 30 having the fixing portion 34 and the thread contact portion 35, the thread holding mechanism 30 is a rod-shaped member extending along the distance direction x of the housing 10 as shown in FIG. An aspect in which the member 37 is provided is included. It is preferable that the rod-shaped member 37 is held in a hollow portion inside the housing 10 . Moreover, it is preferable that a thread abutting portion 35 for hooking the thread 60 is provided at the distal end of the rod-like member 37 . The hollow portion of the housing 10 as a whole extends in the far-near direction x, and the distal end of each rod-shaped member 37 is bent in a direction perpendicular to the far-near direction x of the needle member 20 . preferable. The distal end of rod-shaped member 37 is preferably constructed of an elastic material. As a result, when the operating portion is operated to move the rod-like member 37 distally, the thread contact portion 35 curves along the shape of the hollow portion of the housing 10 , and the thread 60 is attached to the thread contact portion 35 . can be hung.

The thread contact portion 35 of the thread holding mechanism 30 is preferably made of an elastic material. As the elastic material, for example, an organic material such as silicone rubber or polyamide elastomer, a metal material such as stainless steel, or a combination thereof can be used. An elastic wire, a stranded wire, or the like can also be used as the rod-shaped member 37 .

As a modification of the embodiment shown in FIG. 9, the rod-shaped member 37 extends along the vertical direction y of the housing 10 in a state in which the needle member 20 and the rod-shaped member 37 do not overlap as shown in FIG. The distal end of the rod-shaped member 37 extends along the vertical direction y of the housing 10 and is movable along the vertical direction y of the housing 10. is preferably In that case, the distal end of rod-like member 37 is preferably made of a rigid or elastic material. Accordingly, when the operating portion is operated to move the rod-shaped member 37 in the upward direction y1, the thread contact portion 35 protrudes toward the axial center of the needle member 20, and the thread 60 can be hooked on the thread contact portion 35. can.

The thread contact portion 35 of the thread holding mechanism 30 is preferably made of a rigid or elastic material. As the elastic material, for example, an organic material such as silicone rubber or polyamide elastomer, a metal material such as stainless steel, or a combination thereof can be used. As the rigid material, for example, a metal material such as stainless steel or a combination thereof can be used. An elastic wire, a stranded wire, or the like can also be used as the rod-shaped member 37 .

Still another aspect of the thread holding mechanism 30 will be described with reference to FIGS. 11 and 12. FIG. 11 is an explanatory diagram of the thread holding mechanism 30 that clamps the thread 60, and FIG. 12 is an explanatory diagram of the two-way medical suturing device 1 having the thread holding mechanism 30 shown in FIG. FIG. 10 shows a cross-sectional view (partial side view) on the position side. 11(a) and 12(a) show the state in which the two holding members 38 are separated, and FIGS. 11(b) and 12(b) show the state in which the two holding members 38 are brought close to each other.

The thread holding mechanism 30 can also be configured to sandwich and hold the thread 60 . As shown in FIG. 11, the first thread holding mechanism 31 may have two clamping members 38 facing each other. Similarly, the second thread holding mechanism 32 may also have two clamping members 38 facing each other. The thread 60 can be held by bringing the two clamping members 38 close together to sandwich the thread 60 . The holding member 38 only needs to have strength enough to hold the thread 60, and its shape is not particularly limited, and may be plate-like or block-like. From the viewpoint of weight reduction, the holding member 38 is preferably plate-shaped.

The opposing direction of the two holding members 38 may be along the direction z perpendicular to the perspective direction x and the vertical direction y of the housing 10 as shown in FIG. may be along the perspective direction x of the housing 10 . When the opposing direction of the two holding members 38 is along the far-near direction x of the housing 10, the two holding members 38 preferably have insertion paths 38A penetrating in the opposing direction. It is preferable that the minimum inner diameter of the insertion passage 38A is larger than the outer diameter of the needle member 20 . By providing the insertion passage 38A in this manner, the needle member 20 can pass through the insertion passage 38A, so that the needle member 20 can be moved further to the distal side or the proximal side. When viewed from the opposing direction of the two clamping members 38, the insertion passage 38A can have a circular shape, an elliptical shape, a polygonal shape, or a combination of these shapes. Note that FIG. 11 shows an example in which the insertion passage 38A of the holding member 38 has a square shape. The clamping member 38 may have a notch 38B leading to the insertion passage 38A.

