JPH09289991A - Suture device for medical treatment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve safety without allowing a staple to be driven out of a staple head even if a lever is gripped in the state of not mounting the staple head to the front end of a main body at the time of executing anastomosis of the vascular cavity organs, such as the intestine and the gullet. SOLUTION: This suture device for medical treatment is composed of a main body 2 consisting of an operation part and an insertion part 4 extended from the operation part and an anvil head 5 which is disposed at the front end of the main body 2 and deforms the plural staples 11. In such a case, the front end of the main body 2 is provided with the anvil head 5 and the staple head 6 arranged with the plural staples 11 is disposed in the position facing the anvil head 5.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical suturing device used in a surgical operation on a living organ (intestinal tract, esophagus, etc.).

[0002]

2. Description of the Related Art Currently, a medical suture instrument for performing anastomosis of a luminal organ in a surgical operation on a luminal organ (eg, intestinal tract, esophagus, etc.) is U-shaped at the tip of an insertion portion extending from an operating portion. A head in which a plurality of staples having a shape are arranged on the circumference and an anvil in a position facing the head for deforming the staple are provided.

Then, the head and the anvil are inserted into the inside of the luminal organs opposed to each other, the distance between the head and the anvil is shortened, and then the staples are punched out, and the staples are formed by the grooves provided on the opposed anvil surfaces. It is generally known that a suturing device that completes an anastomosis by deforming and simultaneously cutting off excess tissue remaining inside the staple row by a cylindrical blade arranged inside the staple row.

For example, as in US Pat. No. 5,392,979, the anvil can be attached and detached relatively easily from the head on the main body side, and the distance between the anvil and the head is the optimum distance for anastomosis. The anvil cannot be removed from the main unit head when it becomes. Here, the staple can be ejected by releasing the safety mechanism. The optimum distance at this time was visually transmitted to the operator by an indicator. U.S. Pat. No. 5,205,459 is generally known as a suture instrument having such a structure.

Apart from this, JP-A-55-108347.
Although there is a case where a suture instrument for a non-disposable luminal organ is also used, as in Japanese Patent Publication No. JP-A-2003-242, the structure is such that a main body composed of an insertion portion and an operation portion is reused to staple the tip of the insertion portion. It was meant to be used multiple times by exchanging the cartridge and anvil.

Further, as a structure common to the conventional suturing devices for hollow organs, since the staple is arranged at the tip of the insertion portion and the staple is pushed out toward the distal end, the leg of the staple has a distal end because of the structure. The structure is oriented.

[0007]

However, US Pat. No. 5,392,979 and US Pat.
In the case of the suturing device for luminal organs disclosed in 5, 459, even if the anvil is not attached, if the indicator shows the optimum distance for anastomosis, a safety mechanism is not provided. The operator may accidentally eject the staples after being released, resulting in wasteful ejection of the staples and careless protrusion of the cylindrical blade. Such a suturing device for luminal organs is a disposable type, and once used, the entire suturing device is discarded, so it is necessary to purchase it for each operation, which incurs a hospital cost.

Further, in the suture instrument for reusing the main body of the type disclosed in JP-A-55-108347, the anvil and the staple cartridge can be exchanged, but the anvil is of a screw type to the rod at the tip of the insertion portion. Since the structure is removable, the method of attaching the anvil during surgery was complicated.

The above-mentioned US Pat. No. 5,392,979, US Pat. No. 5,205,459, and JP-A-55.
Commonly in Japanese Patent Laid-Open No. 108347, in an anastomosis using a suture device for a known luminal organ, which is already known, it is directed toward the distal end direction of the staple leg, and whether or not the staple leg can be properly deformed immediately after the operation. It could not be confirmed, and postoperative complications could not be prevented.

The present invention has been made in view of the above circumstances, and its purpose is to eliminate waste of stapling, easy replacement of staple cartridges and anvil heads, and cost reduction. It is intended to provide a medical suturing device that reduces subsequent complications.

[0011]

In order to achieve the above-mentioned object, the present invention deforms a plurality of staples provided at the tip of the main body, which comprises an operating portion and an inserting portion extending from the operating portion. In the medical suturing device having the anvil head, an anvil head is provided at the tip of the main body, and a staple head having a plurality of staples is provided at a position facing the anvil head.

According to the above construction, the staple head is inserted into one end of the already separated intestinal canal, and the purse string suture is performed with the elongated connecting portion extending from the staple head protruding from the end of the intestinal canal. The insertion part is inserted from another incision part of the intestinal tract or inserted transanally, and purse string suture is performed with the connecting part of the staple head at the tip of the insertion part protruding from the other end of the intestinal tract.

After completion of purse string suturing of each intestinal end, the staple head is attached to the connecting portion at the distal end of the insertion portion, and then the rotary knob of the operation portion is turned to pull the staple head toward the anvil head. When the distance between the staple head and the anvil head is appropriate for anastomosis, grasp the lever of the operating section, and force will be transmitted through the connecting section of the staple head that connects the staple head and the tip of the insertion section. The staples are ejected from the head, and the legs of the staples are deformed by the grooves provided in the anvil head. At the same time, the anastomosis is completed by cutting off excess tissue inside the staple line with a cylindrical cutter.

