JP2002095667A - Ligator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a ligator with features that a thread would not come off from its tip and can be put back to a status of being hooked easily even when the thread comes off, and that a knot can be shifted to a side to be ligated, to enable a surgeon to ligate easily, and to reduce burden on the surgeon and a patient by enhancing workability. SOLUTION: A tip opening 3 and side openings 4 are made at an end of a main part 2 of a ligator. Each end of a thread 50 hooked at a part to be ligated is put through the tip opening 3 and the side opening 4. While the ends of the thread 50 are held with a knot 51 positioned in the tip opening 3, a surgeon operates the main part 2 of the ligator to insert it and ligate. As a result, the surgeon can insert the ligator into a body without happenings that the knot 51 shifts or that the thread 50 comes off and can ligate quickly. As the knot 51 can be moved while having it followed the tip of the main part 2 of the ligator, and an excessive force is not applied to the part to be liageted and the thread 50, safety is increased.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a ligature used for tying a thread in a body in a medical surgical operation, in particular, an endoscopic operation.

[0002]

2. Description of the Related Art In surgical operations, reducing the size of an incised portion has been regarded as important in order to speed up post-operative recovery and to reduce the size of the surgical trace remaining on the body. Endoscopy operations that can be performed are being actively performed. In such endoscopic surgery, it is necessary for a practitioner to ligate tissues or blood vessels in the body with a thread or to fix the suture after suturing through a small incision provided in the body, A device called a ligature has been conventionally used to enable such a work of tying a thread in the body from outside the body. An example of such a conventional ligature is disclosed in Japanese Patent Publication No. 6-40880, which is shown in FIGS. 22 and 23. FIG. 22 is a schematic configuration diagram of a conventional ligature, and FIG. 23 is a longitudinal sectional view of a main part of the conventional ligature.

A conventional ligature 100 shown in each of the above figures has a handle 101 having a predetermined length, a recess 102 formed at the tip of the handle 101, and a communication with the recess 102.
And a guide path 103 disposed on both sides of the handle 101 at the tip of the handle 101 from the bottom of the recess 102.
The ligating operation of the conventional ligating device 100 will be described. In advance, use a different device to ligate the body in the body (body tissue,
A thread 50 is hung on a blood vessel or the like, and both ends of the thread 50 are drawn out of the body. First, the practitioner makes a knot 51 on the thread 50 outside the body, hangs the thread at both ends of the knot 51 on the guide path 103 next to the concave portion 102, and holds the end of the thread 50 to push the ligature 100. The thread 50 smoothly slides on the guide path 103 without the concave portion 102 contacting the knot 51,
The knot 51 shifts with the tip of the ligature 100. The ligature 100 is inserted into the body as it is, and the knot 51 is shifted toward the ligature target portion in the body. When the knot 51 is finally pushed down to the ligature target portion, the thread 50 is moved without moving the ligature 100 as it is. The thread 51 is tied by pulling from outside the body, and the ligated portion is set in a ligated state.

[0004]

In conventional endoscopic surgery, a port (see FIG. 1) is used which is fixed to the surface of a body and facilitates insertion and removal of instruments such as ligatures into the body. When using a sealed port for endoscopic surgery using the pneumoperitoneum method, the port has a built-in valve to prevent gas leakage, and the port is hung over the ligating target site and the end is pulled out of the body. An intermediate portion of the warp yarn 51 is in a bent state in contact with the valve. When the ligature 100 is inserted into such a port, one of the yarns 50 hung on the guide paths 103 at both ends is disengaged by bending of the yarn in the vicinity of the valve, and the knot 51 is displaced from the concave portion 102, so that the slip of the yarn becomes poor. There was a problem that it was easy. Also,
When the ligature 100 pushes and opens the valve and further enters the port, the force for pushing back and closing the valve is applied to the ligature 1.
00 acts as a resistance, but the practitioner
There is a problem that it is difficult to determine whether the resistance has been shifted or the resistance of the repulsive force of the valve, and it may not be possible to correctly determine whether to continue the work.

If the operator continues to insert the ligature 100 without determining the displacement of the knot 51 of the thread 50,
There is a risk that the thread 50 may be cut off in the middle or that the portion to be ligated to which the thread 50 is hung may be excessively applied and damaged. However, when the thread 50 comes off from the distal end of the ligature 100 in the port, the inside of the port may not be visible, and there is a problem that it is extremely difficult to thread the ligature 100 again. On the other hand, in the case of using a closed type port, since the thickness of the conventional ligature 100 is different on the way, a gap is generated in a port large enough to pass through the largest part, and the insufflation gas is not operated. However, there is a problem that it is easy to leak to the outside, and it is difficult to secure a visual field with an endoscope, which may lead to interruption of the operation. The present invention has been made in order to solve the above-mentioned problem, and has a tip shape in which the thread is hard to be detached from the tip and can be easily returned to a hung state even when the thread is detached, and the knot of the thread is securely shifted to the side to be ligated. In addition, an object of the present invention is to provide a ligating device that allows a practitioner to easily perform a ligating operation, significantly improve workability, and reduce the burden on both the practitioner and the practitioner.

[0006]

A ligating device according to the present invention comprises:
A ligating device body formed of a substantially rod-shaped body having a substantially uniform thickness within a range of at least a predetermined length from one end, and a predetermined shape drilled from one end surface of the ligating device body to a predetermined depth in a longitudinal direction of the ligating device body. And a side hole of a predetermined shape formed in a substantially perpendicular direction from two side positions sandwiching the tip hole at one end of the ligating device main body and communicating with the tip hole. Both ends of a predetermined thread are respectively passed through the tip hole and the side hole. As described above, in the present invention, the distal end hole and the side hole are formed at the distal end of the substantially rod-shaped ligature main body, the threads at both ends of the knot are passed from the distal end hole to the respective side holes, and the knot is positioned in the distal end hole. The practitioner operates the ligature body while holding the end of the thread in a state where it is inserted, and at the time of insertion into the body, the part on the end side from the knot of the thread is pushed at each side hole, and the knot is inserted into the tip hole The knot of the thread can be smoothly advanced to the inside of the body while it is positioned, and even if the body of the ligature moves to the outside of the body, the ligature body at the side hole and the tip hole part can contact the thread and securely support the thread. In addition to being able to ligate by passing through the port without shifting the knot or dropping off the thread, the knot moves with the tip of the ligating tool body, so excessive force is not applied to the ligating target site or thread, improving safety I do. In addition, by forming the body insertion portion of the ligating device body into a shape that does not change in size in the longitudinal direction, the size of the port opening can be reduced, and the rate of gas leakage can be reduced during surgery by insufflation method. .

The ligating device according to the present invention is formed by chamfering from the inner surface facing the side hole of the ligating device main body to the outer surface in the direction of the other end of the ligating device main body, if necessary. And a concave portion that smoothly continues the above. As described above, in the present invention, a concave portion that partially connects the outer surface of the ligating device main body and the inner surface of the side hole is formed,
The thread passing through the side hole is guided to the concave portion and reaches the outside of the ligating device main body, so that the thread is hardly displaced from the side hole and can be securely held in the side hole, and the operator holds the end of the thread In this state, the thread does not come off from the distal end of the ligation tool main body. In addition, at the time of insertion of the ligating device main body, the thread smoothly advances from the side hole to the outside of the ligating device main body, thereby reducing the contact resistance between the thread and the ligating device main body so that the insertion can be performed promptly without sagging of the thread. .

In the ligating device according to the present invention, if necessary, a predetermined portion of the ligating device main body from the inner surface to the outer surface facing the distal end hole and the side surface hole at one end of the ligating device main body may be cut out. A gap portion communicating from the tip hole and the side hole to the outside is provided so that the yarn can be taken in and out of the tip hole and the side hole through the gap portion. As described above, in the present invention, a gap is formed at one end of the ligating device main body from the tip hole and the side hole to the outside, and the thread can be freely inserted into and taken out of the tip hole and the side hole through the gap. It is possible to efficiently perform threading work to the tip hole and side hole before starting and thread removal work from each hole at the time of completion of ligation,
The treatment time can be reduced, and the burden on both the practitioner and the practitioner can be reduced.

Further, the ligating device according to the present invention may be such that the ligating device main body is formed in a substantially cylindrical shape within the predetermined length as required, and an internal space is formed as the distal end hole. is there. As described above, in the present invention, at least a predetermined range of the ligating device main body is formed in a substantially cylindrical shape, the distal end hole is defined as a cylindrical internal space, and a portion that is inserted into the body through the port is formed in a transversely symmetric shape. Thereby, the gap between the port and the ligating device main body can be reduced, and the rate of gas leakage can be remarkably reduced in the case of an operation based on the insufflation method.

In the ligating device according to the present invention, if necessary, the peripheral portion of the ligating device main body in a range from one side of the side hole to the other of the side hole is cut off as the gap. At the same time, at least a portion of the ligating device main body along the removed portion at the one end side is notched and removed,
A portion on one end side of the ligating device main body along the gap portion becomes two substantially arc-shaped projections. As described above, in the present invention, the gap portion is formed in a substantially T-shape at a portion extending from between the side holes to one end surface of the ligating device main body, and the one end of the ligating device body is surrounded by the gap portion, the tip hole, and the side hole. Two projections are formed in a folded state, and the practitioner hooks the thread outside the ligating device main body with one or both of the two projections, enters the gap, and guides the thread to pass through the tip hole and the side hole. Even when the thread does not pass through the tip hole and the side hole, the operation of the ligating device main body can easily make the thread pass through the side hole and the tip hole, and threading work into each hole before the start of the ligation operation. It is not only necessary to remove the thread from each hole at the time of completion of ligation, but also to easily and properly perform fine work by freely inserting and removing the thread to each hole at the tip of the ligation tool main body even when tying in the body Work efficiency in the body can be greatly improved.

The ligating device according to the present invention is drilled as required until the distal end hole reaches at least a predetermined depth from the side hole drilling position of the ligating device body to the other end of the ligating device body, The gap is formed from a position where the end of the substantially cylindrical body is at least closer to the other end of the ligature body than the gap in the tip hole, and is formed of a substantially cylindrical body having a predetermined cross-sectional shape that can be inserted into and removed from the tip hole. The ligating device is slidably disposed in the longitudinal direction to a position where at least a part of the portion is closed from the tip hole side and the thread passing through the side hole can be prevented from coming off from the side hole through the gap. It has an inner cylinder. As described above, in the present invention, the inner cylinder that is slidable in a predetermined range in the longitudinal direction of the ligating device main body is disposed in the distal end hole, and the inner cylinder is moved through the gap as a position where the gap is opened by the operation of the practitioner. The ligation tool body by allowing switching between a state in which the thread is allowed to enter and exit and a state in which the thread is not allowed to enter and exit through the gap as a position where the gap is partially closed. The entry and exit of the thread through the gap can be controlled, and the operation of inserting the ligature body into the body and approaching the ligating target site can be performed with the thread completely prevented from dropping from the gap, and the tip hole and side surface The efficiency of the operation of inserting the ligature body into the body can be remarkably improved while maintaining the ease of the operation of passing the thread through the hole, and the operator's work load can be greatly reduced.

Further, the ligating device according to the present invention is located at a position where one or both of the protruding tip portions at one end of the ligating device main body are opposed to each other in the direction of the other end of the ligating device main body via the gap as required. The ligating device has a concave portion formed by chamfering a predetermined portion of the end surface facing the gap portion from the outer surface to the outer surface, and smoothly connecting the end surface and the outer surface. As described above, in the present invention, the concave portion is formed to partially continue the predetermined portion of the end surface of the ligature main body facing the gap portion and the outer surface of the ligature main body facing the tip end of the projection, and the thread separated from the ligature main body is formed into the concave portion. When applied along the line, a force is applied to the thread toward the tip hole side, and the thread is easily caught by the protrusion, so that even when the thread comes out of the gap in the body and once separates from the ligature body, The operator can easily hook the thread with the protrusion and guide it to the gap by the operation of the practitioner, it can be returned to the state passed through the tip hole and the side hole, and once the ligature body is inserted into the body once, the thread is tied as it is The work can be continued inside the body, eliminating the need to put the ligation tool body in and out of the body multiple times and re-threading the thread, allowing the ligation work to proceed smoothly without any hassle, greatly reducing the burden on the practitioner. Can be

The ligating device according to the present invention may be mounted on the ligating device main body in a movable state, if necessary, to close at least a part of the gap and pass the thread through the side hole. And an opening / closing body that can be fitted into the gap of the ligating device main body to a position where it can be prevented from being detached from the side hole through the ligature. As described above, in the present invention, the opening / closing body that is movable with respect to the ligating device main body is disposed, and the opening / closing body is set to a position where the gap is opened by operation of a practitioner to allow the thread to enter and exit through the gap. And the state in which the thread is not allowed to enter and exit through the gap as the position where the gap is closed, as necessary, in a state in which the drop of the thread from the gap is completely prevented. The operation of inserting the ligature body into the body and approaching the ligated part can be performed separately, significantly improving the efficiency of the operation with the ligature tool while ensuring the operator's easy operation of inserting and removing the thread from the tip hole and side hole. The work load on the practitioner can be greatly reduced.

[0014]

DESCRIPTION OF THE PREFERRED EMBODIMENTS (First Embodiment of the Present Invention) Hereinafter, a ligating device according to a first embodiment of the present invention will be described with reference to FIGS. FIG. 1 is an explanatory view of a use state of the ligating device according to the present embodiment, FIG. 2 is a front view of a main part of the ligating device according to the present embodiment, and FIG. FIG. 4 is an explanatory view of a threading state of the ligating device according to the present embodiment, FIG. 5 is an explanatory diagram of a state of inserting the ligating device according to the present embodiment in the body, and FIG. FIG. 7 is an explanatory diagram of a threading position correcting operation using a ligating device, FIG. 7 is an explanatory diagram of a ligating operation using the ligating device according to the present embodiment, FIG. FIG. 9 is an explanatory view of the latter half of the single knotting operation using the ligating device according to the present embodiment.

As shown in the figures, a ligating device 1 according to the present embodiment includes a ligating device body 2 formed of a substantially rod-like body having a uniform thickness, and a ligating device 1 ligated from one end surface of the ligating device body 2. Tool body 2 circular tip hole 3 drilled to a predetermined depth in the longitudinal direction
A substantially circular side hole 4 that is drilled in a substantially perpendicular direction from two side positions sandwiching the distal end hole 3 at one end of the ligating body 2 and communicates with the distal end hole 3; (2) A gap portion 5 provided by cutting out a predetermined portion of a substantially T-shape from the inner surface to the outer surface facing each of the front end hole 3 and the side surface hole 4 at one end.

The ligating device main body 2 has a peripheral portion in contact with the distal end hole 3 at one end and a range extending from one side to the other side of the side hole 4. Notches are removed in a predetermined range near one side hole 4, and these removed portions are used as gap portions 5, and the portions that are not removed on one end side from the gap portions 5 are two portions each having a length. This is a configuration that results in different substantially arc-shaped curved protrusions 6. In addition, a concave portion 7 that smoothly connects the inner surface and the outer surface to each other is formed by chamfering from the inner surface facing the side hole 4 of the ligating device main body 2 to the outer surface in the direction of the other end of the ligating device main body 2. Further, a concave thread hooking portion 2a is formed at a predetermined position near one side surface hole 4 on one end surface of the ligating device main body 2 for a single knotting operation to be described later.

In addition, a handle portion 10 is formed at the other end of the ligating device main body 2 to facilitate holding of the ligating device 1 by a practitioner to facilitate a ligating operation. The handle 10 is formed such that the direction of a portion that protrudes greatly from the outer periphery of the ligature main body 2 corresponds to the position of the side hole 4 or the gap 5 at one end of the ligature main body 2. The orientation of one end of the main body 2 can be determined, such as when the ligature main body 2 is small in diameter and the position of each part of the one end is difficult to see, or when the one end of the ligature main body 2 cannot be inserted into the body and cannot be seen. In this case, the operator can grasp the positions of the side holes 4 and the gaps 5 from the direction of the handle 10 and perform the work.

Next, a ligating operation using the ligating device based on the above configuration will be described. In advance, the practitioner makes a knot 51 on the thread 50 pulled out by being hung on a ligation target site such as a blood vessel with another instrument, and holds the two threads 50 on the end side of the knot 51 in the vertical direction. Hold. The ligature 1 is stood upright with one end facing down against the two threads 50 held, while the curved projection 6 at one end is held.
When the thread 50 is inserted into the gap 5 so that the two threads 50 are hooked respectively (see FIG. 4A), the thread 50 passes through the tip hole 3 and the side hole 4 through the gap 5 (see FIG. 4A). FIG. 4 (B)).

Thereafter, when the ligature 1 through which the thread 50 passes is brought closer to the knot 51 while the end of the thread 50 is being pulled so that the thread 50 does not slack, the thread which comes into contact with each position on one end side of the ligature 1 The position of 50 shifts to the knot 51 side, and the knot 51 is located in the distal end hole 3 of the ligature 1 so that the ligature 1 can be inserted into the body (see FIG. 5A). The end of the thread 50 passing through the side hole 4 is guided by the recess 7 to reach the outside of the ligature 1 and is held by the practitioner.
The thread does not come off from the side hole 4 while the practitioner is holding the end of the thread 50. While holding the end of the thread 50, the practitioner inserts the ligature 1 into the port 60 fixed to the surface of the body and serving as an entrance into the body (see FIG. 5B).

As the practitioner pushes the ligature 1 into the body, the knot 51 shifts along with the tip of the ligature 1 while the thread 50 smoothly slides through the side hole 4 and the recess 7. In a state where the ligature 1 is being moved to the inside of the body, a part of the side hole 4 that is slightly closer to the end than the knot 51 of the thread 50 is pressed,
With this, the knot 51 proceeds smoothly to the inside of the body while being located in the distal end hole 3. Further, even when the ligature 1 is moved to the outside of the body due to the reaction force of the valve in the port 60, the ligature main body 2 in a portion facing the side hole 4 and the tip hole 3 is provided.
Can reliably support the yarn 50 by contacting the yarn 50,
The displacement of the knot 51 and the dropping off of the thread 50 in the inside can be prevented, and the knot 51 reliably moves following one end of the ligating device 1, so that an excessive force is not applied to the ligating target portion or the thread.

The knot 51 is shifted toward the region to be ligated in the body by the tying device 1, and when one end of the ligating device 1 approaches the ligating region (see FIG. 5C), the thread 50 is accurately positioned at the desired position. It is visually checked whether it can be ligated over the site. If the position where the thread 50 is hooked is shifted and the ligating position is likely to shift as it is, the ligating tool 1
Is moved laterally while maintaining the state where the thread 50 has passed through the side hole 4, to shift the place where the thread 50 is hooked, and return to the state where the thread 50 is hooked correctly on the ligating target site (see FIG. 6). Finally, when the knot 51 is pushed down to the site to be ligated (FIG. 7).
(See (A)), the thread 50 is pulled from the outside of the body and the thread 51 is tied without moving the ligature 1 as it is, and the part to be ligated is ligated (see FIG. 7B). When the site to be ligated is ligated, the ligature 1 is separated from the site to be ligated (see FIG. 7C). Thereafter, the thread 50 may be removed from the ligature 1 through the gap 5 and the ligature 1 may be pulled out of the body.

On the other hand, when the ligature 1 is pressed against the portion to be ligated and both ends of the thread 50 are pulled, the knot ends and the ligature 1 is separated from the portion to be ligated (see FIG. 8A). Then, the ligature 1 is rotated so that the thread 50 that has passed through the side hole 4 near the shorter curved protrusion 6 is separated from the side hole 4 (see FIGS. 8B and 8C). The thread 50 that has been passed is removed from the ligature 1 through the gap 5 (see FIG. 9A). While holding the end of the detached thread 50 so that the practitioner does not loosen it by hand, one end of the ligature 1 is moved, and the thread held by the ligature 1 is moved to the thread hook 2
When the tension is applied to the part to be ligated while preventing it from dropping by applying a, the knot 51 is further narrowed as a single knot, and a more reliable ligating state can be obtained (see FIG. 9B). .

As described above, in the ligating device according to the present embodiment, the distal end hole 3 and the side surface hole 4 are formed at one end of the ligating device main body 2, and the gap portion communicating from the distal end hole 3 and the side surface hole 4 to the outside is provided. In addition, two curved protrusions 6 having different lengths are formed on one end side, and both ends of the thread 50 hooked on the ligating target portion are passed through the gap portion 5 into the distal end hole 3 and each side hole 4 respectively. While holding the end of the thread 50 with the knot 51 positioned in the distal end hole, the practitioner operates the ligature main body 2.
To perform the insertion and ligation work,
In addition to being able to pass through the port 60 and be inserted into the body without slippage or dropping of the thread 50, in addition to being able to perform ligating work quickly,
The knot can be moved by following the distal end of the ligating device main body 2, so that excessive force is not applied to the ligating target portion and the thread, and the safety is improved.
In addition, since the practitioner hooks the thread 50 outside the ligating device main body 2 with the curved projection 6 and puts the thread into the gap portion 5 and guides the thread through the distal end hole 3 and the side hole 4, regardless of the inside and outside of the body By operating the ligating device main body 2, the thread can be easily passed through the distal end hole 3 and the side hole 4, and the threading operation into each hole before the start of the ligating operation and the thread from each hole when the ligating operation is completed. At the time of removing work and knotting in the body, the thread 50 can be freely inserted into and removed from each hole to perform fine work properly, and work efficiency in the body can be greatly improved, and The burden can be reduced. Further, since the body insertion portion of the ligature main body 2 is formed in a substantially cylindrical shape, the size of the opening of the port 60 and the gap between the port 60 and the ligature main body 2 can be reduced. In the case of the operation by the gas, the rate of gas leakage can be significantly reduced.

In the ligating device according to the embodiment, the notch removal position as the gap 5 on one end surface of the ligating device main body 2 is located near one side hole 4 and two curved projections 6 are provided.
However, the length is not limited to this, but as shown in FIG. 10, the gap portion 5 is positioned at an intermediate position with respect to the side surface holes 4 so that one end surface is symmetrical, and the two curved projections 6 are the same. It is also possible to adopt a configuration in which the thread 50 is hardly detached from the gap 5 and the ligation tool main body 2 during the ligation operation unless the two threads 50 held by the practitioner are loosened. The yarn 50 can be prevented from coming off from the tip. Alternatively, the distal end hole 3 and the side hole 4 can be provided without providing the gap 5 at one end of the ligating device main body 2, and the thread 50 can be completely prevented from falling off and the knot 51 can be securely ligated. The ligation operation can be performed by reaching the target site.

In the ligating device according to the embodiment, a predetermined portion of one end of the ligating device main body 2 having a substantially T-shape is cut out to form a gap 5, and the tip hole 3 and the side hole 4 are passed through the gap 5. In addition, as shown in FIG. 11, one of the distal ends of the curved projections 6 at one end of the ligating device main body 2 is separated by a gap 5 in the direction of the other end of the ligating device main body 2 as shown in FIG. The end face of the ligating device main body 2 facing the gap portion 5 at the opposing position may be cut out in a predetermined range and chamfered over the outer surface, so that the gap portion 5 can be partially enlarged. When shifting to the one-side tying operation later, the operation of removing the thread 50 that has passed through the side hole 4 from the ligature 1 can be performed more smoothly by enlarging the gap portion 5, and the workability is improved.

(Second Embodiment of the Present Invention) The second embodiment of the present invention
The ligating device according to the embodiment will be described with reference to FIGS. FIG. 12 is a front view, a bottom view, and a side view of a main part of a ligating device according to the present embodiment, and FIG. 13 is a first half explanatory diagram of a threading operation in a body using the ligating device according to the present embodiment; FIG. 6 is a diagram illustrating the latter half of the threading operation in the body using the ligature according to the present embodiment. As shown in the drawings, the ligating device 1 according to the present embodiment includes a ligating device main body 2, a distal end hole 3, a side hole 4,
A different point is that the ligating device main body 2 is located at a position facing one end of the curved projection 6 at one end of the ligating device main body 2 across the gap 5 in the direction of the other end of the ligating device main body 2. Of the end face facing the gap 5 from the predetermined portion to the outer face, and has a concave portion 8 for smoothly connecting the end face and the outer face.

Next, a ligating operation using the ligating device having the above configuration will be described. As in the first embodiment, the practitioner makes a knot 51 on the thread 50 that has been previously hung on the ligation target site with another device and pulled out, and holds both ends of the thread 50. When the ligature 1 is moved with respect to the held two threads 50, and the two threads 50 are hooked by the curved protrusions 6, respectively, the threads 50 are inserted into the gaps 5. Through the tip hole 3 and the side hole 4. Thereafter, the knot 51 of the thread 50 is positioned in the distal end hole 3 of the ligature 1, and the operator inserts the ligature 1 from the port 60 into the body while holding the end of the thread 50,
The knot is advanced into the body together with the tip of the ligature 1.

While bringing the ligature 1 close to the site to be ligated,
When the thread 50 comes off the gap 5 in the body (FIG. 13A)
However, if the concave portion 8 is applied along the thread 50 that has come off by the practitioner's operation (see FIG. 13B), the thread 50 can be easily hooked by the curved projection 6 and inserted into the gap 5. (Refer to FIG. 14 (A)), it can be returned to a state where it has passed through the distal end hole 3 and the side surface hole 4 (refer to FIG. 14 (B)). It is not necessary to take out the ligature 1 from the body and pass the thread 50 through each hole again. When one end of the ligating device 1 reaches the ligating target portion, the practitioner pulls the extracorporeal thread 50 and ligates by double knot while pressing the ligating device 1 against the ligating target portion. Even in the case where the thread 50 at hand of the practitioner is loosened during the both knots and the thread 50 comes off from one end of the ligature 1, the concave portion 8 is applied to the thread 50 that has come off immediately as described above. It can be guided again to the side hole 4 side, and the ligature by both knots can be reliably performed. After the two knots, even when the single knot is performed in the same manner as in the first embodiment, the thread 50 is inserted into the gap 5 by applying the concave portion 8 to the removed thread 50, and the thread 50 is again inserted into the side hole 4. It is possible to return and perform a new double knot.

As described above, in the ligating device according to the present embodiment, the concave portion which makes the predetermined portion of the end surface of the ligating device main body 2 facing the curved portion 6 facing the gap portion 5 and the outer surface partially continuous. 8 is formed, and a thread 50 separated from the ligating device main body 2 is applied along the concave portion 8 so that the thread 50 has a distal hole 3
When the thread 50 comes off from the gap 5 in the body, the thread 50 can be easily manipulated by the practitioner since the force to turn to the side is applied and the thread 50 is easily caught by the curved protrusion 6.
Is guided by the curved projection 6 into the gap 5 and
And can be returned to the state passed through the side hole 4, and the ligature 1
Once inserted into the body, the work can be continued in the body until the ligation is completed, the ligation work can be performed in a shorter time, and the burden on the operator can be greatly reduced.

(Third Embodiment of the Present Invention) The third embodiment of the present invention
The ligation tool according to the embodiment will be described with reference to FIG.
FIG. 15 is a front view, a bottom view, and a side view of a main part of the main part of the ligature according to the present embodiment. As shown in the previous figure, the ligating device 1 according to the present embodiment includes a ligating device main body 2, a distal end hole 3, a side hole 4, a gap portion 5, and a concave portion 8 as in the second embodiment. On the other hand, a different point is that the distal end hole 3 is formed so as to penetrate the ligating device main body 2 in the longitudinal direction and has an inner cylinder 9 slidably disposed in the distal end hole 3. Things.

The inner cylinder 9 is formed of a substantially cylindrical body that can be inserted into and removed from the distal end hole 3. The distal end of the substantially cylindrical body is formed in a plurality of steps. The ligating device main body 2 is slidably disposed in a longitudinal direction from a position closer to the other end of the ligating device main body 2 than the gap portion 5 to a position where the portion sandwiched between the side holes 4 in the gap portion 5 is closed from the distal end hole 3 side. It is a configuration that is provided. The operation of the inner cylinder 9 with respect to the ligating device main body 2 is a mechanism performed by an operation by a practitioner from the other end side of the ligating device main body 2. A predetermined urging means for urging the inner cylinder 9 in the direction of the other end of the ligating device main body 2 may be provided in the ligating device main body 2. While the gap 5 is closed by a one-way pressing operation by the practitioner, the gap 5 is opened by urging when the pressure is released from the practitioner, so that the practitioner can easily operate the gap 5 with one hand.
Can be opened and closed.

Next, a ligating operation using the ligating device based on the above configuration will be described. As in the second embodiment, the practitioner makes a knot 51 on the thread 50 which has been previously hung on the ligation target site with another device and pulled out, and holds both ends of the thread 50. The practitioner moves the ligature 1 relative to the ends of the two threads 50 while holding the inner cylinder 9 in the ligature 1 so that the tip of the inner cylinder 9 is opened without closing the gap 5. When the recess 8 at one end is applied along the thread 50,
A force is applied to the yarn 50 to move toward the tip hole 3, and the yarn 50
Is easily hooked by the curved protrusion, and when the yarn 50 is inserted into the gap 5 so that the two yarns 50 are hooked by the curved protrusion 6 as it is, the yarn 50 passes through the tip hole 3 and the side hole 4 through the gap 5. It is in a state to pass.

When the thread 50 passes through the side hole 4, the practitioner moves the inner tube 9 in the ligature 1 toward one end of the ligature 1 and
A portion of the distal end portion sandwiched between the side holes 4 of the gap 5 is closed from the distal end hole 3 side. When the gap 5 is partially closed,
The thread 50 can be maintained in a state where it does not come off from the side hole 4. Thereafter, as in the second embodiment, the knot 51 of the thread 50 is positioned in the distal end hole 3 of the ligature 1 and the practitioner moves the thread 5
The ligature 1 is inserted into the body from the port 60 while the end of the ligature 1 is held, and the knot 51 is advanced into the body together with the tip of the ligature 1. When one end of the ligature 1 reaches the ligature target site, the practitioner pulls the extracorporeal thread 50 in a state where the ligature device 1 is pressed against the ligature target site, performs ligation by double knotting, and after tying, the ligature device. The inner cylinder 9 in the ligature 1
Moved toward the other end to hold the gap 5 open,
The thread 50 can be removed from one end of the ligature 1. Thereafter, if necessary, one-sided knotting can be performed as in the first embodiment.

As described above, in the ligating device according to the present embodiment, the inner cylinder 9 slidable in the longitudinal direction of the ligating device main body 2 within the predetermined range is disposed in the distal end hole 3, and the inner tube 9 is operated by the operator. Cylinder 9
Is set as a position where the gap 5 is opened, and the thread 50 is allowed to enter and exit through the gap 5, and a position where the gap 5 is partially closed is made impossible to enter and exit the thread 50 through the gap 5. Since the state can be switched as necessary, the operation of inserting the ligating device body 2 into the body and approaching the ligating target site can be performed in a state where the thread 50 from the gap portion 5 is completely prevented from falling off. The efficiency of the operation of inserting the ligature 1 into the body can be remarkably improved while ensuring the ease of the operation of inserting and extracting the thread 50 into and out of the distal end hole 3 and the side hole 4 by the operator, and the operator's work load can be greatly reduced.

(Fourth Embodiment of the Present Invention) The fourth embodiment of the present invention
The ligation tool according to the embodiment will be described with reference to FIG.
FIG. 16 is a front view, a bottom view, and a side view of a main part of the main part of the ligature according to the present embodiment. As shown in the previous figure, the ligating device 1 according to the present embodiment includes a ligating device main body 2, a distal end hole 3, a side hole 4, and a gap portion 5 as in the first embodiment. The difference is that the opening / closing body 11 is provided slidably on the ligating device main body 2 and opens and closes the gap 5.

The opening / closing body 11 is formed in a substantially cylindrical shape having a substantially columnar shape when combined with the ligating device main body 2, and has a plurality of steps at its tip. The ligating device main body 2 is configured to be slidable in the longitudinal direction from the position where the gap 5 is opened away from the protrusion 6 to the position where the gap 5 is fitted into the gap 5 and closes the gap 5. The operation of the opening / closing body 11 with respect to the ligating device main body 2 is a mechanism that is performed by an operation performed by a practitioner from the other end side of the ligating device main body 2. A predetermined urging means for urging the opening / closing body 11 in the direction of the other end of the ligating tool main body 2 may be provided between the ligating tool main body 2 and the opening / closing body 11. While the gap 5 is closed by an operator's pressing operation in the one end direction from the other end side, the operator releases the gap 5 by urging when depressed by the operator, so that the operator can easily use one hand. The opening / closing operation of the gap portion 5 can be performed at the same time.

Next, a ligating operation using the ligating device based on the above configuration will be described. As in the first embodiment, the practitioner makes a knot 51 on the thread 50 that has been previously hung on the ligation target site with another device and pulled out, and holds both ends of the thread 50. Then, the practitioner moves the ligature 1 relative to the ends of the two threads 50 while holding the opening and closing body 11 of the ligature 1 so that the distal end thereof is in a position to open without closing the gap 5. When the yarn 50 is inserted into the gap portion 5 so that the two yarns 50 are hooked by the curved protrusions 6, respectively, the yarn 5
0 passes through the tip hole 3 and the side hole 4 through the gap 5. When the thread 50 passes through the side hole 4, the practitioner slides the opening / closing body 11 of the ligating tool 1 toward one end of the ligating tool 1 and closes the gap 5 at the tip of the opening / closing body 11. By closing the gap 5, the thread 50 can be maintained in a state where the thread 50 does not come off from the side hole 4. Thereafter, similarly to the first embodiment, the knot 51 of the thread 50 is positioned in the distal end hole 3 of the ligature 1,
The practitioner inserts the ligature 1 into the body from the port 60 while holding the end of the thread 50, and connects the knot 51 to the ligature 1.
Let go inside the body with the tip.

When one end of the ligating device 1 reaches the site to be ligated, the practitioner pulls the extracorporeal thread 50 in a state where the ligating device 1 is pressed against the site to be ligated, ligates by double knotting, and Then, the opening / closing body 11 in the ligature 1 is slid toward the other end of the ligature 1 to hold the gap 5 open so that the thread 50 can be removed from one end of the ligature 1. Thereafter, if necessary, one-sided knotting can be performed as in the first embodiment. As described above, in the ligating device according to the present embodiment, the opening / closing body 11 that is slidable in a predetermined range in the longitudinal direction of the ligating device main body 2 is disposed, and the opening / closing body 11 is opened by the operation of the practitioner. The state where the thread 50 is allowed to enter and exit through the gap 5 as a position to be closed and the state where the thread 50 is unable to enter and exit through the gap 5 as the position where the gap 5 is closed are switched as necessary. Therefore, the operation of inserting the ligating device main body 2 into the body and approaching the ligating target site can be performed in a state where the thread 50 is completely prevented from dropping from the gap portion 5, and the distal end hole 3 and the side hole of the operator The operation efficiency of the ligature 1 can be remarkably improved while the ease of the operation of inserting and extracting the thread 50 with respect to the thread 4 can be remarkably improved, and the work load on the practitioner can be greatly reduced.

In the ligature according to the above embodiment, the opening / closing body 11 is slid with respect to the ligature main body 2 to open and close the gap 5; however, the present invention is not limited to this.
As shown in FIG. 17, the opening / closing body 11 is pivotally attached to a predetermined position of the ligating device main body 2, is arranged to be swingable with respect to the ligating device main body 2, and is remotely operated from the other end side of the ligating device main body 2. The opening / closing section 11 may be moved to open and close the gap 5, and similarly to the above-described embodiment, a state where the thread 50 is allowed to enter and exit through the gap 5 and a state where entry and exit are disabled by the practitioner's operation. Can be switched as necessary to improve the efficiency of the operation with the ligature 1 and can be used in the same manner as a known forceps such as sandwiching the thread 50 or the like between the opening and closing body 11 and the ligature main body 2. It can be further improved.

Further, in the ligating device according to each of the first to third embodiments, the distal end portion 3 is formed in the distal end portion of the ligating device main body 2 in a shape occupying most of the distal end portion. However, the present invention is not limited to this, and as shown in FIG. 18, the tip surface of a predetermined size or more in order to reduce the ratio of the distal end hole 3 and secure a contact area with the body tissue at the distal end of the ligating device main body 2. In order to make the incision at the surface of the body smaller in endoscopic surgery and to reduce the burden on the body of the subject and to be able to perform the procedure, it is necessary to further reduce the diameter. Although it is dangerous to simply slim the ligature that is being used, it is easy to pierce it when it comes into contact with body tissue, but by reducing the diameter and forming the tip surface to a predetermined size, the safety at the time of contact is reduced. Can be secured. Further, as shown in FIG. 19, it is also possible to adopt a tip shape in consideration of the size of the tip surface and the ease with which the thread 50 can be passed through the tip hole 3 and the side hole 4 through the gap 5. Further, as shown in FIG. 20, as in the case of the first embodiment, while ensuring the ease of use in the operations from threading to ligating, the tip shape is increased in size of the tip surface to achieve both safety and safety. You can also.

In the ligating device according to each of the first to third embodiments, the ligating device main body 2 is a substantially rod-like body having a uniform thickness, and the distal end hole 3 is formed from one end. However, the present invention is not limited to this, and it is also possible to adopt a configuration in which the ligating device main body 2 is a cylindrical body and the inner portion of the cylindrical body is used as the distal end hole 3 as it is in each of the above embodiments. The structure can be simplified, the manufacturing is easy, and the cost can be reduced, while maintaining the good quality. Further, in the ligating device according to each of the first and second embodiments, one end of the ligating device main body 2 is always exposed to the outside. However, the present invention is not limited to this, and as shown in FIG. ,
A substantially cylindrical outer tube 12 is disposed outside the ligating device main body 2, and the outer tube 12 is connected to at least the gap 5 outside the ligating device main body 2.
A configuration is also possible in which the gap 5 is slidable from a position closer to the other end of the ligature body 2 to a position where the gap 5 is closed from the outside.

According to such a configuration, the outer cylinder 12 is set to a position where the gap 5 is opened by the operation of the practitioner to allow the thread 50 to enter and exit through the gap 5, and the gap 5 is closed. The state in which the thread 50 cannot enter and exit through the gap 5 can be switched as necessary, so that the thread 50 passing through the side hole 4 is completely prevented from dropping out of the gap 5. The operation of inserting the ligature main body 2 into the body and approaching the ligated target site can be performed by the ligature 1 while securing the ease of the operation of inserting and withdrawing the thread 50 into the distal end hole 3 and the side hole 4 by the practitioner. Work efficiency can be significantly improved, and the burden on the practitioner can be greatly reduced. In addition, as shown in FIG. 21, a portion facing the curved projection 6 of the ligating device main body 2 across the gap 5 is chamfered by a predetermined range. A series of operations for passing the yarn 50 through the distal end hole 3 and the side hole 4 via 5 can be easily performed. If the outer cylinder 12 is located at a position where the gap 5 is closed, the curved projection 6 can also be covered with the outer cylinder 12, and the valve in the port 60 of the curved projection 6 when the ligature 1 is pulled up from the body. Can be prevented, and the curved protrusion 6 can be reliably protected.

[0043]

As described above, according to the present invention, a tip hole and a side hole are drilled at the tip of a substantially rod-shaped ligature body, and the yarns at both ends of the knot are passed through the side holes from the tip hole, respectively. The practitioner operates the ligature body while holding the end of the thread in a state where the thread is positioned in the tip hole, so that when inserted into the body, a portion of the side hole on the side closer to the end than the knot of the thread is pushed. The knot of the thread is smoothly advanced inside the body while the knot is located in the tip hole, and even when the body of the ligation tool moves to the outside of the body, the ligature body in the side hole and the tip hole portion contacts the thread. In addition to being able to securely support the thread and to perform the ligating work by passing through the port without shifting the knot or dropping the thread,
The knot moves together with the distal end of the ligating device main body, so that an excessive force is not applied to the ligating target portion or the thread, and the effect of improving safety is achieved. In addition, by making the body insertion portion of the ligating device main body into a shape that does not change in size in the longitudinal direction, the size of the port opening can be reduced, and the rate of gas leakage can be reduced at the time of surgery by insufflation method. It has the effect of.

Further, according to the present invention, a concave portion is formed to partially connect the outer surface of the ligating device main body and the inner surface of the side hole, and the thread passing through the side hole is guided by the concave portion to reach the outside of the ligating device main body. Thereby, the thread is less likely to be displaced from the side hole and can be securely held in the side hole, so that the thread does not come off from the distal end of the ligating device main body while the operator holds the end of the thread. Furthermore, when the ligature body is inserted, the thread proceeds more smoothly from the side hole to the outside of the ligature body, so that the contact resistance between the thread and the ligature body can be reduced and the insertion can be performed quickly without sagging of the thread. Has an effect.

Further, according to the present invention, a gap is formed at one end of the ligating device main body from the tip hole and the side hole to the outside, so that the thread can be freely inserted into and taken out of the tip hole and the side hole through the gap. , Threading work through the front and side holes before ligation work and thread removal work from each hole when ligation is completed can be performed efficiently, shortening the operation time and reducing the burden on both the practitioner and the practitioner It has the effect of being able to.
Further, according to the present invention, at least a predetermined range of the ligating device main body is formed in a substantially cylindrical shape, the distal end hole is defined as a cylindrical internal space, and a portion to be inserted into a body through a port is formed in a transversely symmetric shape. As a result, the gap between the port and the ligating device body can be reduced, and the rate of gas leakage can be significantly reduced in the case of an operation based on the pneumoperitoneum. In addition, the structure can be simplified, the manufacturing is easy, and the cost is reduced. It has the effect that it can be achieved.

Further, according to the present invention, the gap is formed in a substantially T-shape at a portion extending from between the side holes to one end surface of the ligating device main body, and the gap, the tip hole and the side hole are formed at one end of the ligating device main body. Two projections in a state surrounded by are formed, and the practitioner hooks the thread outside the ligature body with one or both of the two projections and puts it into the gap, and passes the thread through the tip hole and the side hole. By guiding, even when the thread does not pass through the tip hole and the side hole, it is possible to easily make the thread pass through the side hole and the tip hole by operating the ligating tool main body, and to the respective holes before the start of the ligation work. It is not limited to threading work and thread removal work from each hole at the time of completion of ligation. And can greatly improve the efficiency of work in the body. To.

Further, according to the present invention, the inner cylinder slidable within a predetermined range in the longitudinal direction of the ligating device main body is provided in the distal end hole, and the inner cylinder is set to a position where the gap is opened by the operation of the practitioner. Ligating by allowing switching between a state in which the thread can enter and exit through the gap and a state in which the thread cannot enter and exit through the gap as a position where the gap is partially closed as necessary It is possible to control the entry and exit of the thread from the ligature body through the gap, and the operation of inserting the ligature body into the body and approaching the ligation target site can be performed in a state where the thread is completely prevented from dropping from the gap. The efficiency of the operation of inserting the ligature body into the body can be remarkably improved while maintaining the ease of the operation of passing the thread through the hole and the side hole, and the operation load on the practitioner can be greatly reduced.

Further, according to the present invention, a concave portion is formed to partially connect a predetermined portion of the end surface of the ligating device body facing the gap end portion and the outer surface of the ligating device body facing the tip end of the projection, and is separated from the ligating device body. When the thread is applied along the concave part, a force is applied to the thread toward the tip hole side, and the thread is easily caught by the protrusion, so that the thread comes out of the gap in the body and temporarily separates from the ligature body. Even if it is, the operator can easily hook the thread with the projection and guide it to the gap by the operation of the practitioner, it can be returned to the state passed through the tip hole and side hole, and once the ligature body is inserted into the body, the thread The work up to tying can be continued in the body, eliminating the need to put the ligating device body in and out of the body several times and re-threading the thread.This allows the ligating operation to proceed smoothly without any hassle, reducing the burden on the practitioner. It can be greatly reduced It has an effect.

Further, according to the present invention, an opening / closing body which is movable with respect to the ligating device main body is provided, and the opening / closing body is set to a position where the gap is opened by the operation of a practitioner to allow the thread to enter and exit through the gap. By making it possible to switch between an allowable state and a state in which the thread cannot enter and exit through the gap as a position where the gap is closed as necessary, the drop of the thread from the gap is completely prevented. In this state, the operation of inserting the ligation tool body into the body and approaching the ligation target site can be performed, and the efficiency of the operation with the ligation tool while ensuring the ease of the operation of inserting and removing the thread with respect to the tip hole and the side hole of the operator. Is remarkably improved, and the operation burden on the practitioner can be greatly reduced.

[Brief description of the drawings]

FIG. 1 is an explanatory diagram of a use state of a ligating device according to a first embodiment of the present invention.

FIG. 2 is a main part front view of the ligating device according to the first embodiment of the present invention.

FIG. 3 is a bottom view and a main part side view of the ligating device according to the first embodiment of the present invention.

FIG. 4 is an explanatory diagram of a threading state through a ligating device according to the first embodiment of the present invention.

FIG. 5 is an explanatory view of a ligating device according to the first embodiment of the present invention inserted into a body.

FIG. 6 is an explanatory diagram of a thread hooking position correcting operation using the ligature according to the first embodiment of the present invention.

FIG. 7 is an explanatory view of a ligating operation using the ligating device according to the first embodiment of the present invention.

FIG. 8 is an explanatory diagram illustrating a first half of a single knotting operation using the ligature according to the first embodiment of the present invention.

FIG. 9 is a diagram illustrating the latter half of the single knotting operation using the ligating device according to the first embodiment of the present invention.

FIG. 10 is a front view, a bottom view, and a side view of a main part of another main part of the ligature according to the first embodiment of the present invention.

FIG. 11 is a front view, a bottom view, and a side view of a main part of another main part of another ligature according to the first embodiment of the present invention.

FIG. 12 is a front view, a bottom view, and a side view of a main part of a main part of a ligating device according to a second embodiment of the present invention.

FIG. 13 is an explanatory view of the first half of a threading operation in a body using the ligating device according to the second embodiment of the present invention.

FIG. 14 is a diagram illustrating the latter half of the threading operation in the body using the ligating device according to the second embodiment of the present invention.

FIG. 15 is a front view, a bottom view, and a side view of a main part of a main part of a ligating device according to a third embodiment of the present invention.

FIG. 16 is a front view, a bottom view, and a side view of a main part of a main part of a ligating device according to a fourth embodiment of the present invention.

FIG. 17 is a side view of a relevant part of another ligature according to the fourth embodiment of the present invention.

FIG. 18 is a front view, a bottom view, and a side view of a main part of a main part of a ligating device according to another embodiment of the present invention.

FIG. 19 is a front view, a bottom view, and a side view of a main part of a main part of a ligating device according to another embodiment of the present invention.

FIG. 20 is a bottom view and a main part side view of a ligating device according to still another embodiment of the present invention.

FIG. 21 is a main part front view and a main part side view of a ligating device according to still another embodiment of the present invention, and a main part side view in a gap closed state.

FIG. 22 is a schematic configuration diagram of a conventional ligating device.

FIG. 23 is a longitudinal sectional view of a main part of a conventional ligating device.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1, 100 Ligation tool 2 Ligation tool main body 2a Thread hook part 3 Tip hole 4 Side hole 5 Gap 6 Curved projection 7 Depression 8 Depression 9 Inner cylinder 10 Handle 11 Opener 12 Outer cylinder 50 Thread 51 Knot 60 Port 101 Handle 102 Recess 103 Guide path

Claims (8)

[Claims] 1. A ligating device main body formed of a substantially rod-like body having a substantially uniform thickness within a range of at least a predetermined length from one end, and a ligating device main body pierced from one end surface to a predetermined depth in a longitudinal direction of the ligating device main body. A tip hole having a predetermined shape to be provided, and a side hole having a predetermined shape penetrated in a substantially perpendicular direction from two side positions sandwiching the tip hole at one end of the ligating device main body and communicating with the tip hole. A ligature, wherein both ends of a predetermined thread to be tied are passed through the distal end hole and the side hole, respectively. 2. The ligating device according to claim 1, wherein the ligating device is formed by chamfering from an inner surface facing the side hole of the ligating device main body to an outer surface in the other end direction of the ligating device main body. A ligating device comprising a concave portion for smoothly connecting the ligature. 3. The ligating device according to claim 1, wherein a predetermined portion of the ligating device main body from the inner surface facing the distal end hole and the side surface hole at one end of the ligating device main body to the outer surface is removed. A ligating device, wherein a gap portion communicating from the tip hole and the side hole to the outside is provided, and the thread can be put in and out of the tip hole and the side hole through the gap portion. 4. The ligating device according to claim 3, wherein the ligating device main body is formed in a substantially cylindrical shape within the predetermined length, and an internal space is formed as the distal end hole. Ligating tool. 5. The ligating device according to claim 4, wherein a peripheral portion of the ligating device main body, which is in contact with the tip hole and extends from one side to the other side hole, is cut off as the gap. At the same time, a portion at one end of the ligating device main body along the removed portion is notched and removed at least in part, and a portion at one end of the ligating device main body along the gap portion is a projection that is curved into two substantially arcs. A ligating device characterized by the following. 6. The ligating device according to claim 5, wherein the distal end hole is drilled at least a predetermined depth from the side hole drilling position of the ligating device body to the other end of the ligating device body, The gap portion is formed of a substantially cylindrical body having a predetermined cross-sectional shape that can be inserted into and removed from the tip hole, and the tip of the substantially cylindrical body is located at least closer to the other end of the ligature body than the gap portion in the tip hole. At least a part of the ligature is slidably disposed in the longitudinal direction of the ligating device main body to a position where it is possible to close the at least a part of the ligating device from the tip hole side and to prevent the thread from passing through the gap between the side hole and the side thread. A ligature comprising a tube. 7. The ligating device according to claim 5, wherein one or both of the protruding tip portions on one end side of the ligating device main body and a position facing the other end of the ligating device main body via the gap. A ligating device comprising: a concave portion formed by chamfering a predetermined portion of an end surface of the ligating device main body facing a gap portion from an outer surface to smoothly continue the end surface and the outer surface. 8. The ligating device according to claim 3, wherein the ligating device is movably attached to the ligating device main body, closed at least a part of the gap, and passed through the side hole. A ligating device comprising an opening / closing body that can be fitted into the gap of the ligating device main body to a position where the thread can be prevented from coming off from the side hole through the gap.