As shown in FIG. 11, it is preferable that support members 39 are connected to the two holding members 38, respectively. The support member 39 may be deflected by contact with another member and displaced so that the two support members 39 connected to the two clamping members 38 are moved closer to each other or away from each other. The support member 39 can be, for example, a bar with a circular or polygonal cross section.

Next, a manner in which the cylindrical member 40 containing the needle member 20 is provided will be described. As shown in FIGS. 2 and 3, the device 1 is further provided with a first tubular member 41 enclosing the first needle member 21 and a second tubular member 42 enclosing the second needle member 22, At least one of the first cylindrical member 41 and the second cylindrical member 42 is preferably movable along the perspective direction x. Moreover, it is more preferable that the first cylindrical member 41 and the second cylindrical member 42 are movable along the perspective direction x. Below, the 1st cylinder member 41 and the 2nd cylinder member 42 may be collectively called "the cylinder member 40." Since the cylinder member 40 is movable in this way, tension can be applied by bringing the distal end of the first cylinder member 41 and the proximal end of the second cylinder member 42 close to sandwich the object 70 to be sutured. can. As a result, even if the needle member 20 punctures the object 70 to be sutured, the object 70 to be sutured does not escape easily, and the object 70 to be sutured can be punctured more easily and can be prevented from being punctured in an unintended position. The inner diameter of the tubular member 40 is larger than the outer diameter of the needle member 20 because the needle member 20 moves within the tubular member 40 . In addition, in FIG. 2, in order to facilitate understanding of the internal configuration of the device 1, the cylindrical member 40 is shown as being semi-cylindrical. The same applies to subsequent perspective views.

Each of the first cylindrical member 41 and the second cylindrical member 42 can be composed of one or a plurality of parts. In FIG. 7, both the first cylindrical member 41 and the second cylindrical member 42 are configured by one cylindrical part. As an example of configuration with a plurality of parts, the inner wall of the housing 10 and one or more parts can be combined to form a cylindrical shape.

In addition, since the needle member 20 is included in the cylindrical member 40 , when the thread 60 is moved in the distance direction x by the needle member 20 , the thread 60 moves along the shape of the lumen of the cylindrical member 40 in the distance direction x. is wrapped to The thread 60 for suturing preferably has a firmness, ie, an appropriate rigidity, so that when the thread 60 comes into contact with the inner wall of the tubular member 40, the thread 60 extends outward in the radial direction. As a result, the folded portion 61 of the thread 60 is accommodated in the inner cavity of the cylindrical member 40, thereby preventing the thread 60 from moving in an unintended direction.

It is preferable that the distal end surface of the first tubular member 41 and the proximal end surface of the second tubular member 42 face each other. Moreover, it is more preferable that the distal end surface of the first cylindrical member 41 and the proximal end surface of the second cylindrical member 42 overlap each other when viewed in the far-near direction x. As a result, the object to be sewn 70 can be easily sandwiched and fixed between the first cylindrical member 41 and the second cylindrical member 42 .

Here, an example in which the object to be sewn 70 is sandwiched and fixed by the first cylindrical member 41 and the second cylindrical member 42 is shown, but the first thread holding mechanism 31 and the second cylindrical member 42, the second thread holding mechanism 32 and the second thread holding mechanism 32 are shown. The object to be sewn 70 may be sandwiched and fixed by one cylindrical member 41 or by the first thread holding mechanism 31 and the second thread holding mechanism 32 .

The length of the first cylindrical member 41 with respect to the first needle member 21 and the length of the second cylindrical member 42 with respect to the second needle member 22 in the distance direction x are not particularly limited.

The cylindrical member 40 can be cylindrical, elliptical, or polygonal. The shape and length of the first cylindrical member 41 and the second cylindrical member 42 may be the same or different.

A first opening 41A is preferably provided on the outer peripheral surface of the first tubular member 41, and more preferably, the first opening 41A is provided on the outer peripheral surface of the distal end portion of the first tubular member 41. . The first thread holding mechanism 31 can be arranged in the lumen of the first cylindrical member 41 through the first opening 41A. Similarly, the second opening 42A is preferably provided on the outer peripheral surface of the second tubular member 42, and the second opening 42A is preferably provided on the outer peripheral surface of the proximal end portion of the second tubular member 42. more preferred. The second thread holding mechanism 32 can be arranged in the lumen of the second tubular member 42 through the second opening 42A.