[0014]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 12 show a first embodiment, and as shown in FIG. 1, a main body 2 of a medical suturing device 1
Is composed of an operating section 3 and an insertion section 4 extending from the operating section 3 while gently curving. An anvil head 5 to be described later is provided at the tip of the insertion portion 4, and a staple head 6 to be described later is detachably provided to the anvil head 5.

The operation section 3 is provided with a rotary knob 7 for pulling the staple head 6 toward the anvil head 5 and a lever 8 for driving the staple head 6 to eject a staple 11 as a tissue coupling fastener described later. .

The staple head 6 will be described with reference to FIGS.
The structure of the tip of the insertion portion 4 will be described. The staple 11 is U-shaped by a base portion 11a and two legs 11b bent substantially at right angles to the base portion 11a, as shown in FIG. 2 (d). It has a mold shape.

As shown in FIGS. 2A and 2B, the insertion portion 4
A staple head 6 is attached to a position facing the anvil head 5 provided at the tip of the staple head 6, and inside the staple head 6, a plurality of staples 11 are normally provided in a plurality of hole-shaped staple channels 12 arranged annularly. It is stored. At this time, the staple 11 is in a state in which the tips of the two legs 11b extending from the base portion 11a face the anvil head 5 side. Inside the staple channel 12, there is provided a cylindrical cutter 13 arranged coaxially therewith for cutting off the tissue. The cylindrical cutter 13 directs the staple 11 directly with its sharp tip 13a directed toward the anvil head 5. It is attached to a staple pusher 14 as a staple ejecting means.

Further, a plurality of rod-shaped projections 14a are provided on the side of the staple pusher 14 on the anvil head 5, and the tips of the respective rod-shaped projections 14a are inserted inside the staple channel 12. A staple drive shaft 15 for driving the staple pusher 14 is fixed to the center of the staple pusher 14.

A pair of leaf springs 16 are attached to the staple drive shaft 15 on the anvil head 5 side, and a latch 17 protruding inward is provided at the tip of the leaf spring 16 on the anvil head 5 side. . A staple head sleeve 18 for accommodating the staple drive shaft 15 and the leaf spring 16 is provided on the anvil head 5 side of the staple head 6.

As shown in FIGS. 3 and 4, a pair of leaf springs 19 are formed on the anvil head 5 side of the staple head sleeve 18. Further, a latch 20 protruding inward is provided at the tip of the leaf spring 19. A leaf spring head 16 is provided on the outer peripheral portion of the staple head sleeve 18.
A leaf spring moving hole 18a is provided to allow the a to spread outward from the outer peripheral portion of the staple head sleeve 18. The leaf spring moving hole 18a is longer than the axial length of the leaf spring head 16a. As shown in FIGS. 1B and 4A, a plurality of ribs 21 are provided on the outer peripheral portion of the staple head sleeve 18 on the anvil head 5 side for positioning the staple 11 in the radial direction.

Further, as shown in FIG. 2 (b), the ribs 23 in the distal end direction of the staple head sleeve 18 are also positioned with respect to the key groove 22 of the staple channel casing 12a forming the staple channel 12. There is. This allows the staple head sleeve 18 to be positioned in the radial direction of the staple 11. The components housed in the staple head 6 are held by the staple head casing 24.

Further, as shown in FIG. 2 (c), the insertion portion 4
An anvil 26 having a plurality of annularly arranged grooves 25 for bending the staple 11 is provided on the anvil head 5 at the tip of the anvil 26, and radial positioning means 27 is provided for the grooves 25 of the anvil 26. Has been. A receiving plate 28 that receives the cylindrical cutter 13 is provided coaxially with the anvil 26 and at a position facing the cylindrical cutter 13.
A trocar 30 is provided inside and in the center of the receiving plate 28.

The trocar 30 is provided with a circular cross section groove 29 which engages with a latch 17 of a leaf spring 16 mounted on the staple drive shaft 15. Trocar 30
Is connected to the trocar driving guide 31 on the operating portion 3 side, and a trocar driving member 32 for transmitting the force from the lever 8 of the operating portion 3 to the trocar driving guide 31 is provided. Further, a latch 20 for accommodating the trocar 30 and provided on the leaf spring 19 of the staple head sleeve 18 is provided.
Trocar sleeve 3 having a circular cross-section groove 33 for engaging with
4 is provided outside the trocar 30.

As shown in FIG. 3, the trocar sleeve 3
A staple head drive guide 35 is connected to the operation unit 3 side, and a staple head pulling member 36 for transmitting a force from the rotary knob 7 of the operation unit 3 to the staple head drive guide 35 is provided. Then, the trocar driving guide 31 and the staple head driving guide 35 are converted from the positional relationship in which the trocar driving member 32 and the staple head pulling member 36 are not coaxial in the insertion portion 4 to the relationship in which the trocar 30 and the trocar sleeve 34 are coaxial. Playing a role. Also, the trocar sleeve 34
A plurality of key grooves 37 for positioning the staple head 6 in the radial direction are provided inside the anvil head 5 for accommodating therein.

Next, the operation of the medical suture instrument constructed as described above will be described. The staple head 6 is inserted into one end of a luminal organ of the living body, for example, the intestine, purse string suture is applied to the outer peripheral surface of the staple head sleeve 18, and the other end of the intestine in which the insertion portion 4 is inserted is attached to the trocar sleeve 34.
Similarly, purse string suture is applied to the outer peripheral surface.

