JPH06304174A - Suturing and ligating device - Google Patents

Abstract

PURPOSE:To provide the suturing and ligating device capable of preventing troubles and improving durability by preventing the influence of pressure, heat, medicinal liquid, etc., to be exerted on electrical operating means, such as internal power source, motor and control circuits. CONSTITUTION:This suturing and ligating device, such as stapler, for suturing and ligating staples to biotissues is provided with an insertion part 2 having suturing and ligating means for forming the staples freely attachably and detachably to and from an operating part 1. The operating part 1 is internally provided with an electric unit 5 which actuates the suturing and ligating means. The electric unit 5 is covered by a protecting member 9.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suturing and ligating device which penetrates an abdominal wall or the like and is inserted into a body cavity to suture and ligate living tissue in the body cavity.

[0002]

2. Description of the Related Art For example, in the operation of gallbladder stones and the like, when performing a surgical operation to remove the gallbladder to prevent recurrence, the connection between the bile duct and the gallbladder duct is cut, but the gallbladder duct has a gallbladder artery and a gallbladder vein. Since it passes through, it is necessary to cut the gallbladder duct with a knife or the like and at the same time suture and ligate it.

[0003] In such a cholecystectomy operation, a suture ligator is used which penetrates the abdominal wall or the like and is inserted into the body cavity to suture and ligate the tissue in the body cavity. This type of suture and ligature device is conventionally known, for example, in US Pat. No. 5,084,057 and Japanese Patent Laid-Open No. 3-12126.

US Pat. No. 5,084,057 is a device for suturing and ligating tissue in a body cavity with a clip, and JP-A-3-12126 discloses a device for percutaneously inserting into a body cavity and suturing and ligating the tissue in the body cavity. A suture ligator, a main body of the suture ligator, which comprises an insertion part, a cartridge that holds an anvil on one end and a staple on the other end of the insertion part, the cartridge being provided at the end of the insertion part. It is composed of a filing lever that ejects staples from the needle and a suture ligature opening / closing lever that opens and closes the main body of the suture ligator.

In these suture and ligature devices, an operation handle is provided in the operation portion, and the suture and ligature mechanism is operated by manually operating the operation handle, and the tissue is sutured and ligated by the suture and ligature member. The Applicant has developed a suture and ligature device that can electrically actuate the suture and ligature mechanism.

[0006]

By the way, it is desirable that the device for electrically actuating the suture and ligature mechanism is provided with a power source means such as a battery or a battery in the device. This is because, in a device that supplies power from an external power source using a cord or the like, the cord interferes with surgery.

However, a power source means such as a battery or a battery is vulnerable to changes in heat and pressure, resulting in liquid leakage. It is also well known that it is weak against water and chemicals. on the other hand,
When using a surgical instrument, it is necessary to sterilize the instrument. Examples of the method include high-pressure steam sterilization (autoclave), gas sterilization, chemical solution immersion, and the like. In particular, the autoclave is considered to be an excellent method from the viewpoint of environmental hygiene because it has a high sterilization effect and does not use toxic gas or chemicals. However, the instruments are exposed to high temperature, high pressure and high humidity, which creates an unfavorable environment for the power supply means.

Therefore, the one having the built-in power source means
There is no choice but to use limited sterilization means such as gas sterilization. Further, it may be possible to provide a protection means to the device so that the autoclave or the like can withstand the power supply, but this makes the device complicated, large in size, and expensive.

Further, a method may be considered in which, during sterilization, the battery or battery is removed and the device is sterilized and then incorporated again. First, the cover is removed, the battery or the like is removed, and the device is sterilized. It is very troublesome to incorporate such things.

The present invention has been made by paying attention to the above-mentioned circumstances, and an object thereof is that even if it is repeatedly used for cleaning and disinfecting, electric actuation means such as a power source, a motor and a control circuit are under pressure. Another object of the present invention is to provide a suture and ligature device that is not affected by heat, chemicals, etc., can prevent a failure, and can improve durability.

[0011]

In order to achieve the above object, the present invention provides a suture ligation device for suturing and ligating a tissue with a suture ligating member, and a suture ligating means for suturing and ligating the suture ligating member to the tissue, and a driving device. It is provided with an electric actuating means for generating a force and a protective member for covering the electric actuating means.

[0012]

The electrical operating means such as the power source, the motor and the control circuit are covered with the protective member, and the protective member protects the electric parts by shutting off pressure, heat, chemicals, etc. even after repeated cleaning and disinfection. be able to.

