CN115209817A

CN115209817A - Needle holder for endoscope and endoscopic suturing method

Info

Publication number: CN115209817A
Application number: CN202080097830.4A
Authority: CN
Inventors: 林悠太; 松尾伸子
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 2020-03-05
Filing date: 2020-03-05
Publication date: 2022-10-18
Also published as: JPWO2021176636A1; JP7349553B2; WO2021176636A1

Abstract

The needle holder for an endoscope includes: an elongated flexible tube (2); and a 1 st and a 2 nd grasping members (3, 4) connected to the distal end of the flexible tube (2) and capable of opening and closing with each other, wherein the 1 st inner surface (3 a) of the 1 st grasping member (3) has a pair of supporting portions (8) and a groove (10) formed between the pair of supporting portions (8), the groove (10) and the pair of supporting portions (8) extend in a direction along the longitudinal axis of the flexible tube (2), the 2 nd inner surface (4 a) has a protrusion (9) opposed to the groove (10) and extending in the direction along the longitudinal axis, a top surface (9 c) of at least a part of the protrusion (9) is inclined with respect to the longitudinal axis, has a distal end side portion (9 a) and a proximal end side portion (9 b) respectively facing the proximal end side and the distal end side of the groove (10), and the suturing needle is grasped between the pair of supporting portions (8), the distal end side portion (9 a), and the proximal end side portion (9 b).

Description

Needle holder for endoscope and endoscopic suturing method

Technical Field

The invention relates to a needle holder for an endoscope and a method of suturing under the endoscope.

Background

Needle holders for laparoscopes and endoscopes for holding a suture needle for suturing a living tissue have been known (see, for example, patent documents 1 to 4).

Documents of the prior art

Patent document

Patent document 1: specification of us patent No. 5951587

Patent document 2: specification of us patent No. 6063096

Patent document 3: specification of U.S. patent No. 773044

Patent document 4: specification of U.S. Pat. No. 5196023

Disclosure of Invention

Problems to be solved by the invention

In order to suture tissue endoscopically, it is necessary to make the needle tip portion of the suture needle penetrate into the tissue and protrude from the tissue by the operation of a needle holder holding the suture needle, and then to pull out the entire suture needle from the tissue by the operation of the needle holder holding the needle tip portion. That is, when suturing a tissue using a single needle holder, it is necessary to change the holding position of the suturing needle held by the needle holder.

As a method for simplifying the operation without changing the holding position, an operation using two needle holders has been proposed. However, the movement of each needle holder inserted into the body via the endoscope is limited to the forward and backward movement in the longitudinal direction and the rotation around the longitudinal axis, and each needle holder cannot be moved in the lateral direction. In order to smoothly deliver the suture needle from one needle holder to another needle holder by such a restricted movement, it is important that one needle holder stably holds the suture needle in an appropriate posture. However, in the case of using the needle holders of patent documents 1 to 4, the position and posture of the suture needle held by the needle holder are unstable, and it is not easy to transfer the suture needle from one needle holder to another needle holder.

The present invention has been made in view of the above circumstances, and an object thereof is to provide a needle holder for an endoscope and a method of suturing under an endoscope, which can smoothly transfer a suture needle to another needle holder.

Means for solving the problems

In order to achieve the above object, the present invention provides the following means.

One technical solution of the present invention is a needle holder for an endoscope, comprising: an elongated flexible tube having flexibility; and a 1 st gripping member and a 2 nd gripping member which are connected to a distal end of the flexible tube and are capable of opening and closing with respect to each other, the 1 st gripping member having a 1 st inner surface, the 2 nd gripping member having a 2 nd inner surface, the 1 st inner surface and the 2 nd inner surface facing each other in a closed state in which the 1 st gripping member and the 2 nd gripping member are closed, the 1 st inner surface having a pair of support portions juxtaposed with each other and a groove formed between the pair of support portions, the pair of support portions and the groove extending in a direction along a longitudinal axis of the flexible tube in the closed state, the 2 nd inner surface having a protrusion portion facing the groove and extending in a direction along the longitudinal axis in the closed state, a top surface of at least a part of the protrusion portion having an inclined surface with respect to the longitudinal axis, the inclined surface having a distal end side portion facing a proximal end side of the groove and a distal end side portion facing a distal end side of the groove, and the suture needle being gripped between the pair of support portions, the distal end side portion and the proximal end portion.

According to the present invention, the suture needle is held between the projection and the pair of supporting portions by closing the 1 st holding member and the 2 nd holding member with each other. In the case where the suture needle is a curved needle having directionality, the suture needle can be held in a posture along a plane orthogonal or substantially orthogonal to the longitudinal axis of the flexible tube by the pair of support portions supporting the radially outer side surface of the suture needle and the projection portion positioned between the pair of support portions in the circumferential direction of the suture needle and supporting the radially inner side surface of the suture needle.

Further, the front end side portion and the base end side portion of the top surface of the protrusion are inclined in opposite directions to each other. Thus, the suture needle gripped by the projection and the pair of supports can be positioned in the direction along the longitudinal axis at a position where the distal end side portion and the proximal end side portion of the projection simultaneously come into contact with the suture needle.

In this way, since the posture and position of the suture needle gripped by the first gripping member and the second gripping member are stable, the suture needle gripped by the needle holder for an endoscope according to the present invention can be smoothly transferred to another needle holder.