After that, when the trocar 30 and the trocar sleeve 34 are inserted into the staple head sleeve 18 of the staple head 6, the leaf spring head 16a expands from the leaf spring moving hole 18a, so that the staple head 6 is attached to the tip of the insertion portion 4. Is installed. At this time, the circular cross-section groove 29 at the tip of the trocar 30 and the trocar sleeve 34
The circular cross-section groove 33 of the
And are engaged (see FIG. 2 (a)).

When the rotary knob 7 of the operating portion 3 is turned, the pulling force is transmitted to the staple head drive guide 35, the trocar sleeve 34, and the staple head sleeve 18 via the staple head drive member 36, and the staple head 6
Is drawn toward the anvil head 5 side (Fig. 5
(A)).

When the staple head 6 is pulled to some extent, the rib 21 provided on the staple head sleeve 18 engages with the key groove 37 inside the anvil head 5, whereby the radial positioning of the staple head 6 is automatically completed. To do. FIG. 5B shows how the rib 21 is engaged with the key groove 37 of the anvil head 5 and the leaf spring head 16a.
Is in contact with the key groove crest 37a.

When it is confirmed by an indicator (not shown) that the distance between the anvil 26 and the staple head 6 is optimum for performing the anastomosis, the safety lock (not shown) is released. When the lever 8 is gripped, a pulling force is applied to the trocar driving guide 3 via the trocar driving member 32.
1, the trocar 30, the leaf spring 16, the staple drive shaft 15, and the staple pusher 14, and FIG.
As shown in (a), the staple 11 is pushed out from the staple channel 12. Extruded staple 1
1 is deformed by the groove 25 of the anvil 26. FIG.
(B) shows the deformed staple 11. At this time, the leaf spring head 16a tries to expand outward due to the pulling force from the operation portion 3, but it does not expand because it is in contact with the crest 37a of the key groove, and the leaf spring head 16a follows the leaf spring moving hole 18a. 16a
Moves to the operation section 3 side, and restricts the operation so that the staple pusher 14 does not move to the operation section 3 side more than necessary (see FIG. 4B). At the same time, the cylindrical cutter 13 is pushed out from the staple head 6, and the excess tissue inside the staple line inside the intestinal tract is cut off to complete the anastomosis operation.

Next, the proximal side of the operating section 3 and the insertion section 4 will be described with reference to FIGS. 7 to 12. According to FIG. 7 showing an exploded view of the insertion section 4, inside the proximal side of the insertion section 4, staples are provided. Head drive member 36 and trocar drive member 3
2 is sandwiched between three guide members 45a, 45b, 45c inside the curved insertion shaft 46, and the positional relationship between the staple head drive member 36 and the trocar drive member 32 is radial in any position of the insertion shaft 46. The staple head drive member 36 and the trocar drive member 32 are kept constant, and the guide members 45a, 45b, 45
It is movable in the axial direction between c. Further, a hole 32a is formed at the proximal end of the trocar driving member 32.

As shown in FIG. 8, a rod 47 is provided at the center of the operating portion 3 in the axial direction, and a groove 49 having a semicircular cross section is provided in a casing 48a and a casing 48b forming the operating portion 3. It is fitted. A square male screw 50 is processed on the proximal side of the rod 47. A portion of the square male screw 50 is screwed into a square screw shaft 51 on which a square female screw 52 is processed. A rotary knob 7 is provided on the proximal side of the square screw shaft 51.

Further, the rod-shaped safety guide 5 is attached to the rod 47.
3 are assembled. The safety guide 53 is engaged with a square groove 54 provided near the distal end of the casing 48a. Further, the trocar driving member 32 is slidably mounted on the distal end of the rod 47 relative to the rod 47, and the staple head driving member 36 is mounted on the rod 47. The insertion shaft 46 is assembled so as to be sandwiched between the casings 48a and 48b.

Further, a U-shaped staple operating member 55 surrounds the casing 48 so as to surround the outer periphery of the rod 47.
A latch 57 is fixed to the upper surface of the staple actuating member 55. Arms 58a and 58b are provided on both sides of the staple actuating member 55.
Are assembled by pins 56. Arm 58a,
The trigger 58b is rotatably attached to the triggers 59a and 59b. The triggers 59a and 59b are the casing 48.
The thick pin 60 assembled in the above is rotatably assembled, and one end of a coil spring 61 passed through the thick pin 60 is fixed to the trigger 59a. Also, the trigger 59
The a and 59b are fixed so as to sandwich the lever 62.

A safety lock 63 is provided on the lower surface of the safety guide 53.
The casings 48a, 4 so that their upper surfaces 63a are in contact with each other.
8b is rotatably assembled in the axial direction, and the lock portion 63b is in contact with the proximal end side edge 59c of the trigger 59a. The indicator 64 is urged toward the distal end by a leaf spring 65 bent in a J shape, and the casing 4
It is rotatably attached to the inner side surface of 8a. The release lever 66 has a pin 67 at one end and a tension spring 68 at the other end. The release lever 66 engages the finger 48a of the release lever 66 with respect to the casing 48b.
Is rotatably assembled in a state of protruding from the surface of the casing 48b through a hole 69 formed in the casing 48b. The hole 69 is formed in such a shape that the finger hook 66a can be operated.