The first opening 41A is provided in a portion including the distal end of the first cylindrical member 41 so that the first thread holding mechanism 31 can easily hold the thread 60 on the distal end side of the first needle member 21. is preferred. Similarly, the second opening 42A is provided in a portion including the proximal end of the second cylindrical member 42 so that the second thread holding mechanism 32 can easily hold the thread 60 on the distal end side of the second needle member 22. It is preferable that The lengths of the first opening 41A and the second opening 42A in the perspective direction x can be set according to the length of the thread holding mechanism 30. FIG.

The thread holding mechanism 30 may be provided on the tubular member 40 or may be provided on a member other than the tubular member 40 . At least one of a configuration in which the first thread holding mechanism 31 is provided on the first tubular member 41 and a configuration in which the second thread holding mechanism 32 is provided on the second tubular member 42 is provided. is preferred. It is more preferable to have both a configuration in which the first thread holding mechanism 31 is provided on the first tubular member 41 and a configuration in which the second thread holding mechanism 32 is provided on the second tubular member 42 . If the thread holding mechanism 30 is provided on the cylindrical member 40, when the cylindrical member 40 moves along the distance direction, the thread holding mechanism 30 can also move along the distance direction. become.

As with the thread holding mechanism 30, the housing 10 and the tubular member 40 are preferably made of a metal material such as stainless steel or a resin material.

Next, the operating portion provided on the handle 50 will be described with reference to FIG. The device 1 is connected to the proximal side of the first needle member 21, and includes a first operating portion 51 for moving the first needle member 21 in the distance direction x, and the distal side of the second needle member 22. and a second operating portion 52 connected thereto for moving the second needle member 22 in the perspective direction x. FIG. 1 shows an example in which the first operating portion 51 and the second operating portion 52 are levers. When one of the levers is pulled proximally, the first needle member 21 moves distally and the second needle member 22 moves proximally. moves proximally, and when the lever is returned distally, the first needle member 21 moves proximally and the second needle member 22 moves distally.

It is preferable that the first operating portion 51 is also connected to the first thread holding mechanism 31 and the second operating portion 52 is also connected to the second thread holding mechanism 32 . Accordingly, by operating the first operating portion 51, both the first needle member 21 and the first thread holding mechanism 31 can be operated. Similarly, by operating the second operating portion 52, both the second needle member 22 and the second thread holding mechanism 32 can be operated. For example, in the initial state in which the operating section is not moved, the first thread holding mechanism 31 faces the tip of the first needle member 21. However, when the lever constituting the first operating section 51 is pulled proximally, The first thread holding mechanism 31 rotates and is arranged radially outside the first needle member 21 . Furthermore, when the lever of the first operating portion 51 is pulled proximally, the first needle member 21 can be moved distally. When the lever of the first operating portion 51 is returned to the distal side, the first needle member 21 is first returned to the proximal side, and then the first thread holding mechanism 31 rotates in the reverse direction to face the tip of the first needle member 21. do. The second operation section 52 can also be configured in the same manner.

Although not shown, the device 1 includes at least a third operating section for moving the first cylindrical member 41 in the perspective direction x and a fourth operating section for moving the second cylindrical member 42 in the perspective direction x. You may have either one. If the device 1 only has a third operating part, the third operating part is preferably connected to the first thread holding mechanism 31 and the second thread holding mechanism 32 . Thereby, the first cylindrical member 41, the first thread holding mechanism 31, and the second thread holding mechanism 32 can be operated by one third operating portion. If only the fourth operating section is provided, it is preferable that the fourth operating section is connected to the first thread holding mechanism 31 and the second thread holding mechanism 32 . Thereby, the second cylindrical member 42, the first thread holding mechanism 31, and the second thread holding mechanism 32 can be operated by one fourth operating portion. When both the third operating section and the fourth operating section are provided, the first thread holding mechanism 31 and the second thread holding mechanism 32 are connected to either the third operating section or the fourth operating section. In either case, it is desirable to operate the needle member 20 and the tubular member 40 separately. Preferably, the second cylindrical member 42 is not connected.

Various input means can be used as the first to fourth operation sections, and for example, triggers (levers), sliders, dials (rotating bodies including gears), buttons and the like can be used. Also, the input ON/OFF operation and the input amount may be adjusted using a motor or an electronic component, and the operation unit may be operated by a robot hand. The operation unit may be installed outside the housing 10 .