In the above-described aspect, a distal end portion of at least one of the 1 st inner surface and the 2 nd inner surface may include a concave-convex surface having a plurality of convex portions or a plurality of concave portions, and the pair of support portions, the groove, and the protrusion portion may be provided on a base end side of the concave-convex surface.

The convex or concave portions of the concave-convex surface function as an anti-slip member for the surface of the suture needle. By providing such a concave-convex surface on the distal end portion of at least one inner surface, the suture needle can be firmly gripped even at the distal end portion of the gripping member. In particular, a thin needle point portion which is difficult to grasp by the projection portion and the pair of support portions can be firmly grasped at the tip end portion of the grasping member.

In the above aspect, the 1 st inner surface may have the concave-convex surface at a distal end portion thereof, and the pair of support portions may be offset to a side opposite to the 2 nd inner surface with respect to the concave-convex surface.

According to this configuration, the suture needle arranged on the pair of support portions stably stays on the pair of support portions due to the step between the concave-convex surface and the pair of support portions. Therefore, the suturing needle can be prevented from coming off from the pair of gripping surfaces toward the uneven surface against the intention of the operator.

In the above-described aspect, at least a distal end portion of one side surface of each of the 1 st gripping member and the 2 nd gripping member may be a slope surface inclined with respect to the longitudinal axis, the slope surface being inclined in a direction in which a width of the 1 st gripping member and a width of the 2 nd gripping member gradually decrease toward a distal end side.

When the 1 st and 2 nd grasping members grasp the pointed end portion of the suture needle protruding from the tissue, the 1 st and 2 nd grasping members contact the tissue at one side surfaces thereof. At this time, the tissue may be pulled and raised by the suture needle. Since the side surfaces of the distal end portions of the 1 st gripping member and the 2 nd gripping member are sloped, the 1 st gripping member and the 2 nd gripping member can be prevented from being strongly brought into contact with the raised tissue.

In the above aspect, the opening restricting mechanism may be provided to prevent the 1 st gripping member and the 2 nd gripping member from opening.

According to this configuration, the opening restriction mechanism prevents the 1 st gripping member and the 2 nd gripping member from opening against the intention of the operator. Therefore, the operator can release the hand from the needle holder for the endoscope while maintaining the state in which the 1 st gripping member and the 2 nd gripping member that grip the suture needle are closed. Thus, for example, an operator can operate the needle holder for an endoscope and other instruments.

Another aspect of the present invention is an endoscopic suturing method for endoscopically suturing a tissue in a body by inserting a 1 st needle holder and a 2 nd needle holder into the body through an endoscope, the method comprising: penetrating a suture needle into the tissue by an operation of the 1 st needle holder holding the suture needle, and projecting a needle tip portion of the suture needle from the tissue; grasping the needle tip portion protruding from the tissue with the 2 nd needle holder; withdrawing the suture needle from the tissue with the action of the 2 nd needle holder; and a step of disposing a part of the suture needle pulled out from the tissue on a track of the 1 st needle holder by an operation of the 2 nd needle holder.

According to this aspect, after the suture needle is gripped by the 1 st needle holder and inserted into the tissue, the needle edge portion of the suture needle is gripped by the 2 nd needle holder and removed from the tissue. Then, a part of the suture needle is arranged on the track of the 1 st needle holder by the operation of the 2 nd needle holder. The movement of the 1 st needle holder inserted into the body via inside the endoscope is limited to a movement in the direction of the length axis of the 1 st needle holder and a rotation around the length axis. The suture needle can be smoothly transferred from the 2 nd needle holder to the 1 st needle holder.

In the above technical solution, the method may further include the following steps: separating the 1 st needle holder from the suture needle and retracting the 1 st needle holder in a longitudinal direction after the 2 nd needle holder holds the needle tip portion; and gripping a part of the suture needle disposed on the track with the 1 st needle holder.

According to this feature, when the suture needle is extracted from the tissue by the operation of the 2 nd needle holder and when a part of the suture needle is arranged on the track of the 1 st needle holder by the operation of the 2 nd needle holder, the 1 st needle holder can be made to stand by at a position not interfering with the suture needle. In this feature, the method may further include: advancing the 1 st needle holder after disposing a portion of the suture needle on the track of the 1 st needle holder.

In the above-described aspect, the process of disposing a part of the suture needle on the track by the operation of the 2 nd needle holder may include a process of rotating the 2 nd needle holder about a longitudinal axis of the 2 nd needle holder.

According to this feature, when the suture needle is a curved needle, a part of the suture needle held by the 2 nd needle holder can be arranged on the track of the 1 st needle holder by the rotation of the 2 nd needle holder about the longitudinal axis.

In the above technical solution, the method may further include the following steps: when the 2 nd needle holder is rotated after the suture needle is pulled out from the tissue, the suture needle is retracted to a position where the suture needle held by the 2 nd needle holder does not interfere with the tissue.

According to this feature, when the 2 nd needle holder is rotated to dispose a part of the suture needle on the track, it is possible to prevent the suture needle from interfering with the tissue.

In the above-described aspect, a pair of grasping members that can be opened and closed with respect to each other may be provided at a distal end portion of the 2 nd needle holder, and the needle-tip portion protruding from the tissue may be grasped by the distal end portions of the pair of grasping members, and the method may further include: before a part of the suture needle is arranged on the track of the 1 st needle holder by the operation of the 2 nd needle holder, the position for gripping the suture needle is changed from the tip end parts of the pair of gripping members to the base end parts of the pair of gripping members.

When the concave-convex surface is provided on the inner surface of the tip end portion of the pair of gripping members and the protrusion portion and the pair of support portions are provided on the inner surface of the base end portion of the pair of gripping members, the thin needle point portion can be firmly gripped by the concave-convex surface. Thereafter, the suture needle can be held in a predetermined posture by the proximal end portions of the pair of holding members, and the suture needle can be arranged on the track in the predetermined posture.

In the above technical solution, the tissue in the body may be a tissue of a luminal organ.

ADVANTAGEOUS EFFECTS OF INVENTION

According to the present invention, the suture needle can be easily transferred to another needle holder.

Drawings

Fig. 1 is an overall configuration diagram of a needle holder for an endoscope according to an embodiment of the present invention.

Fig. 2A is a side view of the distal end portion of the needle holder for an endoscope of fig. 1.

FIG. 2B is an end view of the distal end portion of the needle holder for an endoscope shown in FIG. 2A taken along line II-II.

Fig. 3A is an end view of the projection and the pair of support portions when viewed from the distal end side in a state where the suture needle is held.

Fig. 3B is a partial vertical cross-sectional view obtained by cutting the pair of gripping members at the position of the line III-III in fig. 3A, and is a cross-sectional view of the projection and the pair of supports in a state where the suture needle is gripped, as viewed from the left side.

Fig. 4A is an example of an endoscopic image for explaining the step 1 of the endoscopic stitching method according to the embodiment of the present invention.

Fig. 4B is an example of an endoscopic image for explaining the step 2 of the endoscopic stitching method according to the embodiment of the present invention.

Fig. 4C is an example of an endoscopic image for explaining the step 2 of the endoscopic stitching method according to the embodiment of the present invention.

Fig. 4D is an example of an endoscopic image for explaining the 3 rd step of the endoscopic stitching method according to the embodiment of the present invention.

Fig. 4E is an example of an endoscopic image for explaining the 3 rd step of the endoscopic stitching method according to the embodiment of the present invention.

Fig. 5 is a view for explaining a method of using the 1 st gripping member and the 2 nd gripping member having the slope surfaces.

Fig. 6A is a diagram showing a configuration example of an opening restriction mechanism provided in an operation portion.

Fig. 6B is a diagram showing another configuration example of the opening restriction mechanism provided in the operation portion.

Fig. 7 is a view showing an example of a mounting member used in an endoscopic suturing method.

Fig. 8A is a view showing a modification of the 2 nd needle holder used in the endoscopic suturing method.

FIG. 8B is a view showing a state where a suture needle is gripped by the 2 nd needle holder of FIG. 8A.

Detailed Description

The needle holder 1 for an endoscope and the endoscopic suturing method according to one embodiment of the present invention will be described below with reference to the drawings.

As shown in fig. 4A to 4E, the needle holder 1 for an endoscope of the present embodiment is used for an endoscopic suturing method for suturing a tissue S in a body under an endoscope using a suturing needle 22 and a suturing thread 23. The endoscope is a flexible endoscope including a long flexible insertion portion, and has a treatment instrument channel that penetrates the insertion portion in the longitudinal direction. The needle holder 1 for an endoscope is inserted into the body through the treatment instrument channel.

As shown in fig. 1, the needle holder 1 for an endoscope includes a flexible, elongated flexible tube 2, a pair of gripping

members

3 and 4 connected to the distal end of the flexible tube 2 for gripping a suture needle 22, and an operating portion 5 connected to the proximal end of the flexible tube 2 and operated by an operator.

In the following description, the vertical direction is a direction orthogonal to the longitudinal axis a of the flexible tube 2, and the horizontal direction is a direction orthogonal to the longitudinal axis a and the vertical direction.

The flexible tube 2 includes, for example, a coil sheath, and has rigidity capable of transmitting a movement and a force applied to the base end portion of the flexible tube 2 by an operator to the tip end portion of the flexible tube 2. The movement is, for example, a movement in the direction of the length axis a and a movement in the rotational direction around the length axis a. Therefore, in a state where the flexible tube 2 passes through the treatment instrument channel and the

gripping members

3 and 4 protrude from the distal end surface of the endoscope, the operator can advance or retreat the pair of gripping

members

3 and 4 by advancing or retreating the proximal end portion of the flexible tube 2 in the direction along the longitudinal axis a, and can rotate the pair of gripping

members

3 and 4 about the longitudinal axis a by rotating the proximal end portion of the flexible tube 2 about the longitudinal axis a.

The pair of gripping

members

3, 4 are arranged in the vertical direction, and the base end portions of the pair of gripping

members

3, 4 are connected to each other so as to be swingable about a swing axis extending in the horizontal direction. The pair of gripping

members

3 and 4 can be opened and closed in the vertical direction.

In the drawing to be referred to, the pair of gripping

members

3 and 4 is a single-opening type in which the lower 1 st gripping member 3 is fixed to the flexible tube 2 and the upper 2 nd gripping member 4 swings, but may be a double-opening type in which both the 1 st gripping member 3 and the 2 nd gripping member 4 swing.