Next, the operation will be described. In the initial state of FIG. 9, when the rotary knob 7 of the operating portion 3 is rotated clockwise, the rod 47 is pulled toward the rotary knob 7 (hand side) due to the square screw. However, the pulling force acts on the staple head driving member 36 attached to the distal end of the rod 47, and the pulling force is applied to the staple head driving guide 35 and the trocar sleeve 34.
The staple head 6 attached to is pulled toward.

At this time, although a moment is applied to the rod 47, it does not rotate because the safety guide 53 is slidably assembled in the angular groove 54 for preventing rotation of the rod 47, and the staple head 6 is at hand. Even before it is sufficiently pulled to the side, the safety guide 53 is inserted inside the U-shaped staple actuating member 55 so that it does not rotate.

Inside the casing 48, the safety guide 53 extends from the upper surface 63a of the safety lock 63 when the operator is visually informed by the indicator 64 that the distance between the staple head 6 and the anvil 26 has been optimized. Come off. Further, the trocar driving member 32 slidably attached to the distal end of the rod 47 is also drawn to the proximal side, and the hole 3 formed in the proximal end of the trocar driving member 32 is formed.
The latch 57 is engaged with 2a (see FIG. 10).

Next, when the safety lock 63 is rotated about an axis parallel to the axis of the rod 47, the trigger 59a
The lock portion 63b that was in contact with the proximal end side edge 59c of the is released, and the triggers 59a and 59b are rotatable. When the lever 62 is gripped here, the triggers 59a and 59b
Trigger 59 because it rotates around the thick pin 60
arm 58a rotatably attached to a and 59b,
The staple actuating member 55 is also pulled proximally via the long pins 56 to push 58b proximally.

At this time, the pulling force also acts on the trocar driving member 32 engaged with the latch 57 on the upper surface of the staple operating member 55, and the trocar 30 at the tip of the insertion portion 4 is pulled through the trocar driving guide 31. The staples 11 arranged in the staple head 6 are ejected (see FIG. 11).

After the staple 11 has been ejected, when the force for gripping the lever 62 is loosened, the triggers 59a and 59b return to their original positions by the action of the winding spring 61, and the arms 58a and 58b.
The compressive force acts on b, the staple actuating member 55, the latch 57, the trocar driving member 32, and the trocar 30, and finally the rod-shaped projection 14a of the staple pusher 14 is returned to the inside of the staple channel 12. At this time, since the leaf spring 19 of the staple head sleeve 18 is in contact with the inside of the anvil head 5, the leaf spring 19 does not spread,
The staple head 6 does not come off from the anvil head 5.

After the staple 11 has been ejected, in order to expand the space between the staple head 6 and the anvil 26, the release lever 66 provided on the casing 48b of the operating portion 3 is lowered as shown in FIG. The pin 67 of the release lever 66 hits against the trocar driving member 3
2 is lifted, the hole 32a of the trocar driving member 32 is removed from the latch 57 on the staple operating member 55, and when the rotary knob 7 is rotated counterclockwise, a compressive force acts on the staple head driving member 36 and the staple head driving guide 35 Since the trocar sleeve 34 is pushed in the distal direction via the staple head 6, the staple head 6 operates in the distal direction from the anvil head 5.

The hole 32a of the trocar driving member is disengaged from the latch 57 and is operated in the distal direction. Then, if the finger is removed from the finger rest 66a of the release lever 66, the release lever 66 returns to its original position.

In order to remove the medical suturing device 1 of this embodiment from the intestinal tract or the like, when the release lever 66 of the operating portion 3 is lowered, the trocar driving member 32 is disengaged from the latch 57 and the rotary knob 7 is rotated counterclockwise. When rotated (about 1/3 rotation), the staple head 6 moves away from the anvil head 5. Even if the lever 8 is strongly gripped in this state, the bar-shaped protrusion 14a of the staple pusher 14 and the cylindrical cutter 13
Does not stick out. Then, the insertion section 4 is rotated and removed from the intestinal tract. The medical suturing device 1 after use removes the staple head 6 from the trocar sleeve 34,
By mounting a new staple head 6, the main body 2 can be used any number of times.

Therefore, the staple head 6 alone ejects the staples 11 or the stapler 6
You can't stick out 3. The staple 11 can be ejected for the first time after performing the three steps of attaching the staple head 6 to the tip of the insertion portion 4, adjusting the distance between the staple head 6 and the anvil head 5, and releasing the safety lock 63. Therefore, as compared with the configuration of the conventional medical suturing device, wasteful stapling due to forgetting to attach the anvil head is prevented, and the adverse effect of the cylindrical cutter is prevented.
Excellent safety until anastomosis.

Further, in the conventional suturing device, after the safety lock is released, if the lever is grasped, the staple pusher and the cylindrical cutter are projected if the anvil head is at any position if it has been used. In the case of a container, the distance between the anvil surface 26 and the staple head 6 must be a distance suitable for ejecting the staple 11 even if the lever 62 is erroneously grasped with the safety lock 63 released after being used for surgery. For example, since the rod-shaped projection 14a of the staple pusher 14 and the cylindrical cutter 13 do not protrude from the staple head 6, the safety after anastomosis is excellent.