[0013]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 4 show a first embodiment, and FIG. 2 shows an entire suture and ligature device for closing a tubular tissue. It is composed of an operation unit 1 and an insertion unit 2. A detachable portion 3 for detachably attaching the insert portion 2 to the operation portion 1.
And a rotation ring 4 for rotating the insertion portion 2 around the major axis direction.

As shown in FIGS. 1 and 4, an electric unit 5 as an electric actuating means is detachably provided inside the operation portion 1. The electric unit 5 includes a power source 6 such as a lithium battery, a control circuit 7 that controls the current and voltage from the power source 6, and a motor 8 such as a stepping motor.

The power source 6, the control circuit 7 and the motor 8 are entirely covered with a rectangular box-shaped protective member 9 made of a synthetic resin material such as polysulfone or polyimide to form a hermetically sealed structure. Further, locking leg portions 9a are integrally provided at both end portions in the longitudinal direction of the protection member 9, and the engaging leg portions 9a are provided on the engaging portions 10 of the electric unit housing portion 1a provided inside the operation portion 1. It is elastically engaged and fixed.

Further, contacts 11a and 11b are provided at connection terminals for electrically connecting the control circuit 7 and the motor 8,
A contact plate 11c opposes the contacts 11a and 11b so as to come in contact with and separate from each other, and constitutes a switch 12. The switch 12 faces an opening 9b formed in the protection member 9. A push button 12a provided integrally with the contact plate 11c is provided in the opening 9b of the protective member 9, and the push button 12a is watertightly covered by a protective cover 12b.

Further, the rotary shaft 8a of the motor 8 penetrates the side wall of the protective member 9 and projects outward, and the rotary shaft 8a is connected to the pinion shaft 8c via a joint 8b. A first pinion 7a is attached to the pinion shaft 8c, and the first pinion 7a is transmitted to the rotation transmission shaft 13 via the second pinion 7b.
A worm 14a is attached to the. The worm 14a is connected to the drive shaft 15 via a worm wheel 14b.
Is linked to.

The drive shaft 15 is rotatably supported by a bearing (not shown) at the rear end of the operating portion 1. The drive shaft 15 has a large diameter first pulley 16a and a small diameter second pulley 16a. The pulley 16b of is attached. First pulley 16
A disk 16c is connected to a by a connecting pin 16d,
The second pulley 16 is adapted to rotate integrally.
A connecting pin 16e is projectingly provided on b.

The base end of the first pusher link 17a is connected to the connecting pin 16d of the first pulley 16a, and
The base end of the second pusher link 17b is connected to the connecting pin 16e of the pulley 16b. The tip end of the first pusher link 17a is connected to the first pusher tube 18, and the second pusher link 17b is connected to the second pusher link 17b.
Is connected to the pusher tube 19.

The first pusher tube 18 has a second
The pusher tube 19 is inserted in the pusher tube 19 so as to be movable back and forth in the axial direction, and the second pusher tube 19 is supported so as to be movable back and forth in the axial direction with respect to the guide cylinder 20 fixed to the operation portion 1.

Further, a first pusher bar 21 is rotatably connected to the distal end of the first pusher tube 18 about the longitudinal axis, and a distal end of the second pusher tube 19 rotates about the longitudinal axis. The second pusher bar 22 is possibly connected.

A rear end portion of the clip pusher 23 is detachably engaged with the front end portion of the first pusher bar 21.
Similarly, the rear end portion of the jaw pusher 24 is detachably engaged with the front end portion of the second pusher bar 22. The clip pusher 23 and the jaw pusher 24 are inserted in the insertion part 2 in a parallel state.

Further, the electric unit 5 is detachable from an electric unit housing portion 1a formed of a concave portion provided on the outer wall of the casing 25 of the operation portion 1, and the opening of the electric unit housing portion 1a is covered by a lid 26. It is blocked.

On the other hand, the insertion part 2 will be described.
A clip 33 as a suture ligation member is provided inside the insertion portion 2.
And a suture ligating means for deforming the clip 33 to suture and ligate.

That is, a plurality of clips 33 are slidably accommodated in the clip track 34 inside the insertion portion 2. The clip track 34 is provided with a lid 35, and a rear side is provided with a pressing member 37 which is biased toward the tip side by a pressure spring 36, and the clip 33 is biased from the rear side of the clip track 34 toward the tip side. ing.