The operation portion 5 is connected to the 1 st gripping member 3 by a vertically long power transmission member such as a wire rod passing through the inside of the flexible tube 2. The force applied by the operator to the operation unit 5 is transmitted to the 1 st gripping member 3 by the power transmission member, and the 1 st gripping member 3 is swung, whereby the gripping

members

3, 4 are opened and closed. For example, the operation portion 5 has a shaft 5a extending along the longitudinal axis a and a slider 5b slidable along the shaft 5 a. The operator can close the gripping

members

3 and 4 by pulling the slider 5b toward the base end side, and can open the

gripping members

3 and 4 by pressing the slider 5b toward the tip end side.

As shown in fig. 2A and 2B, the 1 st gripping member 3 has a 1 st inner surface 3a, the 2 nd gripping member 4 has a 2 nd inner surface 4a, and the 1 st inner surface 3a and the 2 nd inner surface 4a are opposed to each other in the up-down direction in a closed state where the 1 st gripping member 3 and the 2 nd gripping member 4 are closed.

The 1 st gripping member 3 and the 2 nd gripping member 4 can grip the suture needle 22 both by gripping the suture needle 22 with the concave and

convex surfaces

6 and 7 of the distal end portion and by gripping the suture needle 22 with the pair of support portions 8 and the protrusion portion 9 of the proximal end portion.

Specifically, the front end of the 1 st inner surface 3a has an uneven surface 6, and the front end of the 2 nd inner surface 4a has an uneven surface 7. The concave-

convex surfaces

6 and 7 have a plurality of convex portions or a plurality of concave portions that function as an anti-slip member with respect to the surface of the suture needle 22. For example, the

uneven surfaces

6 and 7 have a large number of

convex portions

6a and 7a formed by cutting a flat surface, and the

convex portions

6a and 7a are each formed into a quadrangular frustum shape by, for example, diamond cutting.

Further, the base end portion of the 1 st inner surface 3a has a groove 10 and a pair of support portions 8, and the base end portion of the 2 nd inner surface 4a has a protrusion 9. The groove 10 and the pair of supporting portions 8 are provided on the 1 st gripping member 3 at a position closer to the base end side than the concave-convex surface 6, and the protrusion 9 is provided on the 2 nd gripping member 4 at a position closer to the base end side than the concave-convex surface 7.

The groove 10 is formed between the pair of support portions 8. The groove 10 and the pair of support portions 8 extend in a direction along the longitudinal axis a and are juxtaposed with each other in the left-right direction of the 1 st inner surface 3 a.

The projection 9 is opposite to the groove 10 in the closed state, extending in a direction along the longitudinal axis a. In the closed state, the vertical distance between the projection 9 and each support 8 is smaller than the diameter of the needle 22. Therefore, as shown in fig. 3A, the suture needle 22 can be held between the projection 9 and the pair of supports 8.

The needle 22 is a curved needle that curves in one direction, the radially outer surface 22b of the needle 22 is supported by the pair of support portions 8 at two positions spaced apart from each other in the circumferential direction of the needle 22, and the radially inner surface 22c of the needle 22 is supported by the projection portion 9 at a position between the two positions in the circumferential direction. By supporting the outer surface of the suture needle 22 at such 3 points, the posture of the suture needle 22 is fixed to a posture along a plane orthogonal or substantially orthogonal to the longitudinal axis a.

As shown in fig. 3A, the protrusion 9 is formed in a protruding shape toward the 1 st gripping member 3 when viewed from the front in the direction along the longitudinal axis a. The protrusion 9 has a top surface 9c facing the 1 st inner surface 3a and extending along the ridge of the protrusion 9. The top surface 9c is curved at a position midway in the longitudinal direction of the protrusion 9 in a side view viewed from a direction orthogonal to the longitudinal axis a and the opening/closing direction of the

gripping members

3, 4, and extends in an arch shape protruding upward on the opposite side of the 1 st inner surface 3a in the closed state.

Specifically, as shown in fig. 3B, at least a part of the top surface 9c of the protrusion 9 has an inclined surface inclined with respect to the longitudinal axis a, the inclined surface having a tip side portion 9a facing the base end side of the groove 10 and a base end side portion 9B facing the tip end side of the groove 10. The leading end side portion 9a and the base end side portion 9b are inclined in opposite directions to each other with respect to the longitudinal axis a. For example, the distance from the groove 10 to the distal end side portion 9a gradually becomes larger as going from the distal end toward the base end, and the distance from the groove 10 to the base end side portion 9b gradually becomes smaller as going from the distal end toward the base end. Thereby, the suture needle 22 is gripped between the distal end side portion 9a, the proximal end side portion 9b, and the pair of support portions 8. The held suture needle 22 is restricted from moving to the distal end side by the distal end side portion 9a and restricted from moving to the proximal end side by the proximal end side portion 9b. Thus, the suture needle 22 is positioned at a position where the leading end side portion 9a and the base end side portion 9b are simultaneously in contact with the outer surface of the suture needle 22 in the direction along the length axis a. The cross-sectional shape of the needle 22 is preferably oblong with mutually parallel sides on the radially inner and radially outer sides.

As shown in fig. 2A, the pair of supporting portions 8 are offset downward with respect to the concave-convex surface 6, and a step in the vertical direction is formed between the pair of supporting portions 8 and the concave-convex surface 6. Thus, the suture needle 22 placed on the pair of support portions 8 stably stays on the pair of support portions 8, and the suture needle 22 can be prevented from coming off from the pair of support portions 8 toward the uneven surface 6 against the intention of the operator.

Next, an endoscopic suturing method for suturing a tissue S in a body with the needle holder 1 for an endoscope will be described with reference to fig. 4A to 4E.

The endoscopic suturing method according to the present embodiment is a method of suturing a tissue S while observing the tissue S with an endoscope using one endoscope having two treatment instrument channels and two needle holders 1, 21. The tissue S is a tissue of a luminal organ such as an esophagus, a stomach, a small intestine, or a large intestine. The 1 st needle holder 21 is an arbitrary needle holder generally used for suturing the tissue S under the endoscope, and the 2 nd needle holder (needle holder for endoscope) 1 is the needle holder for endoscope 1. The 1 st needle holder 21 and the 2 nd needle holder 1 are inserted into the body through the respective treatment instrument channels. The two treatment instrument channels do not necessarily have to be provided inside the endoscope, and one treatment instrument channel may be attached to the outside of the endoscope, for example.

The endoscopic suturing method includes a 1 st step of penetrating a suture needle 22 into a tissue S with a 1 st needle holder 21 and projecting a needle tip portion 22a from the tissue S, a 2 nd step of extracting the suture needle 22 from the tissue S with a 2 nd needle holder 1, and a 3 rd step of delivering the suture needle 22 from the 2 nd needle holder 1 to the 1 st needle holder 21.

As shown in fig. 4A, in the step 1, the operator grips the suture needle 22 in a posture in which the suture needle 22 is arranged along a plane orthogonal or substantially orthogonal to the longitudinal axis of the needle holder 1 by a pair of gripping

members

21a, 21b of the needle holder 1 projecting from the distal end surface of the endoscope. Then, the operator pierces the needle tip portion 22a into the tissue S by rotating the 1 st needle holder 21 about the longitudinal axis of the 1 st needle holder 21, and rotates the 1 st needle holder 21 until the needle tip portion 22a protrudes from the tissue S. In the 1 st step, the 2 nd needle holder 1 is retracted to a position where it does not interfere with the tip portion 22a protruding from the tissue S.

Next, as shown in fig. 4B, in the 2 nd step, the operator advances the 2 nd needle holder 1, and grips the tip portion 22a protruding from the tissue S with the tip end portions of the pair of gripping

members

3 and 4 of the 2 nd needle holder 1. Since the inner surfaces of the distal end portions of the

gripping members

3 and 4 are the concave-

convex surfaces

6 and 7, the needle tip portion 22a can be firmly gripped by the distal end portions of the pair of gripping

members

3 and 4 even in a state where the thin needle tip portion 22a slightly protrudes from the tissue S.

Next, as shown in fig. 4C, the operator separates the 1 st needle holder 21 from the suture needle 22 and retreats. Then, the operator rotates the 2 nd needle holder 1 about the longitudinal axis a to pull out the entire suture needle 22 from the tissue S.

At this time, if necessary, the bending portion of the endoscope may be bent in a direction in which the suture needle 22 is pulled out from the tissue S (in the example of fig. 4B and 4C, the left direction of the endoscopic image). By the bending operation of the bending portion, the pair of gripping

members

3 and 4 and the suture needle 22 gripped by the pair of gripping

members

3 and 4 can be moved to easily pull out the suture needle 22 from the tissue S.

After the suture needle 22 is pulled out from the tissue S and before the 3 rd step is performed, if necessary, the endoscope may be operated to retract the suture needle 22 from the tissue S to a position where the suture needle 22 held by the 2 nd needle holder 1 does not interfere with the tissue S by operating the endoscope when the 2 nd needle holder 1 is rotated. For example, the 2 nd needle holder 1 holding the suture needle 22 may be moved to a position away from the suture site of the tissue S by bending the bending portion of the endoscope. Accordingly, in the subsequent 3 rd step, the situation in which the suture needle 22 interferes with the tissue S due to the rotational operation of the 2 nd needle holder 1 can be prevented.

In addition, in the middle of the withdrawal of the suture needle 22, the grasping position of the suture needle 22 grasped by the 2 nd needle holder 1 may be changed from the needle point portion 22a to a position closer to the base end side than the needle point portion 22a as necessary. At this time, the grasping position of the suture needle 22 of the 2 nd needle holder 1 is changed from between the concave-

convex surfaces

6, 7 at the distal end portion to between the pair of supporting portions 8 and the protrusion 9 at the proximal end portion.

Next, as shown in fig. 4D, in the 3 rd step, the operator rotates the 2 nd needle holder 1 about the longitudinal axis a in the direction opposite to the rotation direction of the 2 nd needle holder 1 in the 2 nd step, and thereby places a part of the suture needle 22 suitable for the 1 st needle holder 21 to be gripped on the track B of the 1 st needle holder 21. The track B is a path through which the 1 st needle holder 21 advances and retreats, and coincides with or substantially coincides with an extension line of the longitudinal axis of the treatment instrument channel into which the 1 st needle holder 21 is inserted.

Here, as described above, the operator changes the position of gripping the suture needle 22 from the distal end portions of the pair of gripping

members

3, 4 to the proximal end portions of the pair of gripping

members

3, 4 before the 2 nd needle holder 1 rotates. That is, the state in which the suture needle 22 is gripped by the

uneven surfaces

6 and 7 is switched to the state in which the suture needle 22 is gripped by the protrusion 9 (the distal end side portion 9a and the proximal end side portion 9 b) and the pair of support portions 8. Thus, the needle 22 is held in a posture along a plane orthogonal or substantially orthogonal to the longitudinal axis a by the projection 9 and the pair of supports 8. Further, since the top surface 9c of the projecting portion 9 is arcuate in side view, the suture needle 22 is positioned in the direction along the longitudinal axis a with respect to the pair of gripping

members

3, 4, and the suture needle 22 is prevented from wobbling in the direction along the longitudinal axis a.

Next, as shown in fig. 4E, the operator advances the 1 st needle holder 21 toward a part of the suture needle 22 disposed on the track B, and grips a part of the suture needle 22 with the 1 st needle holder 21. At this time, since the two needle holders 1 and 21 project from the distal end of the endoscope substantially in parallel to each other, the suture needle 22 held by the proximal end portions of the pair of holding

members

3 and 4 is held in an attitude along a plane orthogonal or substantially orthogonal to the longitudinal axis of the 1 st needle holder 21. Further, the suture needle 22 gripped by the base end portions of the pair of gripping

members

3 and 4, that is, the projection portion 9 and the pair of support portions 8 is stably held at a constant position without being shaken in a direction along the longitudinal axis a. Therefore, the suture needle 22 can be easily held in an appropriate posture by the 1 st needle holder 21.

The movement of the 1 st needle holder 21 inserted into the body via the treatment instrument channel is restricted to the advance and retreat in the direction of the longitudinal axis and the rotation around the longitudinal axis. Also, the movement of the 2 nd needle holder 1 inserted into the body via another treatment instrument channel is restricted to the advance and retreat in the direction of the longitudinal axis a and the rotation around the longitudinal axis a. Therefore, when the suture needle 22 is transferred from the 2 nd needle holder 1 to the 1 st needle holder 21, the position and posture of the suture needle 22 with respect to the 1 st needle holder 21 must be adjusted only by advancing and retracting and rotating the 2 nd needle holder 1 with respect to the 1 st needle holder 21.

According to the present embodiment, the suture needle 22 is stably held at a constant position in a posture along a plane orthogonal or substantially orthogonal to the longitudinal axis of the 1 st needle holder 21 by the pair of support portions 8 and the protrusion portions 9 provided at the base end portions of the pair of gripping

members

3, 4 of the 2 nd needle holder 1. Then, a part of the suture needle 22 is arranged on the track B of the 1 st needle holder 21 by the rotation of the 2 nd needle holder 1. This allows the suture needle 22 to be smoothly transferred from the 2 nd needle holder 1 to the 1 st needle holder 21.

In the present embodiment, as shown in fig. 5, at least the distal end portions of the right side surfaces of the

gripping members

3 and 4 may be

slopes

3b and 4b inclined with respect to the longitudinal axis a. The

slopes

3b, 4b are inclined in such a direction that the width of the

gripping members

3, 4 in the lateral direction gradually decreases toward the distal end side. The

slopes

3b, 4b may be provided over the entire length of the

gripping members

3, 4 in the longitudinal direction. The

slopes

3b, 4b may be flat surfaces or convex curved surfaces in a plan view viewed from the upper side or the lower side.

The left side surface of each gripping

member

3, 4 is parallel or substantially parallel to the longitudinal axis a. Therefore, the gripping

members

3, 4 have an asymmetrical shape with respect to the longitudinal axis a in a plan view viewed from the upper side or the lower side.

In a state where the needle tip portion 22a protrudes from the tissue S, the tissue S is pulled and raised by the needle tip portion 22a. When the 2 nd needle holder 1 is advanced toward the needle tip portion 22a in order to grip the needle tip portion 22a by the pair of gripping

members

3, 4, the sloping

surfaces

3b, 4b of the right side surfaces of the

gripping members

3, 4 advance along the surface of the raised tissue S. Further, the distal end portion of the flexible tube 2 is deflected to the left side, which is the side opposite to the tissue S, by the force received by the slope surfaces 3b and 4b from the tissue S. Accordingly, in the endoscopic image, the suture needle 22 protruding further to the left side can be gripped by the 2 nd needle holder 1, and the

gripping members

3 and 4 can be prevented from being strongly contacted with the raised tissue S.

In the present embodiment, the needle holder 1 for an endoscope may further include an opening restriction mechanism for preventing the pair of gripping

members

3 and 4 from opening each other.

In the operation using the endoscope and the two needle holders 1 and 21 as in the present embodiment, generally, one doctor operates the endoscope and two assistants operate the two needle holders 1 and 21. By providing the needle holder 2 with the opening restriction mechanism, a doctor can easily operate the endoscope and the needle holder 21. That is, when the pair of gripping

members

3 and 4 gripping the suture needle 22 is maintained in the closed state by the opening restriction mechanism, the doctor can operate the endoscope by releasing the hands from the operation portion 5 of the needle holder 1. Alternatively, it becomes easy for one assistant to operate both needle holders 1, 21 at the same time. Thus, the endoscopic suturing method according to the present embodiment can be performed by one doctor and one assistant.

Fig. 6A and 6B show a configuration example of the opening restriction mechanism. The opening restriction mechanism is provided in the operation portion 5 and prevents the slider 5b from moving toward the distal end side corresponding to the opening direction of the pair of gripping

members

3 and 4 in a state where the operator does not apply a force to the slider 5b.

The opening regulating mechanism of fig. 6A includes a biasing member 11 for biasing the slider 5b in a direction toward the base end side corresponding to the closing direction of the pair of gripping

members

3, 4. The urging member 11 is, for example, a compression spring disposed in the shaft 5a and compressible in a direction along the longitudinal axis a. Reference numeral 13 is a power transmission member that connects the slider 5b and the 2 nd gripping member 4. The operator can open the pair of gripping

members

3 and 4 by moving the slider 5b toward the front end side against the biasing force of the biasing member 11.

The opening restriction mechanism of fig. 6B is a ratchet mechanism for restricting the movement of the slider 5B only in a direction toward the base end side corresponding to the closing direction of the pair of gripping

members

3, 4. The opening restriction mechanism includes a plurality of teeth 12a formed on the outer peripheral surface of the shaft 5a, a push button 12b provided on the slider 5b, a movable member 12d fixed to the push button 12b and having claws 12c, and an urging member 12e for urging the movable member 12d in a direction in which the claws 12c are fitted in the grooves between the teeth 12 a. The plurality of teeth 12a are arranged in a direction along the longitudinal axis a, and have a shape that allows the claw 12c to move toward the base end side and locks the claw 12c to move toward the tip end side.

In a state where the button 12b is not pressed, the operator can move the slider 5b toward the base end side to close the pair of gripping

members

3, 4. Further, by pressing the button 12b, the operator can move the movable member 12d in a direction in which the claw 12c is disengaged from between the teeth 12a against the urging force of the urging member 12e, and can switch the slider 5b to a state in which it is movable in both directions in the longitudinal direction of the shaft 5 a.

In order to allow the doctor to easily operate both the endoscope and the 2 nd needle holder 1, a mounting member for attaching the proximal end portion of the 2 nd needle holder 1 to the endoscope may be used. For example, a hook having the letter C shape may be used as the mounting member 30 as shown in fig. 7. The C-letter shaped hook 30 is attached to the distal end portion of the operation portion 5, for example, the shaft 5a of the needle holder 2.

In the present embodiment, both the 1 st inner surface 3a and the 2 nd inner surface 4a have the

uneven surfaces

6, 7, but instead, only one of the 1 st inner surface 3a and the 2 nd inner surface 4a may have the uneven surface 6 or the uneven surface 7. By providing at least one of the

inner surfaces

3a, 4a with the concave-convex surface 6 or the concave-convex surface 7, the thin needle point portion 22a can be firmly gripped.

In the endoscopic suturing method according to the present embodiment, a general-purpose needle holder is used as the 1 st needle holder 21, but instead, the endoscopic needle holder 1 may be used. That is, the endoscopic suturing method may be performed using two needle holders 1 for an endoscope.

In the endoscopic suturing method according to the present embodiment, the needle holder 1 for an endoscope may be replaced with another needle holder as the 2 nd needle holder. For example, a multi-leg forceps 40 having a plurality of legs may be used as the 2 nd needle holder as shown in fig. 8A. The multi-leg forceps 40 includes a tubular, elongated sheath 40a and a plurality of legs 40b disposed within the sheath 40a, the plurality of legs 40b being capable of advancing and retracting independently of one another relative to the sheath 40 a. The distal end portion of each leg 40b is bent outward in the radial direction of the sheath 40a, and is elastically deformed into a linear shape inside the sheath 40 a. Therefore, by projecting the distal end portions of the plurality of legs 40b from the distal end surface of the sheath 40a, the distal end portions of the plurality of legs 40b can be expanded radially outward.

Therefore, the needle tip portion 22a protruding from the tissue S can be held between the plurality of legs 40B or between the legs 40B and the distal end of the sheath 40a as shown in fig. 8B. In this embodiment, since the suture needle 22 is held by advancing and retracting the legs 40b, the 2 nd needle holder 1 can easily perform a variable positioning with respect to the needle tip portion 22a protruding from the tissue S. Further, although the multi-leg forceps 40 are illustrated, the number of legs 40b is not necessarily large, and may be only one. Since the needle point portion 22a can be gripped between only one leg 40b and the distal end of the sheath 40a, even in the case of the 2 nd needle holder having only one leg 40b, the positioning of the 2 nd needle holder with respect to the needle point portion 22a protruding from the tissue S is made variable in the same manner as in the multi-leg forceps 40.

In the present embodiment, the case where a curved needle having an oval cross-sectional shape is used as the suture needle 22 has been described, but a curved needle having a cross-sectional shape of other shapes such as a circle or an ellipse can also be used for the needle holder 1 for an endoscope.

Description of the reference numerals

1. A needle holder for endoscope, a 2 nd needle holder; 2. a flexible tube; 3. 1 st gripping member; 3a, 1 st inner surface; 3b, 4b, a slope surface; 4. a 2 nd holding member; 4a, 2 nd inner surface; 5. an operation unit; 6. 7, concave-convex surfaces; 6a, 7a, convex; 8. a support portion; 9. a protrusion portion; 10. a groove; 11. a force application member and an opening restriction mechanism; 12a, 12b, 12c, 12d, 12e, an opening restriction mechanism; 13. a power transmission member; 21. the 1 st needle holder; 22. a suture needle; 23. a suture thread; 30. a multi-leg forceps, a 2 nd needle holder; A. a length axis of the flexible tube; B. a track; and S, organizing.

Claims

1. A needle holder for an endoscope, wherein,

the needle holder for an endoscope includes:

an elongated flexible tube having flexibility; and

a 1 st gripping member and a 2 nd gripping member which are connected to the distal end of the flexible tube and can be opened and closed with each other,

the 1 st gripping member has a 1 st inner surface, the 2 nd gripping member has a 2 nd inner surface, the 1 st inner surface and the 2 nd inner surface are opposed to each other in a closed state where the 1 st gripping member and the 2 nd gripping member are closed,

the 1 st inner surface has a pair of support portions juxtaposed to each other and a groove formed between the pair of support portions, the pair of support portions and the groove extending in a direction along a longitudinal axis of the flexible pipe in the closed state, respectively,

the 2 nd inner surface has a protrusion portion that is opposed to the groove in the closed state and extends in a direction along the longitudinal axis, a top surface of at least a part of the protrusion portion has an inclined surface that is inclined with respect to the longitudinal axis, the inclined surface has a leading end side portion toward a base end side of the groove and a leading end side portion toward a leading end side of the groove,

the suture needle is held between the pair of support portions, the distal end portion, and the proximal end portion.

2. The needle holder for an endoscope according to claim 1, wherein,

a front end portion of at least one of the 1 st inner surface and the 2 nd inner surface includes a concave-convex surface having a plurality of convex portions or a plurality of concave portions,

the pair of supporting portions, the groove, and the protrusion portion are provided closer to the base end side than the concave-convex surface.

3. The needle holder for an endoscope according to claim 2,

the front end portion of the 1 st inner surface has the concave-convex surface, and the pair of support portions are offset to the opposite side of the 2 nd inner surface with respect to the concave-convex surface.

4. The needle holder for an endoscope according to any one of claims 1 to 3,

at least the front end of one side surface of each of the 1 st gripping member and the 2 nd gripping member is a slope surface inclined with respect to the longitudinal axis,

the slope is inclined in a direction in which the width of the 1 st gripping member and the 2 nd gripping member gradually decreases toward the distal end side.

5. The needle holder for an endoscope according to any one of claims 1 to 4,

the needle holder for an endoscope includes an opening restriction mechanism for preventing the 1 st and 2 nd grasping members from opening.

6. An endoscopic suturing method comprising inserting a 1 st needle holder and a 2 nd needle holder into a body through an endoscope, and suturing a tissue in the body under the endoscope, wherein,

the sewing method comprises the following processes:

causing the suture needle to penetrate into the tissue by an operation of the 1 st needle holder holding the suture needle, and causing a needle tip portion of the suture needle to protrude from the tissue;

holding the needle tip portion protruding from the tissue with the 2 nd needle holder;

withdrawing the suture needle from the tissue with the action of the 2 nd needle holder; and

a part of the suture needle pulled out from the tissue is arranged on a track of the 1 st needle holder by an operation of the 2 nd needle holder.

7. The endoscopic stitching method according to claim 6,

the endoscopic stitching method further comprises the following processes:

separating the 1 st needle holder from the suture needle and retracting the 1 st needle holder in a longitudinal direction after the 2 nd needle holder holds the needle tip portion; and

and holding a part of the suture needle disposed on the track by the 1 st needle holder.

8. The endoscopic stitching method according to claim 7,

the endoscopic stitching method further comprises the following processes:

advancing the 1 st needle holder after disposing a portion of the suture needle on the track of the 1 st needle holder.

9. The endoscopic stitching method according to any one of claims 6 to 8, wherein,

the process of disposing a part of the suture needle on the track by the operation of the 2 nd needle holder includes a process of rotating the 2 nd needle holder about a longitudinal axis of the 2 nd needle holder.

10. The endoscopic stitching method according to claim 9,

the endoscopic stitching method further comprises the following processes: when the 2 nd needle holder is rotated after the suture needle is pulled out from the tissue, the suture needle is retracted to a position where the suture needle held by the 2 nd needle holder does not interfere with the tissue.

11. The endoscopic stitching method according to any one of claims 6 to 10, wherein,

a pair of grasping members capable of opening and closing each other are provided at the tip end portion of the 2 nd needle holder, and the needle point portion protruding from the tissue is grasped by the tip end portions of the pair of grasping members,

the endoscopic stitching method further comprises the following processes: before a part of the suture needle is arranged on the track of the 1 st needle holder, a position for gripping the suture needle is changed from a distal end portion of the pair of gripping members to a proximal end portion of the pair of gripping members.

12. The endoscopic stitching method according to any one of claims 6 to 11, wherein,

the tissue in the body is a tissue of a luminal organ.