JP2001087272A - Automatic suturing unit for excising living body tissue - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a suturing unit capable of suturing an outer peripheral part of a small section with small force by one time operation. SOLUTION: This automatic suturing unit is composed of a body 1 having an openable/closable one sandwiching member for shouldering one of sandwiching by being positioned on the under side of a living body tissue by enclosing so as to surround a tumor existing in the living body tissue (a) and a cartridge 3 installed in the body in response to the sandwiching member, where the cartridge 3 encloses staples 17, plural pushing-out blocks 18 for pushing out the staples and left/right each one actuators 19 for moving the pushing- out blocks in the direction for pushing out the staples in a resin case, and the left/right one actuators installed in the cartridge are actuated with a time difference by operating an operation lever arranged in the body for installing the cartridge to successively push down the pushing-out blocks 18 arranged along an arranging shape of the staples to suture the outer periphery of a biopsy small section including the tumor in a single operation.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an automatic suturing device for resection of living tissue of a human body, and more particularly, to cutting out a small piece for biopsy from a living tissue (i.e., a living body remaining on the human body side). Tissue) with a staple.

[0002]

2. Description of the Related Art A biopsy for pathologically examining the internal organs of a human body is known as
A small section of a living tissue at a site containing a tumor or the like is cut out. When the small section is cut off, the outer periphery of the cut portion of the living tissue remaining on the human body side is stapled with staples. Many suturing devices used for cutting the small pieces have been proposed, but each of them has a pair of straight bar-shaped holding portions that open and close in the vertical direction at the tip of the handle, and one of the holding portions is formed on one of the holding portions. A linear cartridge containing staples is removably mounted, and after holding the living tissue with the holding portion, the operator provided on the handle is operated to stap the staple of the cartridge and stitch the living tissue to be held. It is configured to be. For example, Japanese Patent Application Laid-Open No. H10-195 is mentioned.

However, in the above-described conventional suturing device, the holding portion for holding the living tissue is formed in a straight rod shape. It will be surrounded by multiple operations. That is, when cutting small pieces into a substantially V-shaped plane,
When holding the small section once from the left and right sides of the small section once, a total of two times, and when performing a substantially trapezoidal plane, perform the stitching from the left and right without crossing the tip, and perform the second stitching for the third time Will be connected.

[0004]

Therefore, when a small section for biopsy is to be cut from a living tissue with the above-mentioned conventional suturing device, the suturing device must be cut at least twice or more. Since the outside of the tumor cannot be sutured, it requires a lot of time for the resection operation, and it takes a long time to remove the tumor.
In addition, when the position of the small slice is deep, it is difficult to perform an operation in the thoracic cavity, and there is a problem that the size of the incision width (opening) of the chest or abdomen also increases.

Further, staples for suturing living tissues are performed by exchanging a cartridge for each suturing operation.
There are problems in that staples are overlapped or staples are driven into unnecessary portions because they are divided into V-shaped or trapezoidal shapes by three or three operations.

The inventor of the present invention solves the above-mentioned problems by providing a pair of holding members that open and close in the vertical direction in an annular shape, disposing staples in the annular holding portion, and driving the staples out. A suturing machine equipped with members has been proposed as Japanese Patent Application No. 10-285419. By the way, the suturing device proposed above has a structure in which all the staples arranged in a substantially horseshoe shape along the annular holding portion are punched at a time, so a large force is required to punch the staples, and the suturing operation is difficult. There is a problem that there is.

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned problems of the prior art, and an object of the present invention is to easily perform a staple ejection operation built in a cartridge with a small force. It is to provide a suturing device that can be used. Still another object of the present invention is to provide a suture instrument having a function of taking out a cut small piece while keeping its outer peripheral edge closed.