A locking claw 38 for locking the clip 33 is provided at the tip of the clip track 34.
8 and an elastic clip pressing member 3 provided on the upper part
It is locked by 9 and.

Further, an openable / closable jaw 40 having a forked end is provided in front of the clip row 33, and the jaw pusher 24 for closing the jaw 40 is provided on the lower side of the jaw 40, By sliding to, the side surface of the jaw 40 is pressed and closed. Further, the clip pusher 23 is slidably provided above the row of clips 33, and the leading clip 33 is fed between the jaws 40 at the tip of the clip pusher 23.

Further, the insertion portion housing 4 of the insertion portion 2
A small diameter portion 42 for fitting with the attachment / detachment portion 3 of the operation portion 1 is provided at a rear end portion of the operation portion 1. The key 4 is attached to the thin portion 42.
3, the slit 44 and the locking flange 45 are provided,
Further, an O-ring 46 is provided in front of the small diameter portion 42.

Further, the insert housing 41 is provided with an attachment / detachment button 47. When the attachment / detachment button 47 is pressed, the engagement between the cutout portion 21a of the first pusher bar 21 and the protrusion 23a of the clip pusher 23 is released. The notch 22a of the second pusher bar 22 and the jaw pusher 24 can be disengaged from each other.

Next, the operation of the suture and ligation device constructed as described above will be described. When the electric unit 5 is mounted in the electric unit housing portion 1a of the operation portion 1, the rotating shaft 8a of the motor 8 and the pinion shaft 8c are mechanically connected via the joint 8b, and when the push button 12a is pushed, the contact plate 11c is opened. The contacts 11a and 11b are brought into contact with each other to be switched on, and the control circuit 7 and the motor 8 are electrically connected to each other.

When the motor 8 is rotated by a signal from the control circuit 7, the rotation is transmitted to the rotation transmission shaft 13 via the first and second pinions 7a and 7b, and the worm wheel 14b via the worm 14a. First pulley 16
a, the second pulley 16b rotates.

At this time, the first pusher link 17a moves forward and the second pusher link 17b moves backward,
The first pusher tube 18 slides forward and the second pusher tube 19 slides backward. And the insertion part 2
At the tip end side of the
Is loaded between the jaws 40. After that, when the motor 7 further rotates, the first pusher tube 18 slides backward and the second pusher tube 19 slides forward.

Therefore, the clip pusher 23 is retracted behind the first clip 33 in the row of clips 33,
The jaw pusher 24 slides forward to close the jaw 40, whereby the clip 33 can be deformed into a closed shape and a tissue such as a blood vessel between the clips 33 can be closed.

As described above, the electric unit 5 of the operation portion 1 enables the suture ligation at the distal end portion of the insertion portion 2 to be performed by the electric actuating means. Therefore, the user is less tired and the operability is improved. In addition, if the electric power of the power supply 6 of the electric unit 5 is consumed during use, the operation unit 1 can be used as it is by replacing the electric unit 5 with a new one, reducing the operation cost and reducing the amount of medical waste. Lead to

It is to be noted that the blood cleaning liquid and the like attached to the operating portion 1 and the insertion portion 2 of the suture and ligature device during treatment are prevented from entering the inside of the operating portion 1 by the seal member 3a and the O-ring 46. After use, the operation unit 1 to the electric unit 5,
After the insertion portion 2 is removed and the attachment / detachment portion 3 is closed with a rubber cap, cleaning / sterilization can be performed. In this way, since the operation unit 1 can be washed and sterilized, it can be reused, which leads to a reduction in medical costs.

The protective member 9 is made of a heat-resistant resin such as polysulfone or polyimide, a pressure-resistant resin such as polyethylene, or a vibration-proof material such as a picture garden or vinyl. After washing the blood adhered to the device, high pressure sterilization or E. O. When G is used for sterilization, it is possible to reduce the influence of heat, pressure, moisture, and vibration on electric components such as the power supply 6, the control circuit 7, and the motor 8 in the electric unit 5.

Further, a part of the material of the protective member 9 is made of PPS.
By using an electrically and electrically insulating member such as (polyphenylene sulfide), stainless steel, or ceramic, it is possible to reduce the possibility that the electric component may cause leakage or noise to the outside.

FIG. 5 shows a second embodiment, in which the operating portion 1 of the first embodiment can be replaced with various insertion portions 2 according to the suture and ligation method. That is, A is a clipper having a jaw 40 at the distal end portion of the insertion portion 2 similar to the first embodiment. B is an anvil 5 at the tip of the insertion part 2.
It is a stapler equipped with 2. C is a linear cutter having a cartridge 53 and an anvil 54 at the tip of the insertion portion 2. Reference numeral D is a circular stapler having a staple ejection portion 55 and an anvil 56 at the tip of the insertion portion 2.