Since the leg 11b of the staple 11 is placed inside the staple head 6 with the anus (hand side) facing toward the anus (hand side), after the staple 11 is deformed, the deformed state of the foot 11b is finished after the series of anastomosis work and then the anus. It can be observed by inserting a more scope. Therefore, postoperative complications can be prevented.

Insert the used staple head 6 into the insertion portion 4
The main body 2 can be reused because it can be detached from the tip of the and a new staple head 6 can be attached. Therefore, it can be used any number of times as compared with the disposable-type suturing device, and thus costs less. Furthermore, cylindrical cutter 1
Since 3 is also built in the staple head 6, it can be replaced at the same time, and the sharpness of the cylindrical cutter 13 does not deteriorate.

FIG. 13 shows the second embodiment. The same components as those of the first embodiment are designated by the same reference numerals and the description thereof will be omitted. This embodiment is different from the staple head sleeve 18 of the first embodiment in that it has a staple head sleeve 18a.
Except that the staple head shaft 38 is used instead of the staple drive shaft 15, the trocar 30 is connected to the staple head drive member 36, and the trocar sleeve 34 is connected to the trocar drive member 32. It is similar to the embodiment.

Staple head sleeve 1 of this embodiment
8 a is attached to the staple pusher 14, and the staple head shaft 38 supports the staple head 6. The trocar 30 at the tip of the insertion section 4 is connected to the rotary knob 7 of the operation section 3 via the staple head drive member 36 in the insertion shaft 46, and the trocar sleeve 34 connects the trocar drive member 32 in the insertion shaft 46. The force for gripping the lever 8 is transmitted through the lever.

The staple head sleeve 18a is attached to the trocar sleeve 34 at the tip of the insertion portion 4, and the leaf spring 16 attached to the staple head shaft 38 is attached to the trocar 30 by the latch 17. .

Therefore, as in the first embodiment, the purse string suture of the intestinal tract is applied to the outer peripheral surface of the staple head sleeve 18a and the outer peripheral surface of the trocar sleeve 34. When the staple head 6 is attached to the trocar 30 at the tip of the insertion portion, the staple head sleeve 18a is attached to the trocar sleeve 34, and the leaf spring 16 attached to the staple head shaft 38 is attached to the trocar 30.

When the rotary knob 7 of the operating portion 3 is turned, the tensile force transmitted to the trocar 30 via the staple head driving member 36 is applied to the leaf spring 1 of the staple head shaft 38.
6, the staple head shaft 38, and the staple head 6, and the staple head 6 is drawn toward the anvil head 5.

When the lever 8 of the operating portion 3 is gripped when the staple head 6 and the anvil 26 are in the optimum positional relationship, a pulling force is applied from the trocar sleeve 34 to the staple head sleeve 18a via the trocar driving member 32.
The staple 11 is pushed out from the staple channel 12 by being transmitted to the staple pusher 14. The staple 11 pushed out is the groove 2 provided in the anvil 26.
5, the cylindrical cutter 13 is pushed out from the staple head 6 at the same time, and excess tissue inside the staple line inside the intestinal canal is cut off to complete the anastomosis operation.

Therefore, the same effect as that of the first embodiment can be obtained. FIG. 14 shows the third embodiment, and the same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted. In this embodiment, several types of staple heads 6a and 6b having different outer diameters are prepared for the staple head 6, and in the anvil head 5 of the main body 2, several types of anvils 26a and 26b in which the anvil 26 and the receiving plate 28 have different outer shapes,
This is the same as the first embodiment except that the receiving plates 28a and 28b can be selectively attached to and detached from the anvil head 5. The anvils 26a, 26b and the receiving plates 28a,
28b and the anvil assembly 39
A and 39b can be simultaneously attached and detached from the anvil head 5. It is desirable that the staple heads 6a, 6b and the anvil subassemblies 39a, 39b are packed as a set with the correct staple heads 6a, 6b and the anvil subassemblies 39a, 39b having the correct combination of the outer diameters in order to prevent a mistake in the combination. .

Therefore, when the anastomosis of the intestinal canal or the like is performed, the staple head 6a is inserted into the intestinal canal, but when the outer diameter of the staple head 6a does not match the inner diameter of the intestinal canal, the main body 2
The main body 2 can be used by exchanging the staple heads 6b having different outer diameters in which the staples 11 are stored, without discarding. At that time, the anvil part set 39b, which is assembled together with the anvil 26b and the receiving plate 28b, is aligned by the positioning means 27,
It can be replaced with the anvil head 5 of the main body 2.

According to the present embodiment, in addition to the effect of the first embodiment, when a disposable (disposable type) suturing device is used for anastomosis of the intestinal tract, after the packaging state is released. Then, even if it is found that the outer diameter of the staple head or the anvil head does not match the inner diameter of the intestinal tract, the suturing device as a whole has to be discarded. However, in the suturing device of the present embodiment, the staple head 6a or 6b having a different size is used. The main body 2 can be used as it is by replacing it. Also,
The main body 2 can be reused by replacing the used staple heads 6a and 6b. Therefore, the cost can be significantly reduced in a hospital as compared with a disposable suture device.

FIG. 15 shows a fourth embodiment, and the same components as those of the first and second embodiments are designated by the same reference numerals and the description thereof will be omitted. In the present embodiment, a cylindrical cutter 40 is used instead of the cylindrical cutter 13 of the first and second embodiments, and the sharp tip 40a is arranged inside the anvil head 5 with the sharp head 40a directed toward the staple head 6. . The rack 4 is provided on the outer peripheral portion of the staple head sleeve 18a as a cylindrical cutter driving means for operating the cylindrical cutter 40.
1 and the rack 43 inside the cylindrical cutter 40, and the rack 4
1 is different from the first and second embodiments in that the pinion 42 that meshes with the rack 43 is provided, and the receiving plate 44 is disposed inside the staple head 6 with respect to the cylindrical cutter 40.

According to this embodiment, as in the first and second embodiments, the purse string suture of the intestinal tract is applied to the outer peripheral surface of the staple head sleeve 18a and the outer peripheral surface of the trocar sleeve 34. When the staple head 6 is attached to the trocar 30 at the tip of the insertion portion 4, the staple head sleeve 18a
Is attached to the trocar sleeve 34, and the leaf spring 16 attached to the staple head shaft 38 is attached to the trocar 30. When the rotary knob 7 of the operation unit 3 is turned, the tensile force transmitted to the trocar 30 is applied to the staple head shaft 38.
Is transmitted to the leaf spring 16 and the staple head 6, and the staple head 6 is drawn toward the anvil 26 side (see FIG. 15A).

When the lever 8 of the operating portion 3 is gripped when the staple head 6 and the anvil 26 are in the optimum positional relationship, a tensile force is transmitted from the trocar sleeve 34 to the staple head sleeve 18a and the staple pusher 14, and the staple channel 12 The staple 11 is pushed out from the.

The staple 11 pushed out is the anvil 2
6 is deformed by the groove 25 provided in the rack 6, and at the same time, as the staple head sleeve 18a is pulled toward the anvil head 5, the rack 41 moves the rack 43 toward the staple head 6 through the pinion 42, and the cylindrical cutter A sharp tip 40 a of 40 projects from the anvil head 5.

Receiving plate 4 arranged on staple head 6
When the cylindrical cutter 40 is pressed against 4, the excess tissue inside the staple line inside the intestinal tract is cut off, and the anastomosis operation is completed (see FIG. 15 (b)). After the operation, the staple head 6 is discarded, and the main body 2 can be reused by replacing the staple head 6 at the next use.

According to the present embodiment, in addition to the effect of the second embodiment, by disposing the cylindrical cutter 40 on the anvil head 5 of the main body 2, the replacement cost of the staple head 6 is reduced, so that the cost per replacement is reduced. Surgical costs are reduced.

FIG. 16 shows the fifth embodiment, and the same components as those of the third embodiment are designated by the same reference numerals and the description thereof will be omitted. In the present embodiment, in addition to the configuration of the third embodiment, the staple heads 6a and 6b and the anvil assembly 39 are provided.
a and 39b are packed in the packing materials 70a and 70b according to size, and the staple heads 6a and 6b and the anvil sub-units 39a and 39b are provided with different size-specific collars 71a and 71b, respectively. This is the same as the third embodiment.

According to the present embodiment, during intestinal anastomosis, FIG.
As shown in FIG. 6 (a), when the staple head 6a opened from the packing material 70a and the anvil portion set 39a do not match the inner diameter of the intestinal tract, as shown in FIG. 16 (b), the packing material 70b is opened. The staple heads 6b having different sizes and the anvil subassembly 39b are used. When the combination of sizes is not known, the staple heads 6a and 6b and the anvil parts 39a and 39b are combined and replaced according to the respective size-specific collars 71a and 71b.

According to the present embodiment, in addition to the effects of the third embodiment, the staple heads 6a and 6b and the anvil head sub-units 39a and 39b are combined according to size and packed in the packing materials 70a and 70b. Because
You only have to open one packing material, and you can open several packing materials at the same time.
When 0a and 70b are opened, they can be used without any error because they can be used in combination according to the size-specific colors 71a and 71b of different colors provided for the sizes. Similar effects can be obtained when an index, a combination member, or the like different from the size-based color is provided as another configuration.

According to the above-mentioned embodiment, the structure is obtained as follows. (Supplementary Note 1) A medical suturing device having a main body including an operation portion and an insertion portion extending from the operation portion, and an anvil head provided at a front end portion of the main body for deforming a plurality of staples. A medical suturing device, characterized in that an anvil head is provided in a portion, and a staple head having a plurality of staples is provided at a position facing the anvil head.

(Supplementary Note 2) A medical suture instrument comprising a main body composed of an operating portion and an inserting portion extending from the operating portion, and an anvil head provided at the tip of the main body for deforming a plurality of staples. A medical suturing device in which a head is disposed on a main body, and a plurality of staples and staple ejecting means are located at positions facing the anvil head.

(Supplementary Note 3) In the medical suturing device according to Supplementary Note 1 or Supplementary Note 2, a position where a plurality of staples are arranged and a position where an anvil head is arranged are separated from each other by a first position, There is a second position in which the positions of a plurality of staples and a position of the anvil head are close to each other, and a plurality of staples are movable between the first position and the second position. Suture device.

