JP2006187649A - Suturing/ligaturing implement applier - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a suturing/ligaturing implement applier which can suture/ligature body tissue more assuredly. <P>SOLUTION: It consists of an elongated insertion section 3 which has a leading edge and a proximal end, two elongated legs 121 which are prepared on the leading edge side of the insertion section 3 and have the leading edge and the proximal end, a suture/ligature implement 12 which can insert body tissue between these two legs 121 and has a proximal end section 122 to make a junction with the proximal end of these legs 121, a pressure means which is prepared movably for the insertion section 3 and pushes so that the plastic deformation of the suture/ligature implement 12 is performed, and an operation means 4 which is prepared on the proximal end of the insertion section 3 and moves the pressure means for the insertion section 3. The pressure means is characterized by pushing the suture/ligature implement 12 so that the leading edges are brought into contact with each other before the proximal ends of two legs 121 by moving to the insertion section 3 by the operation of the operation means 4. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a suturing / ligating applier for use in surgical operations and for suturing / ligating biological tissue.

  Conventionally, suture and ligation of living tissue has been performed with a needle thread or a clip or staple made of metal or resin. Among these, metal clips and staples use a clip having a shape as shown in Patent Documents 1 and 2 when ligating a blood vessel or the like, and show a patent document 3 when a tissue is sutured. A staple having such a shape was used.

Further, in the case of the current clip, a continuous type as shown in Patent Documents 4 and 5 is generally used. In order to facilitate the deformation of the suturing / ligating tool, there is also known a technique in which the thickness of the base end portion is reduced as in Patent Document 6.
US Pat. No. 3,326,216 U.S. Pat. No. 4,844,066 US Pat. No. 3,643,851 U.S. Pat. No. 4,325,376 U.S. Pat. No. 4,325,216 U.S. Pat. No. 4,449,530

  In these prior arts, a clip for ligating a blood vessel or the like was attached by compressing and deforming the leg portion of the clip from the outer periphery with a jaw as in Patent Documents 2 and 4, Due to the clip deformation method of compressing the part from the outer periphery, the structure of the applier must be complicated.

  Furthermore, since the structure of the applier is complicated, it is difficult to reduce the insertion diameter, particularly when used in endoscopic surgery, and generally the diameter is 10 mm or more. The insertion diameter is twice as large as that of φ5 mm, and the advantage of endoscopic surgery, which is minimally invasive, is incurred in order to open a hole of that double thickness in the human body. Further, since the deformation method is an operation to be sandwiched between the jaws, the vascular vessel may be directly gripped and damaged by the jaws in the event that a clip is not loaded.

  Further, in the case of Patent Document 3, the structure is simpler than that of a clip, and even if staples are not loaded, there is little risk of damaging the tissue by the operation. Therefore, even if the tissue was sutured, the vessel could not be ligated.

  Conventionally, when a vessel such as a blood vessel is ligated, a metal clip having a shape as in Patent Document 1 or Patent Document 2 has been used, and a continuous applicator as in Patent Document 5 is currently used. It is used.

  These clips need to have a distance between the legs of the two legs that is greater than the diameter of the intended vessel to be ligated, and the length of the legs must also be greater than the diameter of the intended vessel. It was. In addition, the base end portion connecting the two leg portions has a substantially triangular shape for facilitating deformation of the clip, so that the entire length of the clip is longer than the length necessary for ligation. Therefore, an unnecessarily large residue is to be kept in the living body.

  Further, generally, the clips are stored in a permutation state between the operation portion of the applier and the jaw as in Patent Document 4, but the number of clips that can be stored is about 20 because the length of the clips is long. It was as follows, and the clip could not be stored any more.

  Further, in the case of the staple as in Patent Document 3, the base end portion is deformed by pressing it from the rear side, but a strong force is required when deforming for the deformation method. In this operating means, it was necessary to generate a force several times larger than the force required to operate the operating means. At this time, the stroke for operating the operating means due to the moment relationship inevitably increases as the operating force increases with respect to the operating force, and therefore the operating stroke tends to increase. .