A small-diameter portion 42 having the same structure is provided at the base end portion of the insertion portion 2 and is detachably attached to the attachment / detachment portion 3 of the operation portion 1. Therefore, the insertion part 2 can be exchanged depending on the place of use and the method of use, and ligation of tissue, closing of the incision, suture ligation of tissue, ligation of an end to end of an annular tissue, etc. can be performed. After use, the operating section 1 is washed and sterilized for reuse, and the insertion section 2 is discarded. Since the operation unit 1 can be shared, there is an economic advantage for the user.

FIG. 6 and FIG. 7 show the first disclosed example.
This is an example in which a sensor for detecting the suture and ligation state is provided in a clipping device for punching a clip and ligating an annular tissue, and the sensor is covered with water-tight and heat-resistant resin to be hermetically sealed.

Reference numeral 60 denotes a clipping device, which is an operation unit 61.
The operating portion 61 is provided with a handle 61a for connection with a jaw pusher bar and a clip pusher bar (not shown), and a clip jaw 63 is provided at the tip of the inserting portion 62. The clip jaw 63 is composed of a pair of clipping members 64 arranged at the distal end of the insertion portion 62, and the inside of one of the clipping members 64 is watertight by a protective member 65 made of resin,
A pressure sensor 66 covered with heat resistance is provided.

The operating portion 61 of the clipping device 60 is connected to the camera unit 68 via a cable 67. An endoscope 68b is connected to the camera unit 68 via a universal cord 68a.
A monitor 69 is installed in the camera unit 68, and the monitor 69 is provided with a tightening pressure display section 70 for displaying the tightening pressure of the clipping target tissue between the clipping members 64 together with an observation image by the endoscope 68b.

When the clipping device 60 is used, the annular tissue is sandwiched between the clipping members 64 of the clip jaw 63, and the grip is hammered out to close and ligate. During this tissue ligation, the tightening pressure of the clipping target tissue is displayed on the pressure display portion 70 on the screen of the monitor 69.

As described above, since the pressure sensor 66 is covered with the resin protective member 65 in a watertight and heat-resistant manner, it is possible to prevent the infiltration of blood or the like into the pressure sensor 66 when the body tissue is ligated. Further, by making the parts other than the pressure sensor have a structure with good ventilation (passing), when cleaning and sterilization after use are made possible, moisture, heat,
The influence of pressure and vibration can be reduced.

Instead of the pressure sensor 66, various sensors such as ultrasonic elements and light emitting elements for measuring blood flow may be used. Further, it can also be applied to an instrument for ligating a tissue, closing an incision, suturing a tissue, ligating, anastomosing an annular tissue, and the like.

FIGS. 8 to 11 show the second disclosed example, in which an observation means including a solid-state image pickup device is provided at the tip of a suture ligation device for performing end-to-end anastomosis for connecting end faces of an annular tissue, and covered with a protective member. Here is an example.

The suture and ligature device comprises an operating section 71 and an inserting section 72.
The operation unit 71 is provided with a connector 73,
One end of a connection cable 74 is connected to the connector 73, and the other end is connected to the light source device 75 and the monitor 76.

The insertion section 72 is provided with an anvil 77, a staple accommodating section 78, and an elongated housing 79. At the tip of the anvil 77, C covered with an objective lens 80, a cover glass 80a, and a synthetic resin protective member 81.
An observation window 83 having a solid-state image sensor 82 such as a CD and an illumination window 85 having an illumination lens 84 are provided.

Further, a molding surface 87 for molding the staple 86 is circumferentially provided on the rear end surface of the anvil 77, and the anvil 77 is provided on the base end side of the insertion portion 72 via the anvil shaft 88. The anvil opening / closing ring 89 is connected to the insertion portion 72 so as to be movable in the long axis direction.

The staple accommodating portion 78 has a plurality of staples 86 arranged in a circular shape, and the cutter 9 having a circular shape is arranged inside thereof.
0 is provided. Further, the staple 86 and the cutter 9 are located behind the staple 86 and the cutter 90.
Pusher 91 for pressing 0 toward the anvil 77
Is provided, and the pusher 91 is connected to an electric actuating means (not shown) provided inside the operation portion 71.