When the same type of input means is used for the first to fourth operation sections, it is preferable that the user can easily grasp which operation section it is by feeling at hand. For example, when both the first operating portion 51 and the second operating portion 52 are levers, the lengths of the levers of the first operating portion 51 and the second operating portion 52 can be made different. It is preferable that the first operation portion 51 be provided closer to the proximal side than the second operation portion 52 in order to match the operational feeling of the user with the arrangement of members in the actual device.

2. Method of Operating the Bidirectional Medical Suturing Apparatus A method of operating the bidirectional medical suturing apparatus 1 of the present invention will be described as procedure 1-1 with reference to FIGS. 13 to 29. FIG. 13 to 28 are explanatory diagrams of each step of the operation method of the two-way medical suturing device 1 of the present invention, and (a) of each drawing is a perspective view of the interior of the device 1 on the distal side. , (b) of each drawing represents a cross-sectional view (partial side view) of the distal side of the device 1 . FIG. 29 is an explanatory diagram of a suturing object 70 to which the method for operating a two-way medical suturing device of the present invention is applied. Each member constituting the device 1 is as described in "1. Medical two-way suturing device" in this specification.

(1) Preparation of the Apparatus The housing 10 extending in the far-near direction, the first needle member 21 and the second needle member 22 arranged in the housing 10, and the distal side of the first needle member 21 and a second thread retaining mechanism 32 disposed between the tip 22A of the second needle member 22 and the distal end of the first thread retaining mechanism 31. , the first needle member 21 is arranged on the proximal side of the second needle member 22, the first needle member 21 and the second needle member 22 each extend in the far-near direction, and the first needle member 21 extends in the near-field direction. The tip 21A of the first needle member 21 faces distally, and the tip 22A of the second needle member 22 faces the proximal side. S1).

(2) Suturing from the Proximal Side to the Distal Side As shown in FIG. 13, the thread 60 is held by the first thread holding mechanism 31 (step S2). At this time, the second thread holding mechanism 32 may be interlocked with the first thread holding mechanism 31 .

As shown in FIG. 13, the object to be sutured 70 is arranged between the first needle member 21 and the second needle member 22 (step S3). Specifically, it is preferable to place the suture object 70 between the first thread holding mechanism 31 and the second thread holding mechanism 32 .

As shown in FIG. 14, the first thread holding mechanism 31 is moved so that the first thread holding mechanism 31 is located radially outside the first needle member 21 when viewed in the perspective direction x (step S4). At this time, the second thread holding mechanism 32 may be interlocked with the first thread holding mechanism 31 .

As shown in FIG. 15, it is preferable to move the first tubular member 41 distally (step S5). Instead of step S5, the second cylindrical member 42 may be moved proximally, or the first cylindrical member 41 may be moved distally and the second cylindrical member 42 may be moved proximally. good. At this time, it is preferable that the object to be sewn 70 is sandwiched between the first tubular member 41 and the second tubular member 42 and fixed. Since tension is applied to the object to be sutured 70 by the first cylindrical member 41 and the second cylindrical member 42, the first needle member 21 can be easily punctured.

As shown in FIG. 16, the first needle member 21 is moved distally (step S6). Specifically, the first needle member 21 is moved distally, and a portion of the thread 60 is moved distally of the sutured object 70 . At this time, it is preferable to move the first needle member 21 so that the tip 21A of the first needle member 21 is located on the distal side of the sutured object 70 . As a result, after the thread 60 is hooked on the tip of the first needle member 21 , the first needle member 21 is pierced through the sutured object 70 , and the folded portion 61 of the thread 60 is pushed to the distal side of the sutured object 70 . can be placed in Preferably, the folded portion 61 of the thread 60 is arranged in the inner cavity of the second cylindrical member 42 so that the second thread holding mechanism 32 can easily hold the thread 60 in a later step.

As shown in FIG. 17, the first needle member 21 is moved proximally (step S7). At this time, it is preferable to move the first needle member 21 so that the tip of the first needle member 21 is located on the proximal side of the suture object 70 . As a result, the first needle member 21 can be pulled out from the object 70 to be sutured, and only the thread 60 penetrates the object 70 to be sutured.

If step S5 has been performed, at least one of the first cylindrical member 41 and the second cylindrical member 42 is returned to its original position (step S8). For example, if the first cylindrical member 41 was moved distally in step S5, the first cylindrical member 41 is moved proximally as shown in FIG.

As shown in FIG. 19, the yarn 60 is held by the second yarn holding mechanism 32 (step S9). Since the second thread holding mechanism 32 holds the thread 60 on the distal side of the sutured object 70, it is possible to prevent the thread 60 from coming off the sutured object 70 even when the apparatus 1 is moved. The suturing from the proximal side to the distal side is now complete. Here, when finishing the work, one end of the thread 60 can be recovered by moving the device 1 to the proximal side while the thread 60 is held by the second thread holding mechanism 32 as shown in FIG. can.

(3) Suturing from the Distal Side to the Proximal Side The device 1 is moved so that the second needle member 22 is arranged at a position different from the suturing position described in (2) above (step S10). For example, as shown in FIG. 20, the concave portion 11 of the housing 10 is moved away from the stitching position, and the entire device 1 is rotated as shown in FIG. 21 to move the stitching position from the left side to the right side in FIG.

The steps after rotating the device 1 are divided into the following two types.
(a) As shown in FIG. 21, when the second thread holding mechanism 32 is holding the thread 60, the following step S11 and subsequent steps are performed.
(b) When the second thread holding mechanism 32 does not hold the thread 60, the following step S12 and subsequent steps are performed.

As shown in FIG. 22, the second thread holding mechanism 32 is moved so that the second thread holding mechanism 32 is positioned radially outside the second needle member 22 when viewed in the perspective direction x (step S11). At this time, the first thread holding mechanism 31 may be interlocked with the second thread holding mechanism 32 .

As shown in FIG. 23, it is preferable to move the first cylindrical member 41 distally (step S12). Instead of step S12, the second cylindrical member 42 may be moved proximally, or the first cylindrical member 41 may be moved distally and the second cylindrical member 42 may be moved proximally. good. At this time, it is preferable that the object to be sewn 70 is sandwiched between the first tubular member 41 and the second tubular member 42 and fixed. Since tension is applied to the object to be sutured 70 by the first cylindrical member 41 and the second cylindrical member 42, the second needle member 22 can be easily punctured.

As shown in FIG. 24, the second needle member 22 is moved proximally (step S13). Specifically, the second needle member 22 is moved proximally, and a portion of the thread 60 is arranged proximally of the object 70 to be sutured. At this time, it is preferable to move the second needle member 22 so that the distal end 22A of the second needle member 22 is positioned closer to the sutured object 70 on the proximal side. As a result, after the thread 60 is hooked on the distal end of the second needle member 22 , the second needle member 22 is pierced through the sutured object 70 , and the folded portion 61 of the thread 60 is pushed closer to the proximal side than the sutured object 70 . can be placed in It is preferable that the folded portion 61 of the thread 60 is arranged in the inner cavity of the first tubular member 41 so that the second thread holding mechanism 32 can easily hold the thread 60 in a later step.

As shown in FIG. 25, the second needle member 22 is moved distally (step S14). At this time, it is preferable to move the second needle member 22 so that the tip 22A of the second needle member 22 is located on the distal side of the sutured object 70 . As a result, the second needle member 22 can be pulled out from the object 70 to be sutured, and only the thread 60 penetrates the object 70 to be sutured.

If step S12 has been performed, at least one of the first cylindrical member 41 and the second cylindrical member 42 is returned to its original position (step S15). For example, if the first cylindrical member 41 was moved distally in step S12, the first cylindrical member 41 is moved proximally as shown in FIG.

As shown in FIG. 27, the thread 60 is held by the first thread holding mechanism 31 (step S16). Since the first thread holding mechanism 31 holds the thread 60 on the proximal side of the suture object 70 , it is possible to prevent the thread 60 from slipping out of the suture object 70 even when the apparatus 1 is moved. The suturing from the distal side to the proximal side is now complete.

As shown in FIG. 28, the device 1 is moved proximally to pull out the free end of the thread 60 (step S17).

Next, when suturing is to be continued, the process can be performed from step S3 while the first thread holding mechanism 31 is holding the thread 60 . The object to be sewn next may be the object to be sewn described in the previous steps or another object to be sewn (not shown). The object to be sutured is comprehensively determined by the operator based on the purpose of suturing, the size and shape of the incision, and the like. When suturing is completed, for example, as shown in FIG. 29, one side and the other side of the thread 60 exposed on the proximal side of the object to be sutured are pulled, the objects to be sutured are pulled together, and a knot is tied. to make.

Next, referring to FIGS. 30 to 41, another operation method of the medical suturing device of the present invention will be described as procedure 1-2. Specifically, a method of operating a device in which the first thread holding mechanism 31 can move along the perspective direction x will be described. 30 to 41 represent explanatory views of each step of another operation method of the device 1, (a) of each drawing represents a perspective view of the interior of the distal side of the device 1, and (b) of each drawing ) shows a cross-sectional view (partial side view) of the distal side of the device 1. FIG.

(1) Preparation of the Apparatus A housing 10 extending in the far-near direction x, a first needle member 21 and a second needle member 22 provided on the housing 10, and a device distal to the first needle member 21 and a second thread retaining mechanism 32 disposed between the tip 22A of the second needle member 22 and the distal end of the first thread retaining mechanism 31. , the first needle member 21 is arranged on the proximal side of the second needle member 22, the first needle member 21 and the second needle member 22 each extend in the distance direction, The tip 21A of the first needle member 21 faces the distal side, and the tip 22A of the second needle member 22 faces the proximal side. The two-way medical suturing device 1, which is movable in the direction x and the second thread holding mechanism 32 and the second cylindrical member 42 are movable in the direction x, and the thread 60 are prepared (step S101).

(2) Suturing from the Proximal Side to the Distal Side As in step S2, the thread 60 is held by the first thread holding mechanism 31 (step S102).

As in step S3, the object to be sutured 70 is arranged between the first needle member 21 and the second needle member 22 (step S103).

As shown in FIG. 30, the first cylindrical member 41 and the first thread holding mechanism 31 are moved distally while the thread 60 is held by the first thread holding mechanism 31 (step S104). At this time, it is preferable that the object to be sewn 70 is sandwiched between the first tubular member 41 and the second tubular member 42 and fixed. Since tension is applied to the object to be sutured 70 by the first cylindrical member 41 and the second cylindrical member 42, the first needle member 21 can be easily punctured. Instead of step S104, while the thread 60 is held by the first thread holding mechanism 31, the second tubular member 42 and the second thread holding mechanism 32 may be moved proximally. The first thread holding mechanism 31 may be moved distally, and the second tubular member 42 and the second thread holding mechanism 32 may be moved proximally.

As in step S4, the first thread holding mechanism 31 is positioned radially outside the first needle member 21 when viewed in the perspective direction x as shown in FIG. Move (step S105).

As in step S6, the first needle member 21 is moved distally as shown in FIG. 32 (step S106).

As in step S7, the first needle member 21 is moved proximally as shown in FIG. 33 (step S107).

As in step S9, the thread 60 is held by the second thread holding mechanism 32 as shown in FIG. 34 (step S108).

As shown in FIG. 35, the first cylindrical member 41 and the first thread holding mechanism 31 are moved proximally (step S109). The suturing from the proximal side to the distal side is now complete. When finishing the work here, one end of the thread 60 can be recovered by moving the device 1 to the proximal side while the thread 60 is held by the second thread holding mechanism 32 .

(3) Suturing from the Distal Side to the Proximal Side Similar to step S10, the device 1 is arranged so that the second needle member 22 is placed at a position different from the suturing position described in (2) above. Move (step S110).

As shown in FIG. 36, while the thread 60 is held by the second thread holding mechanism 32, the first tubular member 41 and the first thread holding mechanism 31 are moved distally (step S111). At this time, it is preferable to sandwich and fix the object 70 to be sutured between the first cylindrical member 41 and the second cylindrical member 42 in order to make it easier to puncture the second needle member 22 . Instead of step S110, while the thread 60 is held by the first thread holding mechanism 31, the second tubular member 42 and the second thread holding mechanism 32 may be moved proximally. The first thread holding mechanism 31 may be moved distally, and the second tubular member 42 and the second thread holding mechanism 32 may be moved proximally.

As in step S11, as shown in FIG. 37, the second thread holding mechanism 32 is positioned outside the second needle member 22 in the radial direction when viewed in the perspective direction x. is moved (step S112).

As in step S13, the second needle member 22 is moved proximally as shown in FIG. 38 (step S113).

As in step S14, the second needle member 22 is moved distally as shown in FIG. 39 (step S114).

As in step S16, as shown in FIG. 40, the first thread holding mechanism 31 holds the thread 60 (step S115).

As shown in FIG. 41, while the thread 60 is held by the first thread holding mechanism 31, the first tubular member 41 and the first thread holding mechanism 31 are moved proximally (step S116).

Similar to step S17, the device 1 is moved proximally to pull out the free end of the thread 60 (step S117).

Then, if suturing is to be continued, the process returns to step S103.

When using the suturing device 1 , before moving the needle member 20 holding the thread 60 , the other needle member 20 may be used to pierce the suture object 70 in advance. Thereby, the thread 60 can be moved smoothly. Therefore, before the step of moving either the first needle member 21 or the second needle member 22 to move a portion of the thread 60 to the proximal side or the distal side of the suture object 70, the second needle member 21 or the second needle member 22 is moved. a step of moving the other of the first needle member 21 and the second needle member 22 to the distal side or the proximal side of the suture target 70; is moved proximally or distally relative to the suture object 70 .

Specifically, in “(2) Suturing from the proximal side to the distal side” of Procedures 1-1 and 1-2, the first needle member 21 is moved distally, and part of the thread 60 is to the distal side of the suture object 70, the second needle member 22 is moved to the distal side of the suture object 70 (step S120), and the second needle member 22 may be moved to the proximal side relative to the suture object 70 (step S121). Alternatively, in "(3) Suturing from the distal side to the proximal side" of Procedures 1-1 and 1-2, the second needle member 22 is moved proximally to suture part of the thread 60. Before step S13 or step S113 of moving the object 70 to the proximal side, the first needle member 21 is moved to the proximal side of the suture object 70 (step S122), and the first needle member 21 is moved to the proximal side. It may be moved to the distal side from the suture object 70 (step S123).

Although suturing the dura mater in TSS has been described above as an example, the present invention is not limited to this, and the type of surgery and the sutured object (that is, the type of living tissue) can be selected as appropriate. The suturing device 1 of the present invention can be used in all surgeries such as craniotomy, laparotomy, and thoracotomy, regardless of whether or not an endoscope or microscope is used. Furthermore, although the present invention has been described using an example in which a doctor or the like directly operates the operating section, the present invention is not limited to this and can be operated using a robot having a manipulator. The biological tissue is not limited to membranous tissue such as dura mater, arachnoid membrane, pleura, pericardium, peritoneum, etc., but includes all biological tissues such as skin, blood vessels, lungs, heart, gastrointestinal tract, bone, muscle, etc. be able to.

This application claims the benefit of priority based on Japanese Patent Application No. 2018-28154 filed on February 20, 2018. The entire contents of the specification of Japanese Patent Application No. 2018-28154 filed on February 20, 2018 are incorporated herein by reference.

1: Medical two-way suture device 10: Housing 11: Recess 20: Needle member 21: First needle member 21A: Tip 21B: First end 21C: Second end 22: Second needle member 22A: Tip 22B : First end portion 22C: Second end portion 23: Puncture portion 24: Through hole 30: Thread holding mechanism 31: First thread holding mechanism 32: Second thread holding mechanism 33: Rotating shaft 34: Fixed portion 35: Thread abutment Contact portion 36: Connecting member 37: Rod member 38: Clamping member 38A: Insertion path 38B: Notch 39: Supporting member 40: Cylinder member 41: First cylindrical member 41A: First opening 42: Second cylindrical member 42A: Third 2 opening 50: handle 51: first operation part 52: second operation part 60: thread 61: thread folding part 70: object to be sutured

Claims (17)

A two-way medical suturing device capable of suturing an object to be sutured with thread,
a housing extending in the near and far directions;
a first needle member and a second needle member provided on the housing;
the first needle member is arranged on the proximal side of the second needle member,
the first needle member and the second needle member each extend in a distance direction,
With the tip of the first needle member facing distally and the tip of the second needle member facing proximally, the tip of the second needle member is positioned distally of the tip of the first needle member. The tip is arranged,
the object to be sutured is arranged between the first needle member and the second needle member;
movement of the first needle member distally causes a portion of the thread to move distally from the object to be sutured;
A two-way suturing device for medical use, wherein movement of the second needle member to the proximal side moves a portion of the thread to the proximal side relative to the object to be sutured. 2. The device of claim 1, wherein the first needle member and the second needle member are movable along the distance direction. 3. A device according to claim 1 or 2, wherein said first needle member and said second needle member overlap each other when viewed in perspective. A device according to any one of claims 1 to 3, wherein the tip of said first needle member or said second needle member is bifurcated into at least a first end and a second end. In a cross section perpendicular to the perspective direction between the first needle member and the second needle member, the housing extends upward from the center of gravity of the two-way medical suturing device toward the central axis of the first needle member. and a downward direction from the central axis toward the center of gravity;
5. The device of claim 4, wherein said first end and said second end are vertically spaced apart. a first thread holding mechanism disposed distally of the first needle member;
a second thread retention mechanism positioned between the tip of the second needle member and the distal end of the first thread retention mechanism;
The device according to any one of claims 1 to 5, wherein the first thread holding mechanism and the second thread holding mechanism are for holding and releasing the thread. a first thread holding mechanism located proximal to the distal end of the first needle member; and a thread holding mechanism located between the tip of the second needle member and the distal end of the first thread holding mechanism. and a moving mechanism connected to the first thread holding mechanism and configured to move at least a portion of the first thread holding mechanism distally of the distal end of the first needle member. 6. The apparatus according to any one of claims 1 to 5, wherein said first thread holding mechanism and said second thread holding mechanism are for holding and releasing a thread. In a cross section perpendicular to the perspective direction between the first needle member and the second needle member, the housing extends upward from the center of gravity of the two-way medical suturing device toward the central axis of the first needle member. and a downward direction from the central axis toward the center of gravity;
The device according to claim 6 or 7, wherein the first thread holding mechanism or the second thread holding mechanism rotates about a first direction other than the vertical direction. 9. The apparatus of claim 8, wherein the first direction is the perspective direction or a direction perpendicular to both the up-down direction and the perspective direction. The bidirectional suturing device for medical use has an operation part on the proximal side,
The first thread holding mechanism includes a rotating shaft having the first direction as an axis;
a fixed portion provided on one side of the rotating shaft and directly or indirectly fixed to the operation portion;
10. The device according to claim 8 or 9, further comprising: a thread abutting portion provided on the other side of the rotating shaft and against which the thread abuts. 8. A device according to claim 6 or 7, wherein said first thread holding mechanism or said second thread holding mechanism is protrusible towards the axial center of said first needle member or said second needle member. 8. A device according to claim 6 or 7, wherein at least one of the first thread holding mechanism and the second thread holding mechanism is movable along the perspective direction. Further, a first tubular member enclosing the first needle member and a second tubular member enclosing the second needle member are provided, and at least one of the first tubular member and the second tubular member is provided. is movable relative to the housing along the perspective direction. Further, a first tubular member enclosing the first needle member and a second tubular member enclosing the second needle member are provided, and the first thread holding mechanism is provided in the first tubular member. 13. The device according to any one of claims 6 to 12, having at least one of a configuration in which the second thread holding mechanism is provided in the second tubular member. 15. Apparatus according to claim 13 or 14, wherein the distal end face of said first tubular member and the proximal end face of said second tubular member face each other. a housing extending in the distance direction; a first needle member and a second needle member provided in the housing; and a first needle member enclosing the first needle member and movable along the distance direction. and a second tubular member that encloses the second needle member and is movable along the distance direction, wherein the first needle member is closer to the proximal side than the second needle member. , wherein the first needle member and the second needle member extend in the distal and near directions, the tip of the first needle member faces distally, and the second needle A method of operating a bi-directional medical suturing device in which the member points proximally, comprising:
performing at least one of moving the first tubular member distally and moving the second tubular member proximally;
moving the first needle member distally to position a portion of the thread distal to the proximal end of the second tubular member;
moving the first needle member proximally;
moving the bidirectional medical suturing device such that the second needle member is positioned at a position different from the position when the first needle member is moved distally;
moving the second needle member proximally to position a portion of the thread proximal to the distal end of the first tubular member;
moving the second needle member distally;
A method of operating a medical bi-directional suturing device comprising: The two -way suturing device for medical use further comprises a first thread holding mechanism disposed further distally than the first needle member, and a tip of the second needle member and a distal end of the first thread holding mechanism. a second thread retaining mechanism disposed between the ends, the first thread retaining mechanism and the second thread retaining mechanism for retaining and releasing the thread;
The first thread retention mechanism retains the thread prior to the first needle member moving distally and placing a portion of the thread distal to the proximal end of the second tubular member . a step;
moving the first thread holding mechanism so that the first thread holding mechanism is positioned radially outside of the first needle member when viewed from the perspective direction of the two-way medical suturing device;
performing at least one of moving the first tubular member distally and moving the second tubular member proximally;
after the step of moving the first needle member proximally, the step of holding the thread by the second thread holding mechanism;
After the step of moving the bidirectional medical suturing device so that the second needle member is positioned at a position different from the position when the first needle member was moved distally, the medical bilateral suturing device 17. The step of claim 16, wherein said second thread retaining mechanism is moved such that said second thread retaining mechanism is positioned radially outwardly of said second needle member when viewed in a perspective direction of the directional suturing device. the method of.

Images