(Supplementary Note 4) In the medical suturing device according to Supplementary Note 1 or Supplementary Note 2, the staple is arranged at a position where a plurality of staples each having a base portion and two legs extending from both ends of the base portion are arranged and an anvil head are arranged. A first position whose distance from the stapled position is at least longer than the length of the foot of the staple, and a second position where the distance between the positions of the plurality of staples and the position of the anvil head is shorter than the length of the foot of the staple and close to each other. And a plurality of staples are movable between the first position and the second position.

(Supplementary Note 5) In the medical suturing device according to Supplementary Note 3 or Supplementary Note 4, a plurality of staples are housed in a casing, and the casing cannot be removed from the tip of the main body at the second position. vessel.

(Supplementary Note 6) In the medical suturing device according to Supplementary Note 5, the anvil head is disposed on the main body, and the plurality of staples and the means for ejecting the staples are detachably disposed from the position facing the anvil head. Medical suture device.

(Supplementary Note 7) The medical suturing instrument according to Supplementary Note 1 or Supplementary Note 2, further comprising a cutter for cutting tissue. (Supplementary Note 8) The medical suturing device according to Supplementary Note 7, wherein the cutter is arranged at a position facing the anvil head.

(Supplementary Note 9) The medical suture instrument according to Supplementary Note 7, wherein the cutters are arranged in the main bodies facing each other of the staples. (Supplementary note 10) The medical suture instrument according to supplementary note 7, wherein a receiving plate for receiving a blade portion of the cutter is provided.

(Supplementary Note 11) In the medical suturing device according to Supplementary Note 10, the anvil head and the receiving plate are detachably arranged at the tip of the main body, and a plurality of staples, staple ejecting means, and cutters are attached and detached at positions facing the anvil head. A medical suturing device characterized in that it is arranged freely, and radial positioning means is provided at the tip of the anvil head and the main body.

(Supplementary Note 12) In the medical suturing device of Supplementary Note 10, the anvil head and the cutter are detachably arranged at the tip of the main body, and the plurality of staples, the staple ejecting means, and the receiving plate are attached and detached at the positions facing the anvil head. A medical suturing device characterized in that it is arranged freely, and radial positioning means is provided at the tip of the anvil head and the main body.

(Supplementary Note 13) In the medical suturing device according to Supplementary Note 1 or Supplementary Note 2, the staple is composed of two legs and a base portion connecting the two legs, and the tips of the legs have a sharp shape. A medical suturing device characterized in that the sharp tips of two legs are arranged at positions facing the anvil head with the sharp tips facing the anvil head.

(Supplementary Note 15) A tissue coupling fastener, a pushing means for pushing out the tissue coupling fastener, a casing for accommodating the tissue coupling fastener, an auxiliary portion for assisting in fastening the tissue coupling fastener, and a distal end. In a medical suturing device having an insertion portion and a main body having an operation portion at a proximal end thereof, an auxiliary portion is provided at a distal end of the insertion portion, a casing is arranged at a distal end position facing the auxiliary portion, and the casing is A first actuating means extending from the tip of the main body and a second actuating means are connected to each other. The first actuating means adjusts the distance between the casing and the auxiliary portion, and the second actuating means pushes out from the main body. A medical suturing device characterized by transmitting a force for pushing out a tissue-bonding fastener to.

(Supplementary Note 16) In the medical suturing device of Supplementary Note 15, the tissue joining means is a staple, the pushing means is a staple ejecting means, and the auxiliary means is an anvil head having a surface for deforming the staple. And medical suture device.

(Supplementary Note 17) In the medical suturing device according to Supplementary Note 16, the staple is composed of a base and two legs extending from the base, and the distance between the casing and the anvil head is longer than the length of the staple leg. And a second position in which the spacing between the casing and the anvil head is less than the length of the staple foot, the first actuating means is the first
Between the position and the second position, the casing is moved, and the second actuating means transmits the force for ejecting the staple from the main body to the staple ejecting means.

(Supplementary note 18) The medical suturing instrument according to supplementary note 15 or supplementary note 17, wherein the first actuating means and the second actuating means are coaxially movable relative to each other.

(Supplementary Note 19) In the medical suturing instrument according to Supplementary Note 15 or Supplementary Note 18, the second actuating means is a shaft and the first actuating means is a tubular sleeve.
The medical suturing device, wherein the second actuating means is arranged inside the conduit of the first actuating means.

(Supplementary Note 20) In the medical suturing device of Supplementary Note 15 or Supplementary note 18, the first actuating means and the second
2. The medical suturing device according to claim 1, wherein at least a part of the operating means has an outer diameter portion smaller than the outer diameter of the anvil head.

(Supplementary Note 21) In the medical suturing device according to Supplementary Note 16, a part of the first actuating means is a means for separating and combining the first actuation, and a part of the second actuating means is a second actuating means. A medical suturing device comprising means for separating and combining the two actuating means.

(Supplementary Note 22) In the medical suturing device of Supplementary Note 21, the first actuating means is a tubular sleeve, and the second
The operating means of is a shaft, and the first operating means and the second operating means are coaxially operable relatively to each other.

(Supplementary Note 23) In Supplementary Note 21 or Supplementary Note 22, at least a part of the separating and combining means is composed of a latch and a groove. (Supplementary Note 24) In Supplementary Note 21 or Supplementary Note 23 or Supplementary Note 23, a limiting means for limiting the operation of the second actuating means is provided in the first actuating means.

(Supplementary note 25) A medical instrument comprising a plurality of staples, staple ejecting means for ejecting staples, an anvil head for deforming staples, and a main body having an insertion portion at a distal end and an operating portion at a proximal end. In the suturing device for staples, the staple has a base and two legs extending from the base, and a distance between a position where the plurality of staples is arranged and a position where the anvil head is arranged is at least longer than the length of the staple foot. A second position in which the distance between the first position and the position where the plurality of staples are arranged and the position where the anvil head is arranged are shorter than the length of the leg of the staple.
And a tension member that operates the plurality of staples from the first position to the second position, and an operation member that operates the staple ejection means from the second position. The medical suturing device is characterized in that after the pulling member moves the plurality of staples from the first position to the second position, the actuating member is in a ready state for actuation.

(Supplementary note 26) The medical suture instrument according to supplementary note 25, wherein the tension member is a first tension member and the actuating member is a second tension member. (Supplementary note 27) The medical suture instrument according to Supplementary note 25 or Supplementary note 26, characterized in that the anvil head is arranged at the tip of the main body, and the staple and the staple ejecting means are provided at positions facing the anvil head. vessel.

(Supplementary note 28) In the medical suturing device according to supplementary note 23, supplementary note 25, supplementary note 26 or supplementary note 27,
The medical suturing device is characterized in that, when the second tension member is ready for operation, the safety lock is released so that the staple driving means can be operated.

[0089]

As described above, according to the medical suturing device of the present invention, the anvil head is provided at the tip of the main body, and the staple head having a plurality of staples arranged at a position facing the anvil head is provided. Because
When performing anastomosis of luminal organs such as the intestine and esophagus, even if you grasp the lever without attaching the staple head to the tip of the main body,
No staple is ejected from the staple head, and the cutter does not project. Therefore, the risk of wasting staples and cutters is reduced, and
Replacing the staple head and reusing the body will reduce hospital costs.

[Brief description of drawings]

1A and 1B show a medical suturing device according to a first embodiment of the present invention, FIG. 1A is an overall configuration diagram, and FIG. 1B is a side view of a staple head and an anvil head.

2A and 2B show the medical suturing device of the same embodiment, wherein FIG. 2A is a vertical sectional side view of a staple head and an anvil head, and FIG.
1 is a sectional view taken along the line aa in FIG. 1, and FIG.
Sectional drawing which follows the line, (d) is a side view of a staple.

FIG. 3 is a vertical sectional side view of a staple head and an anvil head of the medical suturing device according to the same embodiment.

FIG. 4 is a perspective view of a staple head sleeve of the medical suturing device according to the embodiment.

FIG. 5 is a view for explaining the action of the medical suturing device of the same embodiment, (a) is a vertical sectional side view of a staple head and an anvil head, and (b) is a view taken along the line cc of (a). Sectional view.

6A and 6B are views for explaining the operation of the medical suturing device according to the embodiment, FIG. 6A is a vertical side view of a staple head and an anvil head, and FIG. 6B is a side view when the staple is deformed.

FIG. 7 is an exploded perspective view of an insertion portion of the medical suturing device according to the same embodiment.

FIG. 8 is an exploded perspective view of an operation portion of the medical suturing device according to the same embodiment.

FIG. 9 is a vertical cross-sectional side view of the operation portion for explaining the operation of the medical suturing device according to the same embodiment.

FIG. 10 is a vertical cross-sectional side view of the operation portion for explaining the operation of the medical suturing device according to the embodiment.

FIG. 11 is a vertical cross-sectional side view of the operation portion for explaining the operation of the medical suturing device according to the embodiment.

FIG. 12 is a vertical cross-sectional side view of the operation unit for explaining the operation of the medical suturing device according to the embodiment.

13A and 13B show a staple head of a medical suturing device according to a second embodiment of the present invention, wherein FIG. 13A is a vertical sectional side view before staple ejection, and FIG. 13B is a vertical sectional side view after staple ejection.

FIG. 14 is a vertical sectional side view of a staple head and an anvil head of a medical suturing device according to a third embodiment of the present invention.

15A and 15B show a staple head and an anvil head of a medical suturing device according to a fourth embodiment of the present invention, where FIG. 15A is a vertical cross-sectional side view before staple ejection, and FIG. 15B is a vertical cross-sectional side view after staple ejection. Fig.

FIG. 16 is a perspective view showing a packaging form of a staple head and an anvil head of a medical suturing device according to a fifth embodiment of the present invention.

[Explanation of symbols]

 1 ... Medical suturing device 2 ... Main body 3 ... Operation part 4 ... Insertion part 5 ... Anvil head 6 ... Staple head 11 ... Staple

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[Procedure amendment]

[Submission date] July 19, 1996

[Procedure amendment 1]

[Document name to be amended] Drawing

[Correction target item name] Figure 2

[Correction method] Change

[Correction contents]

[Fig. 2]

Claims (1)

[Claims] 1. A medical suturing device having a main body composed of an operating portion and an insertion portion extending from the operating portion, and an anvil head provided at a tip portion of the main body for deforming a plurality of staples. A medical suturing device characterized in that an anvil head is provided at a tip portion, and a staple head having a plurality of staples arranged at a position facing the anvil head is provided.