Further, inside the housing 79, there are a cord 92 which is connected to the solid-state image sensor 82 and transmits information from the solid-state image sensor 82, and an optical fiber 93 for illumination which is connected to an illumination lens 84 and transmits illumination light. They are inserted, and these are connected to the connector 73 of the operation section 71.

This connector 73 has a conductor 95 connected to a cord 94 led from the insertion portion 72,
The periphery of 5 is covered with a heat resistant member 96. A connecting connector 97 connected to the conductor 95 is provided at one end of the connecting cord 74, and the other end is branched and connected to the light source device 75 and the monitor 76, respectively. have.

Next, the operation of the suture and ligation device constructed as described above will be described. While observing the inside of the tubular tissue through an observation window 83 provided on the front end surface of the anvil 77, the anvil 77 and the staple accommodating portion 78 are brought to a target site, and the tubular tissue is inserted between the anvil 77 and the staple accommodating portion 78. Insert the end face.

By operating the operation portion 71, the staple 86 of the staple accommodating portion 78 is punctured toward the living tissue and is deformed into a closed state by the forming surface 87 of the anvil 77. At the same time, the cutter 87 cuts away the tissue inside the row of staples 86.

Thereafter, the anvil opening / closing ring 89 is operated to open the space between the anvil 77 and the staple accommodating portion 78, and the end-to-end anastomosis of the tissue is completed. During the anastomosis operation, the patient's body fluid, blood, etc. adhere to the anvil 77, but the solid-state image sensor 82 is covered with the cover glass 80a and the protective member 81, and therefore does not enter the periphery of the solid-state image sensor 82. Further, since the connector 73 of the operation portion 72 is also covered with the heat resistant member 96, it does not enter.

As described above, the solid-state image pickup device 82 has the observation window 8
3. Since the protective member 81 covers the watertightness, heat resistance, pressure resistance, and vibration resistance, it is possible to prevent infiltration of blood, body fluid, etc. into the solid-state imaging device 82 when the tubular tissue of the living body is anastomosed.
Further, by forming a part of the protection member 81 with an electrically insulating member, there is an electric resistance effect on the tissue outside the device.

Further, in the case where the structure other than the electric parts has a structure in which the air permeability is improved, after cleaning, E. O. Even if G sterilization, high-pressure steam sterilization, etc. are performed, the electric parts do not break down and can be reused. The present invention can be modified and applied to a device for ligating a luminal tissue, a device for closing an incision, a suture ligation of tissue, and various suture and ligation devices for ligating.

[0058]

As described above, according to the present invention, the electric operating means such as the power source, the motor and the control circuit are covered with the protective member, so that they can be repeatedly used for cleaning and washing.
Even after sterilization, electric actuation means such as power supply, motor and control circuit are not affected by pressure, heat, chemicals, etc.
Prevents breakdowns and improves durability, and blood and body fluids do not enter the inside of the operating part during use,
Further, there is an effect that the operating portion can be easily washed and sterilized.

[Brief description of drawings]

FIG. 1 is a vertical sectional side view of a suture and ligature device showing a first embodiment of the present invention.

FIG. 2 is an overall perspective view of the suture and ligation device of the same embodiment.

FIG. 3 is an exploded perspective view of a distal end portion of the insertion portion of the embodiment.

FIG. 4 is a partially cutaway perspective view of an electric actuating means of the suture and ligature apparatus of the same embodiment.

FIG. 5 is an overall perspective view of a suture and ligature device showing a second embodiment of the present invention.

FIG. 6 is an overall perspective view showing a first disclosed example of a suture and ligature device.

FIG. 7 is a side view of the suture and ligature device with a part of the distal end portion cut away.

FIG. 8 is a perspective view of an insertion portion showing a second disclosed example of the suture and ligature device.

FIG. 9 is a vertical cross-sectional side view of the distal end portion of the suture and ligature device.

FIG. 10 is an overall perspective view of the suture and ligature device.

FIG. 11 is a vertical sectional side view of a connector of the suture and ligature device.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Operation part 2 ... Insertion part 5 ... Electric unit 6 ... Power supply 7 ... Control circuit 8 ... Motor 9 ... Protective member 33 ... Staple (suture ligation member)

Claims (1)

[Claims] 1. A suture ligation device for suturing and ligating a tissue with a suture ligating member, a suture ligating means for suturing and ligating the suture ligating member to a tissue, an electric actuating means for generating a driving force, and an electric actuating means for this. A suture and ligature device, comprising: