JP2002165801A - Surgical suturing instrument, and suturing and cutting instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent viable tissues from protruding from an anvil surface by locking a lock pin to the latchet pin of a jaw part, to surely prevent the shift of a staple surface and the anvil surface and to suture and simultaneously cut the viable tissues with a single action. SOLUTION: When moving a first lever 10 from a release position to an intermediate lock position, the lock pin 22 is locked and fixed to the pin lock bar of the jaw part 90 and positions the anvil 91 to a staple cartridge 71 and the staple cartridge is moved to the position of temporarily clamping the viable tissue with the anvil. Further, a cutting tool and a second lever 50 for executing a cutting operation simultaneously with a suturing operation with a single action are included, the staple suture of one or two or more columns is executed on both sides of a cutting part and a part between both suture part tissues is cut.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical suturing apparatus used for suturing internal organs and living tissues such as the lung, esophagus, stomach, duodenum and small intestine / large intestine, and more particularly to a staple array comprising a plurality of staples. To a surgical suturing device used for penetrating and suturing a living tissue. Further, the present invention provides a staple row composed of a plurality of staples,
The present invention relates to a surgical suturing and cutting apparatus used for penetrating suture to a compressed living tissue and at the same time cutting the living tissue.

[0002]

2. Description of the Related Art In recent years, surgical operations using surgical staples instead of conventional sutures have increased. This is because surgical staples can simplify the complex operations required when using sutures, and therefore can significantly reduce the time required for suturing operations, thus This is because the time required to be in an anesthetic state can be greatly reduced. For this reason, many types of surgical staplers have been developed for various surgical procedures.

[0003] Such surgical staplers were initially provided with
It is a device that is used repeatedly and for multiple purposes, and surgical staples are manually loaded into the device one at a time. However, this type of stapler is generally complex and expensive, heavy, bulky, and requires labor to load surgical staples and to clean and sterilize after use. For this reason, the trend of surgical stapler improvement is
We moved to ones that could be equipped with pre-sterilized single-use staple loading units and staple cartridges. U.S. Pat. Nos. 3,275,211 and 3,31
Nos. 5,863 and 3,589,589 disclose surgical staplers comprising such replaceable staple cartridges.

Further, among such surgical staplers, a stapler of a type applied to a living tissue sandwiched between a staple cartridge and an anvil is known. Such surgical staplers may be metal staples, for example, as in U.S. Pat. No. 3,275,211 or made of a non-metallic resin material, as in U.S. Pat. No. 4,402,445. It may be something. In the case of metal staples, the staple legs are folded so as to penetrate the tissue and secure to the tissue, usually by an anvil. On the other hand, in the case of a non-metallic stapler, each stapler is composed of two parts before mounting, a stapler section provided on a stapler grip section of the apparatus and a holding section provided on an anvil of the apparatus. The legs of the stapler section penetrate the tissue and engage with the retainer to secure the stapler to the tissue. Although most surgical staples are biologically inert and remain permanently in the body, biologically absorbable metallic staples are also known. Surgical staplers made of non-metallic resin materials, on the other hand, can be made bioabsorbable or nonabsorbable.

[0005] Also, from a cost standpoint, there is an interest in single-use surgical staplers that can reduce many operations such as disassembly, cleaning, reassembly, and sterilization, and that do not impair the efficiency of surgical operations. Was growing. For example, U.S. Patent Nos. 4,354,628 and 4,383,
Nos. 634 and 4,527,724 disclose single-use surgical staplers. Surgical staplers are also known that are used to sew a plurality of staples arranged in a straight line or a plurality of staples arranged in an interleaved manner into compressed biological tissue. It is commonly used for lesions in the esophagus, stomach, duodenum, small intestine and large intestine, for excision of affected parts or occlusion of tissues and organs, or in anastomosis and for organ occlusion in thoracic and abdominal shaping procedures.

This type of well-known pulmonary and intestinal surgical stapler and PCT application WO 83/0224 by Freund et al., Published July 7, 1983, are incorporated herein by reference.
A similar stapler described in U.S. Pat. No. 7 is configured to drive staples from a staple-filled staple cartridge or staple cartridge into compressed biological tissue. These staplers have a jaw with an anvil, a staple cartridge, usually including a removable staple cartridge, and a lever.

[0007] Such a stapler has one lever,
A jaw having a free end and a support end, usually having a positioning pin hole formed adjacent thereto, a staple cartridge having a positioning pin passage, or a cartridge assembly for removably storing the staple cartridge, and a positioning pin. . The locating pin extends through a through passage in the staple cartridge to a locating hole in the anvil jaw to reach a locating position. After use, the staple cartridge can be moved to a release position, that is, a non-engagement position away from the positioning through passage and the positioning hole. In this case, the staple cartridge can be removed and the cartridge can be replaced.

In such a surgical stapler, the cartridge assembly is movable in one direction, and the anvil has an anvil surface substantially orthogonal to the one direction. When the locating pin extends through the through passage in the staple cartridge to the locating hole in the anvil jaw (ie, when the locating pin is in the locating position), the anvil surface faces the staple cartridge surface that stores unused staples. I do. The cartridge assembly is movable between a closed or stapling position where the staple cartridge and the anvil surface are close to each other, and a release position which is spaced apart from the closed position.

[0009] A staple cartridge of a general stapler is positioned at a position close to the tissue to be stapled. At this time, the anvil / jaw is approaching the tissue, and the positioning pin has moved to the positioning position. Movement of the first lever of the stapler moves the staple assembly toward the anvil to position the staple cartridge in a closed position for driving staples. Then, when the second lever is moved, the staple is driven into the living tissue.

[0010] In surgical procedures, clamping forces can result in high compression of the tissue, especially to ensure proper hemostasis of the tissue to be sutured. However, with conventional surgical staplers, the degree of clamping force is adjusted differently in each case of the surgical procedure, but such clamping force may cause some trauma to the sandwiched tissue.

In the case of a very strong clamping force, in a conventional surgical stapler having no engaging locating pins, the anvil portion and the staple cartridge are laterally displaced from each other, ie, the anvil portion is transverse to the long axis of the stapler. Or the staple cartridge is displaced in the lateral direction opposite to the direction of displacement of the anvil portion, and stapling may fail. Further, it is necessary to prevent the anvil portion from being deformed or escaping when the living tissue is held or staples are driven.

If the staples in the staple cartridge and the anvil surface are positioned relative to each other by moving a positioning pin to a positioning position before driving the staple, for example, before suturing the tissue between the anvil and the staple cartridge, Failure of the ring is prevented, and the staples to be driven can be driven into the intended position more accurately. Further, by moving the positioning pin to the positioning position, it is possible to prevent the tissue from coming out from between the anvil and the staple cartridge when the cartridge assembly is clamped on the intended tissue.

In the conventional stapler, the staple is driven between the anvil and the staple cartridge, that is, the tissue is sutured in a state where the positioning pin is not positioned at the positioning position. Face problems. It is difficult to determine whether the locating pins of a conventional stapler are engaged, especially during surgery. Inadvertently, the positioning pin may fail to move to the positioning position. Also, if the locating pins do not move to the locating position before suturing the tissue between the anvil and the staple cartridge, the tissue to be sutured may fall out of the space between the anvil and the staple cartridge, which may result in incomplete suturing. And other undesirable consequences. Further, if the locating pins do not move to the locating position before the staples are driven in, the staples may not be sutured well. Conventional staplers also present various problems because it is difficult to tell if a staple in a cartridge has been used. In a surgical procedure that requires stapling the same patient many times, empty cartridges after the staples have been driven are inadvertently left in the stapler or used cartridges tend to fire. The stapler may have been inadvertently loaded. If the stapler is still loaded with a staple cartridge other than a suitable unused staple cartridge, and the stapler is stapled to the tissue to be sutured, the compressive force of the stapler harms the tissue and causes unnecessary trauma. Will be. In such a case, stapling the living tissue intended to be stapled with a stapler having an inappropriate staple cartridge after use, or (2) stapling with a stapler having an empty staple cartridge. Performing a ring operation; (3) re-preparing a suitable unused stapler thereafter; (4) re-applying the stapler to the intended biological tissue; (5) re-firing the staple; The sequence of operations wastes valuable time during the surgical procedure. In addition, staplers may be used in procedures where a surgeon uses a scalpel to make an incision near the suture site. In such a procedure, if a used stapler cartridge is used by mistake, the patient undergoing the procedure may cause unnecessary bleeding and tissue damage due to inappropriate hemostasis. As a conventional surgical device having a cutting tool, there has been a linear cutter such as a “Proxymate” linear cutter 55 sold by Ethicon. This is a device that has the function of cutting off alternate tissues in total of four rows with a knife, two rows on each side. That is, linear suturing and separation are performed simultaneously, but the firing knob on the anvil half has to be slid linearly in order to operate. Actuating the firing knob while holding the living tissue to be sutured or cut requires approximately 120 minutes, as in the case of suturing and resection of the stomach.
In surgery on a long part of mm, both hands must be used, and there is a problem that suturing and resection work may cause blurring due to the use of both hands. Therefore, suture and resection can be easily performed by one action with one hand. The emergence of devices that can do this was required.

A safety device for a surgical stapler cartridge for preventing staples from being hit is disclosed in US Pat. Nos. 4,863,088, 4,955,959 and US Patent Application No. 07/629. 597. The driving mechanism in those staplers continuously drives and closes staples into tissue. As each staple closes the tissue one after another, the force required to drive the staple is
All staples are generally less than the force required to drive a stapler that is closed in tissue at the same time.

US Patent No. 4,527,72 to Shaw et al.
No. 4 describes a surgical stapler similar to the surgical stapler sold by Ethicon, Inc. of Summerville, NJ, under the trade name "Proxymate". The stapler has a lockout device that prevents rotation of the adjustment knob for the stapler to clamp tissue if the locating and retaining pins do not move to the operative position. However, this lockout device operates until the user moves the locating pin and the retaining pin to the operative position. Once the user has moved the locating pin and the retaining pin to the operative position, the lockout device is configured to not return. Thus, to deactivate the lockout device, the user need only move the pin to the operative position and release it from the operative position. However, the stapler does not have a pin or other device to hold its working position when the stapler clamps tissue.

[0016] Surgical staplers having two more levers are also known, an example of which is disclosed in US Pat.
7,976 and 5,452,836. These are surgical staplers having a body and a gripping handle down from the body. The clamping lever and the firing trigger are likewise lowered from the body and pivotally mounted on the body for actuation. Initially, the surgeon is positioned so that he can hold the handgrip with his palm and extend his fingers to grab and pull the clamping lever. When the lever is pulled, the clamping lever pivots counterclockwise toward the handgrip handle. When that happens, the firing trigger will be approximately 45
Turn from the original position of 旋回 to the intermediate position, which was the initial position of the clamping lever. Thus, once the surgeon pulls the clamping lever completely, the clamping lever reaches a position adjacent to the handle. The surgeon can then grab the firing trigger and pull the firing trigger. When the firing trigger is pulled, staples are fired,
The suturing of the living tissue is completed. However, in such an apparatus, it is not considered that the living tissue is sutured with one touch and cut at the same time. Locking the positioning pin to the jaw is not considered.

[0017]

According to the present invention, a main body having a handle; a lock pin;
A suturing tool comprising a jaw having an anvil and a staple cartridge; a first lever interlocking with the lock pin and positioning the staple cartridge with respect to the jaw;
A surgical suturing instrument having a second lever for performing a suturing operation, the first lever moving and locking the staple cartridge sequentially from an initial release position to an intermediate lock position to a final lock position. Is set,
When the first lever is moved from the release position to the intermediate locking position, the lock pin is locked to the pin lock bar of the jaw to position the anvil with respect to the staple cartridge, and the staple cartridge moves between the staple cartridge and the anvil. A surgical suturing instrument is provided, which is moved to a position for temporarily holding biological tissue.

Further, according to the present invention, a main body having a handle; a lock pin; a cutting tool; a suturing tool comprising a jaw having an anvil and a staple cartridge; And a second lever for performing a cutting operation simultaneously with a suturing operation with one touch. One or more rows of staple stitches are provided on both sides of the cut portion, and both stitches are performed. A surgical suturing and cutting instrument for cutting between partial tissues, wherein a first lever is set to sequentially move and fix a staple cartridge from an initial release position to an intermediate lock position and a final lock position.
When the lever is moved from the release position to the intermediate locking position, the lock pin is locked to the pin lock bar on the jaw to position the anvil with respect to the staple cartridge, and the staple cartridge holds tissue between the staple cartridge. A surgical suturing and cutting instrument is provided, which is moved to a temporary holding position. The surgical suturing instrument of the present invention includes a main body having a handle as a component. The handle is used when the operator holds the surgical suture cutting instrument of the present invention for operation. The main body houses the main mechanism of the device of the present invention, and further has a rotation axis of the first lever and the second lever.

According to the surgical suturing instrument of the present invention, when a living tissue to be sutured is sandwiched between the staple cartridge and the anvil surface, the living tissue is prevented from falling off and the staple is prevented from being displaced from the anvil surface. And a lock pin for preventing deformation of the anvil surface. The surgical suturing instrument of the present invention has a suturing tool comprising a jaw having an anvil and a staple cartridge. The anvil surface of the anvil faces the staple cartridge surface, and the anvil surface has a concave portion for folding the corresponding staple when the staple is fired and suturing the living tissue. The recesses correspond to all the staples held by the staple cartridge. The jaw holds the anvil, lock pin hole for receiving and locking the lock pin, extends to the bottom of the lock pin hole, locks and locks the lock pin, prevents falling off of living tissue, and staples. It has a pin lock bar for preventing displacement and misalignment between the surface and the anvil surface. Further, a lock pin release button for releasing the lock of the lock pin can be provided. The jaw has a base portion which is a connection portion with the main body, and an end portion. The lock pin release button can be provided at the base portion, and a lock pin hole is provided at the end portion. The lock pin may be formed by one bar, but may also be formed by two or more bars.

The staple cartridge is set in a staple assembly that is linked to the first lever.
If the surgical suturing instrument of the present invention is to be used only once, then the staple cartridge can be integral with the staple assembly. When the staple cartridge is detachable, the surgical suturing instrument of the present invention can be used a plurality of times by exchanging the staple cartridge. Staples for suturing are stored in the staple cartridge. The staples on the staple cartridge surface are arranged in one or more rows, and each row is composed of a plurality of staples. The direction of each staple and the direction of the staple row are each independently, depending on the nature of the living tissue to be sutured,
The staple cartridge may be assembled in a direction parallel to the length direction of the staple cartridge surface, at an angle, at a right angle, or a combination thereof. The surgical suturing instrument of the present invention has a first lever interlocking with the lock pin and positioning the staple cartridge relative to the jaw. The first lever has its rotating shaft in the main body, and is set so as to sequentially move and fix the staple cartridge from an initial release position to an intermediate lock position and a final lock position. While moving to the intermediate lock position, the lock pin is locked and fixed to the pin lock bar on the jaw to position the staple cartridge with respect to the anvil,
In addition, the staple cartridge moves to a position where the tissue is temporarily held between the staple cartridge and the anvil.

The first lever is slightly biased in a direction opposite to the handle. When in the release position, it extends in a direction substantially perpendicular to the longitudinal direction of the main body from the rotation shaft in the main body. The operator operates the first lever by holding the handle with one hand and hanging the finger on the first lever. In the release position, the first lever is movable only in the handle direction. The first lever can be moved in any direction from the release position to the temporary lock to the intermediate lock position. As a result, the operator can freely change the position and direction of the living tissue sandwiched between the anvil and the staple cartridge, and can specify the optimum suture site. When the operator specifies the optimal suture site, the operator locks the first lever in the intermediate locking position. At this stage, the surgeon can further check that the suture site is optimal. If it is determined that there is a further optimum part, the lock can be released from the intermediate lock by pressing the lock release button. If it is determined that the intermediate lock portion is optimal, the operator further moves the first lever toward the handle to lock the first lever in the final lock position. When the first lever is locked in the final lock position, the staple cartridge is fixed close enough to completely clamp the living tissue to be sutured to the anvil. The distance between the staple cartridge and the anvil is appropriately adjusted depending on the thickness of the living tissue to be sutured, and is about 2.5 to 4 mm for a thick internal tissue or the like and about 0. 4 mm for a thin tissue.
5 to 1 mm, thus usually 0.5 mm to 4 mm,
Preferably, it is in the range of 1 to 2.5 mm.

When the first lever is at the release position, the tip of the lock pin is housed in the staple cartridge. As the first lever moves toward the temporary lock position, the tip of the lock pin moves from the staple cartridge toward the jaw. When the first lever is provisionally locked, the lock pin is locked and fixed to the pin lock bar. This locked state is maintained from the provisional lock to the final lock state, and the anvil tip is twisted due to the repulsive force of the sandwiched living tissue, causing inconsistency between the anvil surface and the staple cartridge surface. To prevent That is, in the step of moving the first lever from the temporary lock position to the final lock position, the lock pin is always engaged so that the anvil is always parallel to the staple cartridge surface against the repulsive force from the living tissue on the anvil. Has been stopped. The surgical suturing instrument of the present invention has a second lever for performing a suturing operation with one touch. The second lever is further away from the handle than the first lever when the staple cartridge is in the release position, the operator is in a position where the second lever cannot be operated, and any force is applied to the second lever. You can't do anything with it. This state and position are maintained until the first lever is provisionally locked in the provisionally locked position. When the first lever moves to the intermediate lock position and further starts moving to the final lock position, the second lever at the initial position generally moves to the release position of the first lever from a certain stage up to the final lock position. The movement of the second lever toward the operation start position is started. This step is optional if the second lever is set to the operation start position when the first lever is locked in the final lock position, and may be the time when the first lever starts moving to the final lock position. And the first
Only when the lever is fixed in the final locked position, the second lever is interlocked with the staple assembly, and the suturing operation can be performed. The second lever can take two positions, an operation start position and an end position, and cannot be stopped at an intermediate position between them. By this one-touch operation from the operation start position to the end position, staples are fired against the living tissue sandwiched between the anvil surface and the staple cartridge, and the staple legs are bent at the recesses on the anvil surface to be bent. Is sutured. Thereby, the suturing of the living tissue is completed.

The sutured living tissue is still sandwiched between the anvil surface and the staple cartridge. Then, when the lever lock release button is pressed, the two levers are released, and the staple cartridge is also released in the release position direction. At this time, the lock pin may be released at the same time. At this stage, the lock pin is not released, and the lock pin is released by pressing the pin lock release button independently of the lever lock release button. May be released. By making the release of the lock pin independent of the lever lock release button, it is not necessary to link both functions, so the structure can be simplified, and the lever can be released while the lock pin is locked. Since it is possible to clearly indicate that the used staple cartridge has been used, it is possible to prevent an inadvertent empty staple cartridge from being hit. When the lock pin is released, the lock pin tip is stored in the staple assembly. This frees the living tissue from the anvil and staple cartridge and allows the surgical suturing instrument to be removed from the living tissue. By moving the first lever in the release position to the intermediate lock position while operating the pin lock release button, the living tissue can be sutured without locking the lock pin on the anvil side. Is also good. By doing so, the anvil can be inserted into the intestinal tract and used, so that the use in surgery can be expanded, and it is not necessary to release the lock of the pin each time, and the surgery can be advanced quickly. There are cases.

Next, the surgical suturing instrument of the present invention is basically configured in the same manner as the surgical suturing instrument except that it further has a cutting tool. Accordingly, the surgical suturing instrument of the present invention comprises a body having a handle and further having a lock pin. The cutting tool of the surgical suturing and cutting instrument of the present invention has a blade for cutting, and the shape of the blade is arbitrary depending on the living tissue to be cut, such as a linear shape, a curved shape, and a V-shape, but is usually Is preferably linear in order to reduce lateral displacement of the living tissue at the time of cutting. In addition, the blade at the time of cutting is substantially parallel to the anvil surface and moves substantially perpendicular to the anvil surface, that is, in parallel with the moving direction of the staple cartridge, to cut the living tissue in order to prevent the bias of the living tissue.

The surgical suturing and cutting instrument of the present invention has a suturing tool comprising a jaw having an anvil and a staple cartridge. The anvil surface of the anvil faces the staple cartridge surface, and a cutting tool storage groove for storing the blade of the cutting tool after cutting the living tissue is provided on the anvil surface in a shape corresponding to the shape of the cutting tool. By providing such a groove, the living tissue is completely cut, and failure of the cutting is prevented. At the center of the staple cartridge surface, a cutting tool through passage is provided in the length direction thereof. The staples on the staple cartridge surface are arranged in one row or two or more rows on both sides of the cutting tool through path, and each row is composed of a plurality of staples. The direction of each staple and the direction of the staple row may be either parallel or oblique to the cutting tool penetration path,
Or it may be a right angle.

The surgical suturing and cutting instrument of the present invention has the same first lever as the above-mentioned suturing instrument, and it is possible to select and specify an optimum suture and cutting site. When the operator has identified the optimal suture cut site, the operator locks the first lever in the intermediate locking position. At this stage, the surgeon can further check that the suture cut site is optimal. If it is determined that there is a further optimum part, the lock can be released from the intermediate lock by pressing the lock release button. If it is determined that the intermediate lock portion is optimal, the operator further moves the first lever toward the handle to lock the first lever in the final lock position.

The surgical suturing and cutting instrument of the present invention has a second lever for performing a cutting operation with a single touch simultaneously with a suturing operation. The second lever is initially in an initial position distal from the handle and the operator cannot operate the second lever. And the second lever in the initial position is the first lever
When the lever moves to the intermediate lock position and further starts moving to the final lock position, the movement to the operation start position of the second lever starts from a certain stage up to the final lock position. This step may be at the start of the movement of the first lever to the final lock position if the second lever is set to the operation start position when the first lever is locked at the final lock position, and is optional. The second lever is interlocked with the staple assembly only when the first lever is fixed at the final locked position, and the suturing operation and the cutting operation are enabled. When the second lever is moved from the operation start position to the start position, stapling is performed, staples are fired against the living tissue sandwiched between the anvil surface and the staple cartridge, and the staple feet are moved toward the anvil surface. The living tissue is bent by the concave portion and sutures the living tissue. Immediately thereafter, the cutting tool is ejected from the body direction through the cutting tool penetrating passage in the center of the staple cartridge, and the cutting tool is activated to activate the living tissue between the two staple stitching portions. The tissue is cut, and the cutting blade reaches the cutting blade storage groove on the anvil surface. Thereby, the suture cutting of the living tissue is completed. Here, in the surgical suturing and cutting instrument of the present invention, the moving direction of the tissue cutting blade of the cutting tool is parallel to the moving direction of the staple cartridge.
By adopting such a configuration, suturing and resection can be performed without applying unnecessary load by deforming the living tissue, and one-touch suture cutting of the living tissue is enabled.

The sewn living tissue is still sandwiched between the anvil surface and the staple cartridge. Then, when the lever lock release button is pressed, the two levers are released, and the staple cartridge is also released in the release position direction. At this time, the lock pin may be released at the same time.At this stage, the lock pin is released without pressing the pin lock release button independently of the lever lock release button. The pins may be released. When the lock pin is unlocked and the lock pin is released, the lock pin tip is housed in the staple assembly. This frees the living tissue from the anvil and staple cartridge and allows it to be removed from the surgical suture cutting instrument without damaging the living tissue. In the case of single use, the cutting tool may be released by a lever lock release button, but it can be kept locked to prevent an accident due to the cutting blade. On the other hand, when used repeatedly, the cutting blade may be released together with the staple cartridge by the lever lock release button, or a cutting blade release button may be provided independently. In this case, the cutting blade needs to be replaceable as in the case of the staple cartridge in order to prevent contamination by body fluid such as blood or biological tissue attached to the cutting blade.

[0029]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described in more detail with reference to the drawings. One embodiment of the surgical suture cutting instrument of the present invention is shown in FIGS. FIG. 1 is a front view of the surgical suture cutting instrument of the present invention. The surgical suture cutting instrument of the present invention can observe the case 1, the handle 2, the release button 30, the first lever 10, the second lever 50, the suture tool 70, and the jaw 90. The first lever 10 moves the staple cartridge 71 from the initial release position to an intermediate lock position,
When the first lever 10 is moved from the release position to the intermediate lock position, the lock pin is locked and fixed to the pin lock bar of the jaw 90 to move the anvil 91 to the final lock position. The staple cartridge is positioned with respect to the staple cartridge, and moves to a position where the staple cartridge temporarily holds the tissue with the anvil 91.

First, the operation of the first lever will be described with reference to FIG. The surgeon grasps the handle 2 and the first lever 10,
The first lever 10 is pulled toward the handle. The first lever 10 first moves to the intermediate lock position around the first lever rotation shaft 11. At this time, the link arm A1
2 is pushed while being rotated in the anvil direction by a link shaft A13 at one end thereof, and the link arm A12 further moves the link shaft B15 straight in the anvil direction, thereby moving the inner plate 14 composed of two plates in the anvil direction. Press The two plates constituting the inner plate 14 are fixed at a fixed distance by a plurality of columns.

A link arm B19 is provided between the two plates of the inner plate 14, one end of which is rotatably fixed to the guide pin 16, and the intermediate portion thereof is fitted into the elongated hole 17 of the inner plate 14. There is an operating pin 18,
The other end of the link arm B19 is engaged with the end of the lock pin arm 20. When the inner plate 14 is pushed in the direction of the anvil, the elongated hole 17 pushes the operating pin 18 to rotate the distal end of the link arm B19 toward the anvil, thereby moving the link arm B19 to a greater extent than the moving width of the inner plate 14.

The distal end of the link arm B19 is engaged with the lock pin arm 20 by a link shaft C21. The lock pin arm 20 pushes down the lock pin 22 by a predetermined stroke, engages with the ratchet pin 23 of the ratchet mechanism provided inside the anvil, and is fixed to the jaw 90. That is, the ratchet pin 23 is urged upward in the figure by an urging means 24 such as a coil spring or the like, and has a tapered surface at the tip. The lock pin 22 pushes down the ratchet pin 23 against the urging means 24 along the tapered surface, and fits with the ratchet pin 23 by passing through the ratchet pin, and is fixed to the jaw 90. A staple cartridge 71 is mounted between the tip portions of the two inner plates 14, and the inner plate 14
The staple cartridge 71 is moved and pushed out with respect to the two guide pins 16 and 16 ′ fitted into the elongated holes to approach the staple cartridge 71 to a position about 10 mm from the anvil surface and is held parallel to the anvil surface. As shown in FIG. 6, the staple cartridge has a cutting tool through hole 81 through which a cutting tool passes in a cutting operation at a longitudinal center portion thereof, and at least one row or two or more rows alternately arranged on both sides thereof. Staple rows. The intermediate lock is the first
The first lever 10 is provided at the tip of the lever 10 on the side opposite to the lever.
This is performed by the ratchet groove 32 being engaged with the tip of the ratchet lever 31. The ratchet lever 31 has a release button 30 on the opposite side, and
It rotates in a state of being biased about.

Next, the operation when the first lever is moved to the completely locked position will be described with reference to FIG. 1st lever 1
When 0 is further squeezed from the intermediate lock position 6 and moved toward the handle, the inner plate 14 and the staple cartridge 71 further move toward the anvil.
When the staple cartridge 71 approaches the anvil up to the position where the living tissue is completely sandwiched between the staple cartridge 71 and the anvil 91, that is, the final locking position, the distal end of the ratchet lever 31 is engaged with the second ratchet groove 34 and engaged therewith. Then, the staple cartridge 71 is fixed at that position. As the first lever 10 moves from the intermediate lock position 6 to the full lock position 7, the cam ridge 52 of the center plate 53 is disengaged from the cam 51 on the top of the second lever, and the second lever urged in the first lever direction. Reference numeral 50 moves from the operation start position 61 to the start position 62.

The operation in stapling and cutting will be described with reference to FIG. 4. When the second lever 50 is squeezed from the operation start position 62 toward the handle, the cam 51 disposed on the top of the second lever 50 is moved to the center plate 53. Acting on the end face 54, the center plate 53 is moved along the two guide pins 16, 16 'to the anvil side in the elongated hole. The tip of the center plate 53 has a cutter 55
The staple pusher plate is attached and fixed to both sides of the center plate. First, the staple pusher plate pushes all staples in the staple cartridge against the anvil surface to perform stapling. Then, the cutter mounted on the center plate moves parallel to the stapling direction, and cuts the stapled living tissue.

Next, a procedure for releasing the living tissue from the suture cutting instrument will be described with reference to FIG. First, by moving the lock pin release button 95 in the direction opposite to the anvil 91, the ratchet pin 23 is disengaged from the position where the ratchet pin 23 meshes with the lock pin 22, and is ready to move to the initial position. Next, when the release button 30 is pressed, the ratchet lever 31 engaged with the ratchet groove 34 at the end of the first lever 10 is pressed.
Of the first lock position 7
Since the lever 10 is biased, the lever 10 returns to the lever operation start position 5. When the first lever 10 returns to the lever operation start position 5, the center plate 53 is also returned to the initial position, so the second lever 50 linked via the cam 51.
Also returns to the initial position 61. At this time, inner plate 1
4. The center plate 53 is also returned to the initial position.
When the inner plate 14 returns to the initial position, it also acts on the operating pin 18 of the link arm B19 to pull the lock pin back to the initial position. By the above operation, the cut living tissue can be released from the suture cutting instrument.

The main aspects of the present invention are shown below. 1. A body having a handle; a lock pin; a suturing tool comprising a jaw having an anvil and a staple cartridge; a first lever interlocking with the lock pin and positioning the staple cartridge with respect to the jaw; A second lever, the first lever being configured to sequentially move and fix the staple cartridge from an initial release position to an intermediate lock position to a final lock position. When the lock is moved from the release position to the intermediate locking position, the lock pin is locked and fixed to the pin lock bar of the jaw to position the anvil with respect to the staple cartridge, and the staple cartridge moves the living tissue between the staple cartridge and the staple cartridge. A surgical suturing instrument, which moves to a position where it is temporarily held. 2. The method according to claim 1, wherein the first lever further moves to the final lock position after the first lever moves to the intermediate lock position, and the second lever at the initial position moves toward the operation start position. Surgical suturing instruments. 3. First
When the lever is locked in the final locked position, the staple cartridge is approached and locked to a position for completely clamping the tissue, 1.0 to 2.5 mm from the anvil, and the second lever is located at the operation start position. The surgical suturing instrument according to the above 1 or 2, characterized in that: 4. In the step of moving the first lever from the intermediate locking position (the position where the tissue is temporarily held) to the final locking position, the anvil is always parallel to the staple cartridge surface with respect to the repulsive force from the living tissue applied to the anvil. 4. The surgical suturing instrument according to any one of 1 to 3, wherein the surgical suturing instrument is always locked. 5. The surgical suturing instrument according to any one of 1 to 4, wherein stapling is performed when the second lever is moved from the operation start position to the start position.
6. The surgical suturing instrument according to any one of the above items 1 to 5, further comprising a pin lock release button capable of independently releasing the pin lock. 7. 7. The living tissue can be sutured without locking the lock pin to the anvil side by moving the first lever in the release position to the intermediate lock position while operating the pin lock release button. Surgical suturing instruments.

11. A body having a handle; a lock pin; a cutting tool; a suturing tool comprising a jaw having an anvil and a staple cartridge; a first lever interlocking with the lock pin and positioning the staple cartridge with respect to the jaw; At the same time, there is provided a second lever for performing a cutting operation with one touch, and one or two or more rows of staple stitches are provided on both sides of the cut portion, and surgical suturing for cutting between the two stitch portions tissue A cutting instrument,
The first lever is set to sequentially move and fix the staple cartridge from an initial release position to an intermediate lock position and a final lock position. When the first lever is moved from the release position to the intermediate lock position, a lock pin is provided. A surgical instrument, wherein the staple cartridge is fixed to a pin lock bar of the jaw to position the anvil with respect to the staple cartridge, and the staple cartridge is moved to a position for temporarily holding living tissue between the staple cartridge and the anvil. Suture cutting instrument. 12. 12. The surgical method according to 11, wherein the first lever further moves to the final lock position after moving to the intermediate lock position, and the second lever at the initial position moves toward the operation start position. Suture cutting instrument. 1
3. When the first lever is locked in the final locked position, the staple cartridge is 1.0 to 2.5 m from the anvil.
13. The surgical suturing and cutting instrument according to the above item 11 or 12, wherein the second lever is arranged at an operation start position, and is fixed to a position for completely holding the tissue.
14． In the step of moving the first lever from the intermediate locking position (the position where the tissue is temporarily held) to the final locking position, the anvil is always parallel to the staple cartridge surface with respect to the repulsive force from the living tissue applied to the anvil. 11 to 13 which are always locked.
The surgical suturing instrument according to any one of the above. 15. Second
15. The stapling is performed when the lever is moved from the operation start position to the activation position, and immediately thereafter, the cutting tool is activated to perform tissue cutting, wherein the tissue is cut. Surgical suture cutting instrument. 16. The moving direction of the tissue cutting blade of the cutting tool is parallel to the moving direction of the staple cartridge.
The surgical suture / cutting instrument according to claim 1. 17． The above 11 having a pin lock release button which can release the pin lock independently.
The surgical suturing and cutting instrument according to any one of claims 1 to 16. 18. By moving the first lever in the release position to the intermediate lock position while operating the pin lock release button, the living tissue can be sutured and cut without locking the lock pin on the anvil side. The surgical suture / cutting instrument according to claim 1.

21. A suturing tool comprising a jaw having an anvil and a staple cartridge; a cutting tool for cutting biological tissue; a first lever for positioning the staple cartridge with respect to the jaw; and simultaneously performing a suturing operation and a cutting operation. A surgical suturing and cutting instrument having a second lever, wherein a tissue cutting operation direction of the cutting tool is parallel to a stapling direction. 22. A staple cartridge having a cutting tool through-hole at the center in the longitudinal direction through which the cutting tool passes in a cutting operation, and having at least one row or two or more rows of staples alternately arranged on both sides thereof; 22. The surgical suturing and cutting instrument according to 21 above, further comprising a cutting tool storage groove. It should be noted that the scope of the present invention should not be limited to the description described in this specification, but should be construed only by the description in the claims or the equivalent thereof.

[0039]

The lock pin is locked and locked to the ratchet pin of the jaw to prevent the living tissue from protruding from the anvil surface, and to surely prevent the staple surface from being displaced from the anvil surface. Furthermore, the living tissue can be cut at the same time as suturing with one touch.

[Brief description of the drawings]

FIG. 1 is a front view of a surgical suturing and cutting instrument according to one embodiment of the present invention in a released position.

FIG. 2 is a front view of the surgical suture / cutting instrument of FIG. 1 in an intermediate temporary lock position.

FIG. 3 is a front view of the surgical suturing and cutting instrument of FIG. 1 being moved from a temporary lock position to a final lock position and locked.

FIG. 4 is a front view of the surgical suturing and cutting instrument of FIG. 1 when firing staples and cutting biological tissue at the same time.

5 is a front view of the surgical suture and cutting instrument of FIG. 1 being returned to a release position after a suture cut.

FIG. 6 is a front view of the staple cartridge as viewed from the jaw side.

FIG. 7 is a plan view of the surgical suturing and cutting instrument according to one embodiment of the present invention in the released position.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Case, 2 ... Handle, 10 ... 1st lever, 1
DESCRIPTION OF SYMBOLS 1 ... 1st lever rotating shaft, 12 ... Link arm A, 13
... Link shaft A, 14 ... Inner plate, 15
... Link shafts B, 16, 16 '... Guide pins, 1
7 ... elongated hole, 18 ... operating pin, 19 ... link arm B, 20 ... lock pin arm, 21 ... link shaft C, 22 ... lock pin, 23 ... ratchet Pin, 24
... urging means, 30 ... release button, 31 ... ratchet lever, 32 ... first ratchet groove, 33 ... support shaft, 3
4 ... second ratchet groove, 50 ... second lever, 51 ...
・ Cam, 52 ・ ・ ・ Cam peak, 53 ・ ・ ・ Center plate, 5
4 ... Center plate end face, 70 ... Suturing tool, 71 ...
Staple cartridge, 81 ··· Cutting tool through hole, 90 ·
..Jaw, 91 ... Anvil, 95 ... Lock pin release button

Claims (6)

[Claims] A body having a handle; a lock pin;
A surgical tool having a jaw having an anvil and a staple cartridge; a first lever interlocking with a lock pin and positioning the staple cartridge with respect to the jaw; and a second lever for performing a suturing operation. A suturing instrument, wherein the first lever is set to sequentially move and fix the staple cartridge from an initial release position to an intermediate lock position and a final lock position;
When the lever is moved from the release position to the intermediate locking position, the lock pin is locked to the pin lock bar of the jaw to position the anvil with respect to the staple cartridge, and the staple cartridge is moved between the anvil and the living tissue. A surgical suturing instrument, wherein the surgical suturing instrument is moved to a position where it is temporarily held. 2. After the first lever has moved to the intermediate lock position, the first lever further starts to move to the final lock position.
The surgical suturing instrument according to claim 1, wherein the second lever at the initial position moves toward the operation start position. A body having a handle; a lock pin;
A cutting tool; a suturing tool comprising a jaw having an anvil and a staple cartridge; a first lever interlocking with a lock pin and positioning the staple cartridge with respect to the jaw; performing a cutting operation with one touch simultaneously with the suturing operation. A surgical suturing and cutting instrument for performing one or more rows of staple suturing on both sides of a cutting portion and cutting between the two suturing tissues. Is set to sequentially move and fix the staple cartridge from an initial release position to an intermediate lock position and a final lock position. When the first lever is moved from the release position to the intermediate lock position, the lock pin is moved to the jaw portion. The anvil is locked and fixed to the pin lock bar to position the anvil with respect to the staple cartridge. Thus being moved to a position to temporarily hold the living tissue with the Le, surgical suturing cutting instruments. 4. After the first lever has moved to the intermediate lock position, the first lever further starts to move to the final lock position,
The surgical suture cutting instrument according to claim 11, wherein the second lever in the initial position moves toward the operation start position. 5. A suturing tool comprising a jaw having an anvil and a staple cartridge; a cutting tool for cutting a living tissue; a first lever for positioning the staple cartridge with respect to the jaw; a suturing operation and a cutting operation A surgical suturing and cutting instrument having a second lever for simultaneously performing the steps (a) and (b), wherein a tissue cutting operation direction of the cutting tool is parallel to a stapling direction. 6. A staple cartridge has a cutting tool through hole through which a cutting tool passes in a cutting operation at a longitudinal center portion thereof, and at least one row or two or more staple rows arranged alternately on both sides thereof. 3. A cutting tool storage groove on an anvil surface.
The surgical suturing and cutting instrument according to claim 1.