  In addition, in the case of a clip as in Patent Documents 1, 2, and 4, the base end portion of the clip has a substantially triangular shape in order to reduce the amount of force required for the deformation as described above. Has become unnecessarily large, leaving unnecessarily large residues inside the living body, or being unable to store many clips inside the applier.

  That is, as shown in FIG. 28 and FIG. 29, the conventional suturing / ligating tool 51 is indwelled in the living body, and is not toxic to the living body. Manufactured from titanium. Generally, in order to ligate the vessel 50 having the diameter D, the length of the leg portion 52 is required to be about twice as long. Naturally, the distance L1 between the two legs 52 must satisfy L1≥D. Here, in the case of the prior art, the base end portion 53 has a substantially triangular shape with an angle θ in order to easily deform the suture / ligator 51. Therefore, the total length is L 2 + m cos θ.

  When the appliers are stored in a permuted state, as shown in FIG. 29, a wasteful length of n is required for each of the two stitching / ligating tools 51, and the number of stitching / ligating tools 51 increases. The length increases, and as a result, the number of stitching / ligating tools 51 that can be stored in the storage section decreases. In an advanced endoscopic surgical operation called an advanced procedure that is being performed recently, more sutures and ligatures 51 are required than 20 suture and ligatures 51 stored in a conventional applier. However, about 30 are rarely required.

  However, as described above, the prior art can generally store only 20 pieces, and in such a case, two appliers are used. However, since the applier is generally disposable, the remaining ten or more suture / ligators 51 of the second applier are wasted.

  For such a situation, there are some which are easily deformed by reducing the thickness of the base end portion as in Patent Document 5, but in this case, the width of the base end portion is wide. There was also a problem that the applier that stored it became thick.

  Furthermore, since the adjacent portions of the two legs of the conventional clip or staple are not particularly structured to engage each other, the two legs face each other when the tissue is actually sutured or ligated. In such a case, there is a case where reliable suturing / ligating is hindered.

  Since the clip or staple is not provided with attachment means and clip or staple engagement means, when the clip or staple is attached to the living tissue, it may fall off before the attachment is completed, or during the attachment. The direction of the clip or stapler may change due to disturbance.

  Furthermore, when a biological tissue is sutured or ligated with the clip or staple, the clip or staple may slip off from the biological tissue after being attached, and the clip or staple is provided with a non-slip to prevent this. There was a need.

  The present invention has been made paying attention to the above circumstances, and an object of the present invention is to provide a suture / ligator applier that can suture and ligate a living tissue more reliably.

  In order to achieve the above object, according to the present invention, a first aspect of the present invention is an elongated insertion portion having a distal end and a proximal end, and an elongated 2 provided on the distal end side of the insertion portion and having a distal end and a proximal end. A suturing / ligating tool having one leg part and a base end part connected to the base end of the leg part so that a living tissue can be inserted between the two leg parts, and movable relative to the insertion part; A suturing / ligating tool comprising: a pressing means for pressing the suturing / ligating tool so as to be plastically deformed; and an operating means provided at a proximal end of the insertion portion to move the pressing means relative to the insertion portion. In the pliers, the suturing / ligating tool may be configured such that the pressing means moves with respect to the insertion portion by operation of the operating means so that the distal ends come into contact with each other before the proximal ends of the two leg portions. Suture and ligature appra characterized by pressing Located in Yarmouth.

  In a second aspect of the present invention, the pressing means according to the first aspect includes a first pressing portion that is disposed inside a proximal end portion of the suturing / ligating tool and presses a substantially central portion of the proximal end portion, and the proximal end portion And a second pressing portion that presses other than the substantially central portion of the base end portion.

  A third aspect of the present invention is characterized in that the second pressing portion according to the second aspect has a concave portion that abuts on the suturing / ligating tool and is plastically deformed.

  According to a fourth aspect of the present invention, the first pressing portion according to the second or third aspect is a support pin fixedly connected to the insertion portion, and the second pressing portion is operated with respect to the insertion portion by the operation of the operating means. It is a pusher that moves forward and backward.

  According to the suture / ligator applier of the present invention, a substantially U-shaped suture having two elongated legs having a distal end and a proximal end and a proximal end connected to the proximal ends of the two legs. -Since the ligature is closed from the tips of the legs, the biological tissues inserted into the two legs are less likely to come off, and the biological tissues can be sutured and ligated more reliably.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 22 show a first embodiment. FIG. 1 shows an applier 1 for attaching a suturing / ligating tool, which will be described later, to a living tissue. The applier 1 has an attaching means 2 for deforming the suturing / ligating tool and a trocar (not shown). The insertion part 3 which is an endoscopic means for inserting into a living tissue through the like, and the operation means 4 for operating the attachment means 2 are configured. Further, the insertion portion 3 is rotatable with respect to the operation means 4, and a knob 5 for performing the rotation operation is provided at a joint portion with the operation means 4 on the hand side of the insertion portion 3. .

  As shown in FIG. 2, the insertion portion 3 is composed of a substantially transparent upper insertion member 6 and lower insertion member 7 which are divided into upper and lower parts, and is assembled by covering the outer tube 8 after combining the both. Yes. The outer tube 8 is formed by a transparent heat shrinkable tube so that the inside of the insertion portion 3 can be confirmed.

  As shown in FIG. 1, the operation means 4 includes a movable handle 9 and a fixed handle 10, and the attachment means 2 can be operated by rotating the movable handle 9 with respect to the fixed handle 10. it can.

  Further, a lid body 11 is attached to the upper portion of the fixed handle 10 of the operation means 4 as will be described later. By opening and closing the lid body 11, the insertion portion 3 can be attached to and detached from the operation means 4, The inside can be cleaned and sterilized.

  Next, the structure of the attachment means 2 is shown in FIGS. The attachment means 2 has a guide member 13 that serves as a guide when attaching the suturing / ligating tool 12 to the tip, and the suturing / ligating tool 12 is loaded therein. The operation of loading the suture / ligator 12 and attaching it to the living tissue is performed by a pusher 14 as will be described later.

  The guide member 13 is provided with a support pin 15 that supports the suturing / ligating tool 12 when the suturing / ligating tool 12 is attached, so that the suturing / ligating tool 12 is supported without dropping forward. In the prior art, since there is no guide member 13 and the suturing / ligating tool 12 cannot be securely held, two support pins 15 are provided at an interval, so the distance between the leg portions 12a of the suturing / ligating tool 12 is the leg. Although it is relatively wide with respect to the entire length of the portion 12a, in this embodiment, since there is only one support pin 15 as the first pressing portion constituting the pressing means, the distance between the leg portions 12a is relatively narrow. In addition to being very effective for ligation of the blood vessels, the outer shape of the guide member 13 and the outer diameter of the insertion portion 3 can be reduced, which is effective in terms of minimal invasiveness.

  In general, the outer diameter of the insertion portion 3 of the applier 1 for attaching the suturing / ligating tool 12 to the living tissue is 10 to 12 mm, but in the case of this embodiment, the suturing to be used is performed by the simple structure as described above. -Since it is sufficient to secure 7 mm, which is a width necessary to store the ligature tool 12, further secure the thickness of the upper insertion member 6 and the lower insertion member 7 by 0.5 mm each, and the outer diameter of the insertion portion 3 And achieves φ8mm. In the prior art, the support pin 15 protrudes from the tip of the attachment means 2 and the risk of damaging the living tissue cannot be ignored. However, in the present embodiment, the support pin 15 is stored in the guide member 13. There is no fear of touching living tissue.

  Further, since the guide member 13 does not need to be so strong except for the portions where the support pins 15 are provided, the guide member 13 may be at least partially transparent so that the stitching and ligation operations can be easily observed. Therefore, the safety of the applier 1 is improved.

  The pusher as the second pressing portion is used to deform the suturing / ligating tool 12 into a predetermined shape when the suturing / ligating tool 12 is attached to the living tissue by the support pin 15 as the first pressing portion. 14 is provided with a concave portion 16. The support pin 15 and the pusher 14 constitute pressing means. Then, after attaching the suture / ligator 12 to the living tissue by the pressing means, an ejector 17 for releasing from the applier 1 is attached to the lower part of the suture / ligator 12 inside the guide member 13.