[0008]

SUMMARY OF THE INVENTION In order to achieve the above object, the present invention has been made to solve the above-mentioned problem by providing an outer peripheral portion of a small section containing a tumor for removing a small biopsy section from a living body tissue of a human body. A main body including an openable and closable holding member that surrounds and surrounds a tumor existing in the living tissue and is positioned below the living tissue and serves as one of the holding devices.
A staple, a plurality of extruding blocks for extruding the staples, and a left and right actuator for moving the extruding blocks in a direction for extruding the staples are incorporated in a resin case, which is mounted on the main body corresponding to the holding member. Consisting of a cartridge that carries the holding member of
The holding portion of the holding member is formed in a ring shape, and the case of the cartridge is also formed in a ring shape,
The annular case accommodates the staples except for the base side, and the left and right actuators mounted on the cartridge operate with a time lag by operating the operation lever provided on the main body on which the cartridge is mounted, Push down the extruded blocks arranged according to the staple arrangement form,
The outer periphery of a small biopsy section containing a tumor is sutured in one operation.

The holding member and the holding portion of the cartridge have an annular shape that surrounds at least the tumor portion, and is not limited to an annular shape (O-shape) whose periphery is closed, and a V-shape in which a portion of the annular shape is cut away. Shape, U shape, C shape and the like may be used. The main body constituting the main body of the suturing device is formed in a one-handed pistol shape in which a grip is continuously provided downward and rearward at the rear end of a straight rod-shaped main trunk. The holding member that is openably and closably attached to the main body is closed by pulling (gripping) a trigger-like lever disposed in front of the grip toward the grip, and the lever is separated from the grip. The holding member is configured to open.

The cartridge to be mounted on the main body is mounted on a resin case molded of a synthetic resin material in a ring-shaped (O-shaped) or V-shaped, U-shaped, C-shaped, etc. staple accommodating portion, and mounted outside the staple accommodating portion. A handle portion is continuously provided, and the mounting handle portion is configured to be attached and fixed by inserting the mounting handle portion into a set cylinder provided at the front end portion of the main body. And
In a staple accommodating portion such as a ring, staples are arranged alternately in two rows or three rows and are arranged in a substantially V-shaped or U-shaped plane, and an extruding claw is provided above the staple with an extruding claw for extruding the staple. Multiple blocks are equipped. The pushing block is arranged so as to be able to move vertically downward in order to push out the staples, and an actuator for moving the pushing block vertically downward moves in the annular path in which the pushing block is housed. It is pushed down by moving in the circumferential direction. That is, in order to convert the horizontal movement of the actuator into the vertical movement of the extrusion block, the upper surface of the extrusion block is formed as an inclined surface.

In the staples set in the cartridge, when the living tissue of the lung is sutured, the lung has a thin outer peripheral edge and gradually becomes thicker as it enters from the outer peripheral edge. At the side (back side), the length of the staple is different from the length of the staple, and the width of the staple is made wider. That is, a staple having a short length of the needle leg and a wide width is disposed on the front side, and a staple having a narrow width so that the needle leg is long and can be stitched more curvedly on the curved portion on the distal end side (rear side). To ensure that sutures can be sutured. When suturing in a shape surrounding a tumor portion in one operation of the present invention, it is important to make the width of the staple wider or narrower than the length of the needle leg.

The holding portion such as a ring of the holding member for receiving the tip of the needle leg of the staple may have the inside of the ring kept open, or the inside of the holding portion may be closed or closed. The bottom plate member may be transparent or opaque.

[0013] Further, the actuator for vertically moving the pushing block is provided with an extruding block arranged in a substantially horseshoe shape in a plane substantially in a central position in order to efficiently and smoothly operate the pushing block arranged in a substantially horseshoe shape. The left and right extrusion blocks are provided one by one on the left and right sides so that the left and right extrusion blocks can be operated by separate actuators. And
The left and right actuators are provided with a time difference in the operation start timing of the left and right operators so as to be able to reliably operate each of the extruded blocks.