  The guide member 13 is fixed to the lower insertion member 7 constituting the insertion portion 3 with a pin 17a. A partition plate 18 is attached to the upper portion of the lower insertion member 7, and the suturing / ligating tool 12 is stored thereon. A storage means 19 is provided, and a holding spring 22 is attached to the upper insertion member 6 to hold the suturing / ligating tool 12 downward. Further, the whole is covered with the outer tube 8. Of the members constituting these insertion portions 3, the outer tube 8, the upper insertion member 6, and the lower insertion member 7 are transparently molded with a resin material as described above. The state is visible.

  The pusher 14 is provided with a latching portion 20 which is a transfer means for sending out the suturing / ligating tool 12 in the front row of the storage means 19. The storage means 19 is provided with a one-way clutch 21 so that the suturing / ligating tool 12 does not return backward. The applier 1 stores a plurality of, for example, 20 stitching / ligating tools 12a to 12t from the front end portion toward the rear end portion, but the number of the suturing / ligating tools 12 accommodated in the initial state. Is not particularly limited, and any number may be used depending on the target technique.

  In addition, as will be described later, in the present embodiment, if the same number of stitching / ligating tools 12 is used as compared with the prior art, the entire length of the stitching / ligating tools 12 row can be shortened. More suturing and ligating tools 12 can be stored in the interior of the device.

  Next, FIG. 7 to FIG. 9 show the configuration of the insertion side 3 from the substantially middle part to the hand side. A plate-like buffer 23 for urging the suture / ligator 12 row forward is engaged with the rear portion of the last suture / ligator 12t at the rear of the storage means 19, and this buffer 23 is clipped. It is biased forward by a spring 24. The rear portion of the clip pressing spring 24 is fixed to the proximal side of the insertion portion 3 by a spring holder 25. The buffer 23 is molded in a color tone such as a fluorescent color that is easy to see, and the buffer 23 moves forward each time the suture / ligator 12 is released, so that the remaining amount of the suture / ligator 12 can be determined. ing.

  Further, by arbitrarily setting the color tone, the number, type, and the like of the stored sewing / ligating tools 12 may be displayed. Or you may display by setting the color tone of each component which comprises the insertion part 3 arbitrarily. In such a case, for example, if the color of the guide member 13 is blue, the number of stitching / ligating tools may be 20, if it is red, the number may be 10. Of course, two or more colors may be used and displayed in combination. In general, in the operating room, the selection of equipment to be used is done by an assistant according to the operator's instructions, but the assistant does not judge whether it is the target equipment by reading the characters written on the equipment, but the shape, color, etc. Such color identification is very effective for preventing erroneous selection of equipment and improving the efficiency of the procedure because it is determined by an element that can be readily determined by appearance.

  A ratchet arm 26 is attached to the pusher 14, and a ratchet mechanism 28 is formed by ratchet teeth 27 attached to the lower insertion member 7. When the pusher 14 returns in the middle of operation, a suturing / ligating tool is formed. 12 is prevented from clogging inside the attachment means 2. Further, in the conventional ratchet mechanism, it is common to use a dedicated thin blade-shaped component as a counterpart component that meshes with the ratchet teeth 27, but this is a component that is costly to produce the necessary elastic force. there were. However, in this embodiment, the ratchet arm 26 has a structure in which a round bar is bent. Since the elastic force is generated by increasing the effective length, the ratchet arm 26 can be easily molded without incurring costs. It is a part.

  Next, FIG. 10 shows the proximal side of the insertion portion 3. A knob 5 is provided at the rear end of the insertion portion 3 and is composed of parts divided vertically. A main spring 29 is provided inside the knob 5 and constantly biases the operating rod 30 connected to the pusher 14 toward the hand side. The main spring 29 can return the entire applier 1 including the attaching means 2 and the operating means 4 to the initial state after a series of clip attaching operations.