As a method for causing a time lag in the operation start of the actuator, when the actuator is actuated by engaging an operation lever provided on a main body, a length of a wire connected to the actuator is changed. And a method of shifting the hooking timing of the hook of the operation lever and the engaging element provided on the wire.

[0015] The suturing device may be provided with a cutter for cutting a small biopsy section containing a tumor from a living tissue along the inside of a staple suturing line. In that case,
The cutter may be incorporated in the cartridge, or may be mounted on a main body on which the cartridge is mounted. When incorporated in a cartridge, one cutter on the left and right is stored in a dedicated storage space inside the suture line at the tip of the cartridge, and connected to the left and right wires, respectively, similarly to the actuator described above. By operating slightly later than the operation of caulking (firing) the staples, the living tissue can be cut after being stapled with the staples. When attaching the cutter to the body, two thin flat plates with a cutter at the tip are extruded along the dedicated passage provided inside the suturing line in the cartridge, and the living tissue is cut separately on the left and right. I do. still,
The dedicated passage through which the cutter passes may be formed in either the cartridge or the main body.

Further, when the clamping of the living tissue by the clamping member and the cartridge is released after suturing and cutting, a small biopsy section cut by a cutter is provided inside the annular clamping portion of the clamping member and the cartridge. It is convenient to provide gripping means for holding the outer peripheral edge by holding it from above and below.
The holding means may also serve as a holding member as one of the holding members, and of course, a member dedicated to holding may be provided separately from the holding member.

According to the first aspect of the present invention, there is provided a cartridge including one openable and closable (lower) holding member for holding a living tissue and a staple, an extruding block, and an operating element mounted on the main body. It is formed into a ring (O-shape), V-shape, U-shape, C-shape or the like surrounding a tumor portion present therein, so that a small section including the tumor portion can be sutured in a substantially V-shaped plane or a substantially U-shaped plane. , Can be performed in a single operation in a substantially C-shaped plane or the like. Then, the suturing of the living tissue is performed by closing the lower holding member and operating the operation lever so that the left and right actuators operate with a time lag, and sequentially depresses the pushing blocks accommodated in the cartridge both right and left. Since the annularly arranged staples are sequentially swaged and sewn, they can be easily sewn with a small force. Since the holding portion is formed in an annular shape as described above, it becomes possible to detect a hard, slimy tumor by using a suture instrument by holding the living tissue between the holding members. Then, when the opening of the holding portion of the holding member located below (the holding member located below the living tissue) is closed by the bottom plate, if there is a tumor in the living tissue, the tumor is placed on the bottom plate. Because it is supported, it rises upward in the annular portion of the cartridge mounted on the main body, and it becomes possible to easily search for a tumor visually. According to the means of claims 2, 3 and 4, after suturing the outer periphery of the small section containing the tumor, the cutter is operated to remove the small section containing the tumor from the living tissue along the inside of the suture line. Can be separated. Furthermore, according to the means of claim 5, since the small piece cut by the cutter can be held in a closed state by sandwiching the outer peripheral edge from above and below, the living tissue can be sutured, cut, and removed with a single instrument. it can.

[0018]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is an external view of an automatic suturing device for resection of a living tissue according to the present invention. The suturing device A includes a main body 1 constituting a main body of the suturing device and a lower side attached to the main body 1 so as to be openable and closable. And a cartridge 3 attached to the front end of the main body 1 and holding the living tissue a with the holding member 2.

The main body 1 is formed as a one-handed pistol having a straight bar-shaped main body 1a made of stainless steel and a rearwardly downwardly-facing grip 1b provided at the rear end of the main body 1a. The rear part of the holding member 2 is pivotally supported by a pin 4 so as to be rotatable up and down, and the end of the holding member 2 behind the shaft support part of the pin 4 is attached to the front of the grip 1 b by a pin 7.
A pin 8 is connected to the tip of a connecting rod 6 which is integral with a trigger-like lever 5 which is rotatably supported. That is, lever 5
The gripping member 2 is closed upward with the pin 4 as an axis by pulling (grip) toward the grip 1b side, and the gripping member 2 is opened downward with the pin 4 as an axis by moving the lever 5 away from the grip 1b. ing. The lever 5 that opens and closes the holding member 2 includes a return spring 9 that constantly urges the lever 5 in the “open” direction, a latch mechanism 10 that holds the closed lever 5 in that state, The latch mechanism 1
A release lever 11 for releasing 0 is provided.

The main trunk 1a of the main body 1 includes the main body 1
A space 13 is formed for accommodating an operation lever 12 for pushing and sewing staples contained in the cartridge 3 set in the cartridge 3. A receiving cylinder 14 for setting a handle of the cartridge 3 in the space 13 is vertically rotated. Mounted as possible. The receiving cylinder 14 has a flat cylindrical shape for receiving the handle of the cartridge 3.
The operation lever 12 housed in the space 13 and the cartridge 3
An opening 14 'for engaging with the operating means 15 incorporated in the handle portion is cut out. Then, the handle portion of the cartridge 3 is inserted up to the position where the insertion is stopped in a state where the receiving cylinder 14 is raised and rotated forward and upward, and the receiving cylinder 14 is tilted horizontally in that state, whereby the operation lever 12 and the cartridge Engagement with the actuating means 20 incorporated in the handle 3 is established, and the setting of the cartridge 3 is completed.

The holding member 2 for holding the living tissue a is composed of an annular holding portion 2a formed of a stainless steel material and a handle 2b connected to the rear of the holding portion 2a. The handle portion 2b is formed in a generally egg-shaped planar shape and has a larger diameter. Then, the annular holding portion 2a
A receiving recess 16 is formed on the upper surface of the staple for receiving the tip of the leg of the staple pushed out from the cartridge 3 mounted on the main body 1 and smoothly bending the staple inward, corresponding to the staple accommodated in the cartridge 3. I have. When the suturing device is provided with a cutter for cutting the living tissue a after suturing, the slit 15 is formed to receive the cutting edge of the cutter. Further, the annular holding portion 2a may be left open at its inner opening, but the lower side of the opening of the holding portion 2a may be closed with a bottom plate. Clamping part 2
When the lower side of the opening of a is closed by the bottom plate, when the living tissue a is sandwiched between the holding member 2 and the cartridge 3 to detect a hard stiff-shaped tumor portion, if a tumor exists in the living tissue,
Since the tumor is supported by the bottom plate, the tumor swells upward in the annular portion of the cartridge 3, and the search for the tumor can be easily performed visually.

The cartridge 3 mounted on the main body includes an annular (egg-shaped) staple housing 3a formed of a synthetic resin material.
A resin case in which a mounting handle portion 3b is integrally formed outside the staple housing portion 3a;
a, a plurality of rows (two rows in the drawing) of staples 17, a large number of extrusion blocks 18 for extruding the staples 17, one left and right actuator 19 for vertically moving the extrusion blocks 18, Further, it comprises an operating means 20 connected to the operating element 19.

The planar shape of the staple storage section 3a is as follows.
The holding portion 2a of the holding member 2 is formed in the same shape as the planar shape (egg shape). In addition, since the dimension of the maximum width in the planar shape of the cartridge 3 (same as the width of the holding portion of the holding member) affects the size of an incision to be made to insert the suture instrument into the body, the incision is made larger. In order to reduce the size, the number of staples arranged in the maximum width portion is reduced to a minimum of two. In the annular staple accommodating portion 3a, the staples 17 are alternately arranged in two rows, and the staple accommodating portion 3b is arranged from the front end side of the staple accommodating portion 3a.
The pushing block 18 is provided with a pushing claw 23 for pushing the staple above the staple 17.
Are equipped.

The pushing block 18 is accommodated and arranged so as to be able to move vertically downward to push out the staple 17, and an operating element 19 for moving the pushing block 18 vertically downward is provided with the pushing block 18. Is pushed down by moving in the circumferential direction in the annular path 21 in which is accommodated. That is, the horizontal movement of the actuator 19 is
In order to convert the movement of the push-out block 18 into a vertical movement, the upper surface of the push-out block 18 is formed as an inclined surface 18a facing upward in the moving direction of the actuator 19. The inclination of the inclined surface 18a is an angle that generates a moving amount necessary for pushing out the staple 17.

The staples 17 housed in the staple accommodating portion 3a are accommodated in two rows in a portion except for approximately one third on the rear side of the accommodating portion 3a.
7 may have the same wire diameter and width, but may be changed according to the thickness of the living tissue to be sutured. For example, in the case of lung tissue whose outer peripheral edge is thinner and thicker as it goes inward, it is effective to change the length of the staple and the width of the staple in the two rows of staples 17 in the first half and the second half. In particular, the front half of the housing portion 3a has a substantially V-shaped tip, so that leakage is more likely to occur as compared to the straight portion of the rear half. Are densely arranged, and staples with short and wide needle legs are arranged in the rear half. The staples 17 arranged in two rows inside and outside are accommodated in independent holes 22 which are respectively opened through the staple accommodating portion 3a in the vertical direction.
The staples are also effective even if staples having the same length and the wide and narrow difference as described above are arranged.

An extruding block 18 for extruding the staples 17 includes three of the staples 17 arranged in two rows inside and outside.
The pushing claws 23 corresponding to the staples 17 in charge are formed integrally on the surface (lower surface) opposite to the above-mentioned inclined surface 18b so as to protrude downward.

The pushing block 18 is pushed vertically downward by a horizontal movement of an actuator 19 described later.
In order to make the movement in the vertical direction smooth, guide means for engaging and recessing engagement is provided on the joint surface between the peripheral wall surface of the extrusion block 18 and the peripheral surface of the staple accommodating portion 3a or the joint surface between the blocks 18. It may be formed.

An operator 19 that sequentially pushes down the pushing block 18 from the front end side to the rear side is an annular path 2.
The shape is spherical so that the movement along 1 can be performed smoothly, two such actuators 19 are provided, and all of the pushing blocks 18 arranged in a substantially horseshoe-shaped plane are all at once (about one second) and securely. It is configured so that it can be pushed down. That is, the extruding blocks 18 arranged in a substantially horseshoe shape on the plane are divided into right and left at a substantially central position, and the left and right extruding blocks 18 are provided one by one on the left and right so as to be operated by different actuators. Then, one actuator 19 for each left and right
Is provided with a time difference in the operation start timing of the left and right operators 19 so that the left and right rows of the pushing blocks 18 can be operated reliably. In the illustrated example, the actuator 19a arranged on the right side starts moving first and pushes down the pushing block 18 in the left row, and the actuator 19a passes at least across the movement path of the actuator 19b arranged on the left side. Then, the operator 19b arranged on the left side starts moving.

As shown in FIG. 3, the operating means 20 for providing a time difference between the start of the operation of the left and right operators 19a and 19b is connected to the wires 24a and 24b of the left and right operators 19a and 19b, respectively.
b are connected, and the wires 24a and 24b
Slits 18b which are notched in each of the extrusion blocks 18 which are arranged on the opposite side by being crossed at the tip end of the
Through the mounting handle 3b, and the mounting handle 3b
The lengths of the wires 24a and 24b introduced into the wire are made different from each other, and engagement members 25a and 25b are attached to the ends of the wires 24a and 24b. The difference between the lengths of the wires 24a and 24b introduced into the mounting handle 3b causes the above-described time difference of the operation start, and the initial length of the hook integrated with the operation lever 12 provided on the main trunk 1a of the main body 1 is increased. The length from the position (the origin position of the operation lever) to the engagement elements 25a and 25b of each wire is different.

The operating lever 12 which engages with the operating means 20 to operate the pushing block 18 has the wires 24a, 24b of the operating means 20 fitted therein and the engaging elements 25a, 25b connected to the wires 24a, 24b. 25
b is integrally connected to and held by a rake-like hook 26 with which the contact lever abuts, and the operation lever 12 is gripped along the main trunk 1a by the grip 1b.
By pulling to the side, the operating elements 19a and 19b are operated via the operating means 20.

The above-described embodiment is a suturing device for only suturing a living tissue. The suturing device cuts a small biopsy section containing a tumor from a living tissue a along an inner side of a suturing line by a staple 17. May be provided.
In this case, the cutter 27 may be incorporated in the cartridge 3 or may be mounted on the main body 1 on which the cartridge 3 is mounted. Hereinafter, the mounting structure of the cutter 27 will be described. FIG. 3 shows a case in which the cartridge is built in the cartridge 3.
Like the actuators 19a and 19b, the left and right cutters 27a and 27b are housed in a dedicated storage space 28 formed inside the staple housing 3a of the cartridge 3, and the cutters 27a and 27b are connected to wires 29a and 27b, respectively. 29b and the wire 29
The wires 24a, 2 of the actuator 19 are opposite to the wires a, 29b.
4b, the engaging elements 30a, 3b are introduced into the mounting handle 3b side so that there is a time difference in the operation start timing.
The length up to the mounting position of 0b has a difference in length. The operation of the cutters 27a and 27b is slightly delayed from the operation of caulking (firing) the staple 17, so that the living tissue can be cut after being stapled with the staple.

When the cutter is mounted on the main body 1, two thin strips 32a and 32b having cutters 31a and 31b at the tip end are attached to the cartridge 3 as shown in FIGS.
, The living tissue is cut separately on the left and right sides by extruding along the dedicated passage 33 defined inside the staple accommodating portion 3a. The cutters 31a, 3
The dedicated passage 33 through which 1b passes may be formed in either the cartridge or the main body. (The exclusive passage 33 is formed in the cartridge 3 in the illustration.) Then, the operation of pushing the band plates 32a and 32b forward is as follows.
The operation may be performed by providing an operation lever different from the operation lever 12 for caulking the staples 17, or may be performed using the operation lever 12 for caulking the staples 17, as shown in FIGS. That is, the operation lever 12 is used for the staple 1
7 is pulled toward the grip 1b to tighten the staples 7. When the tightening of all the staples 17 is completed or after that, the hook 26 and the band plate 32 integrated with the operation lever 12 are formed.
The rear ends of the strips 32a and 32b are engaged with each other, and the strips 32a and 32b are pushed forward by the pushing of the operation lever 12. In the configuration, a receiving frame 34 is fitted to the hook 26 integral with the operation lever 12 so that the rear ends of the band plates 32a and 32b are fitted and engaged. On the other hand, the band is provided on the side of the rear end of the band plates 32a and 32b. A biasing means (spring) 35 is provided for biasing the rear ends of the plates 32a and 32b in the direction of engaging with the receiving frame 34.
Thereby, the caulking of the staples 17 is completed and the hooks 26 pass through the rear ends of the band plates 32a and 32b, and at the same time, the rear ends of the band plates 32a and 32b are attached to the receiving frame 34 by the action of the urging means (spring) 35. Are engaged. In the figure, reference numeral 36 denotes a return spring for returning the operation lever 12 to the initial position.

The cutter 27 (or 31) is provided on the innermost side of the annular holding portion of the holding member 2 and the cartridge 3.
A gripping means 37 may be provided for holding the outer peripheral edge of the small biopsy section cut in the above step from above and below. The gripping means 3
7 comprises a bottom plate 43 of the holding portion 2a of the holding member 2 and an upper holding member 39 having an annular shape, and the upper holding member 39 is an annular holding portion 3a of the cartridge 3.
An annular grip portion 39a that fits inside of the
A handle 39b is formed continuously on the outer periphery of 9a.
The front portion of the handle 39b is supported on the main body 1 by a pin 38 so as to be rotatable up and down. The grip portion 39a of the grip member 39 is located closer to the end of the handle 39b than the pivot point by the pin 38. A spring 40 that urges the holding member 2 to rotate toward the bottom plate 43 side of the holding portion 2 a of the holding member 2 is stretched between the holding member 2 and the main body 1.

The mechanism for holding the gripping member 39 non-rotatably against the tensile force of the spring 40 is provided on the lower end surface of the lower push rod 42 of the operation lever 12 for performing suturing and cutting. It is performed by the upper surface of the handle 39b contacting,
When the contact between them is released, the gripping member 39 is
By the action of 0, it is rotated about the pin 38 and the grip 39
a is strongly pressed against the bottom plate 43 side, and the outer peripheral edge of the small piece cut thereby is clamped by the bottom plate 43. The structure for releasing the contact with the operation lever 12 is such that a through hole 41 into which the lower push rod 42 of the operation lever 12 is fitted is formed in the handle 39 b of the gripping member 39, and the operation lever 12 is slid to form the through hole 41.
The through hole 41 is fitted to the lower push rod 42 of the operation lever 12 to release the contact. The opening position of the through hole 41 is a position where the sewing and cutting are completed by operating the operation lever 12, and in the case of the form where the sewing and cutting are completed by simply pulling the operation lever 12 to the rear of the main body 1, the handle portion is used. 39
In the case of cutting the living tissue after suturing by pushing the operation lever 12 toward the cartridge 3 side, the opening is set near the pin 38. The handle 3 of the gripping member 39
When 9b is in contact with the lower push rod 42 of the operation lever 12, the grip 39a of the grip member 39 is held at the height of the holding portion 3a of the cartridge 3.

The operation procedure of the suturing device A (suturing device provided with a cutter and a gripping means) A configured as described above will be described. First, the receiving cylinder 14 provided at the front end of the main body 1 is raised upward, and the mounting handle 3b
Insert and fix. The receiving cylinder 14 is lowered to a horizontal state. Thereby, the main body 1
The hook 26 of the operation lever 12 provided on the cartridge 3 and the operating means 20 of the cartridge 3 are engaged with each other. With the holding member 2 opened, the living tissue a is held, and the lever 5 is operated to search for a tumor portion while holding the living tissue a between the holding member 2 and the cartridge 3. At this time, if there is a tumor or the like in the living tissue, it is supported on the bottom plate 43 of the holding portion 2a of the holding member 2, so that the tumor portion protrudes upward in the annular portion of the cartridge 3, whereby the holding member 2 In addition to the feeling when sandwiched between the cartridge 3 and the cartridge 3, it can be easily recognized visually. If a tumor portion is found, the portion containing the tumor is cut out as a small section in order to determine whether the tumor is malignant or benign. The cutting is performed by operating the lever 5 to hold the portion between the holding member 2 and the cartridge 3, and in this state, pulling the operating lever 12 toward the front side (grip side) at a time to push out and sew the staple 17 (stapling).
Then, cutting (cutting) of the living tissue a by the cutter 27 is performed. When the cutting of the living tissue a is completed by operating the operation lever 12, the grip portion 39a of the grip member 39 constituting the grip means 37 is rotated toward the bottom plate 43 side of the holding member 2 and the outer edge of the cut small piece is cut. With the bottom plate 43 of the holding member 2. Release the lever 1
When the user operates the lever 1 to release the lever 5 and open the holding member 2 downward, the holding of the small piece with the cartridge 3 holding the living tissue around the small piece is released, and the main body 1 is pulled out of the body through the incision. It becomes possible. Since the small pieces are held between the holding member 2 and the holding member 39, the small pieces can be carried and moved.

[0036]

According to the automatic suturing device for resection of living tissue of the present invention, the structure described in claim 1 enables the suture for cutting a small section from the living tissue to be reliably performed by a single operation. The force required for the suturing operation can be easily operated without requiring a large force because the annularly arranged staples are successively swaged by a plurality of extruded blocks. In addition, according to the configuration of the second to fourth aspects, it is possible to cut the small section including the tumor part in a state of being isolated from the living tissue remaining inside the body by suturing. Further, according to the configuration of claim 5, the small section including the tumor portion cut from the living tissue can be carried without closing the outer peripheral edge of the cut small section without using another instrument. When the gripping means is configured to be separable from the suturing device, small pieces can be transported only by the gripping means. Therefore, it is possible to provide an automatic suture device that is easier to use than a conventional suture device.

[Brief description of the drawings]

FIG. 1 is a schematic view showing an example of an embodiment of an automatic suturing device according to the present invention.

FIG. 2 is a schematic view showing a state where a cartridge is mounted on a main body and a holding member is started to be closed.

FIG. 3 is a cross-sectional plan view showing a cartridge having a built-in staple and a cutter and mounted with a gripping means.

FIG. 4 is a cross-sectional plan view showing a state in which an extruding block for extruding staples and a cutter are operated by an operation lever.

5A and 5B are enlarged cross-sectional views showing the leading end side of the cartridge shown in FIG. 4 in a linearly developed manner, wherein FIG.
(B) shows a cutter unit.

FIG. 6 is a schematic diagram showing a state in which stapling and cutting are completed by pulling an operation lever.

FIG. 7 is a cross-sectional view showing a mode in which a cutter is provided on a main body side.

FIG. 8 is a transverse sectional view showing the operation state of FIG. 7;

FIG. 9 is an enlarged cross-sectional view showing a state where a living tissue is sandwiched between a holding member and a cartridge.

FIG. 10 is a schematic diagram showing a state in which the cut small pieces are held by gripping means and the closing movement of the holding member is released.

FIG. 11 is an exploded perspective view showing a main part of the suturing device shown in FIG.

[Explanation of symbols]

A: suturing device a: living tissue 1: body 2: holding member 3: cartridge 12: operating lever 17: staple 18a, 18b: push-out block 19: actuator 27, 31 ... cutter 37: gripping means

Claims (5)

[Claims] 1. A suturing device for suturing an outer peripheral portion of a small section containing a tumor in order to resect the small section for biopsy from a living body tissue of a human body, wherein the suturing device surrounds the tumor existing in the living body tissue. A main body having one openable and closable member that is positioned below the living tissue and carries one of the nipples, and a staple and a staple thereof in a resin case that is attached to the main body corresponding to the nipple. The cartridge comprises a plurality of extruding blocks to be extruded and one of the left and right actuators for moving the extruding blocks in the direction in which the staples are extruded. And a case in which the cartridge is mounted, except that the case of the cartridge is also formed in an annular shape, the staple is housed in the annular case except for the root side, and the cartridge is mounted. By operating the operation lever provided on the cartridge, one of the left and right actuators mounted on the cartridge is operated with a time lag, and sequentially pushes down the pushing blocks arranged along the staple arrangement form, thereby performing the biopsy including the tumor. An automatic suturing device for resection of living tissue, wherein the outer periphery of a small piece for use is sutured in one operation. 2. The automatic suturing apparatus according to claim 1, further comprising a cutter for cutting a small biopsy section containing a tumor from a living tissue along an inner side of the staple suturing line. 3. The automatic suturing device for resection of living tissue according to claim 2, wherein the cutter is incorporated in a cartridge. 4. The automatic suturing apparatus according to claim 2, wherein the cutter is mounted on a main body on which the cartridge is mounted. 5. A biopsy small section cut by a cutter when the clamping of living tissue by the clamping member and the cartridge is released after suturing and cutting, inside the annular clamping portion of the clamping member and the cartridge. The automatic suturing device for resection of living tissue according to any one of claims 2 to 4, further comprising a gripping means for holding the outer peripheral edge by holding it from above and below.