  A spherical portion 32 that engages with an engagement groove 31 provided on the upper portion of the movable handle 9 is formed at the rear portion of the operation rod 30. The operation rod 30 and the rear portion of the knob 5 are sealed by an O-ring 33. Yes. In general, in endoscopic treatment, treatment is performed in a situation where the abdominal cavity called a pneumoperitoneum is inflated with CO2 gas in order to secure a space for operation in the abdominal cavity or the like. The treatment instrument such as the applier 1 used at that time needs to prevent gas in the abdominal cavity from leaking to the outside. The applier 1 is completely covered by the O-ring 33. The gas leakage is suppressed to such an extent that it is sealed or is practically acceptable.

  Further, as described above, the pusher 14 and the operation rod 30 connected to the pusher 14 are provided at the center of the insertion axis in the longitudinal direction of the insertion portion 3, so that the insertion portion 3 can be moved to the operation means 4 by operating the knob 5. When it is rotated, it is positioned at the center of rotation, so that it can be rotated without using a special conversion means for connecting the pusher 14 and the operating rod 30 to cope with the rotation as in the prior art. It is possible to move.

  Next, the operation means 4 is shown in FIGS. As described above, the operation means 4 includes the movable handle 9, the fixed handle 10, and the lid 11 attached to the upper part of the fixed handle 10. The knob 5 of the insertion portion 3 is rotatably attached to the fixed handle 10, and the spherical portion 32 of the operation rod 30 slides on a washer 34 inside an engagement groove 31 provided on the upper portion of the movable handle 9. Engageable and movable.

  The lid 11 is attached to the fixed handle 10 by a hinge 35 so as to be freely opened and closed, and is fixed by a snap fit 36 when closed. Further, when the lid 11 is opened, the knob 37 attached to the snap fit 36 is biased outward, so that the engagement between the snap fit 36 and the fixed handle 10 is released and the hinge 35 is opened. .

  The interior of the fixed handle 10 of the operation means 4 is open so that a cleaning liquid, sterilizing gas, high-temperature steam, or a cleaning tool such as a cleaning brush can be inserted for cleaning and sterilization. By opening the body 11, it can be reliably washed and sterilized, and the operation means 4 is a reuse product that can be used repeatedly. Needless to say, each component constituting the operation means 4 is made of a metal or resin having resistance to washing and sterilization.

  The spherical portion 32 of the operating rod 30 is engaged with the engaging groove 31 on the upper part of the movable handle 9 so as to be rotatable and slidable. Since the engaging groove 31 is opened upward, the spherical portion 32 is engaged by being inserted into the engagement groove 31 from the upper part of the engagement groove 31, and can be removed by the reverse operation.

  Therefore, by opening the lid 11 and removing the spherical portion 32 from the engaging groove 31 as described above, the insertion portion 3 can be removed from the operation means 4, and the insertion portion 3 is operated by the reverse procedure. 4 can be attached. Accordingly, since the insertion portion 3 can be detachably attached to the operation means 4, for example, the insertion portions 3 having different numbers of the suturing / ligating tools 12 stored in the insertion portion 3 are prepared. The insertion section 3 storing the number of suture / ligature tools 12 necessary for the target procedure is used, or the insertion section 3 that has used up the suture / ligature tools 12 is replaced with a new insertion section 3. be able to.

  Further, it is possible to prepare the insertion portions 3 having different shapes of the suture / ligator 12 and replace them according to the situation. In general, the conventional applier 1 has a complicated shape so that the inside cannot be cleaned and sterilized. Further, since the insertion portion 3 and the operating means 4 cannot be removed, the whole is a disposable product. However, as in the present embodiment, the insertion portion 3 is detachable from the operation means 4 and the reusable product in which the inside of the operation means 4 can be reliably cleaned and sterilized as described above. As a result, the disposable part becomes only the insertion part 3 and the operation means 4 can be used repeatedly, so the part to be wasted is reduced, not to mention cost reduction, environmental conservation, energy saving, resource waste Effects such as prevention can be obtained.

  The movable handle 9 is rotatably attached to the fixed handle 10 by a fulcrum screw 38 and a nut 39, and the applier 1 is operated by closing the movable handle 9 from the initial state.

  Next, FIG. 15 and FIG. 16 show the shape of the suturing / ligating tool 12 and the engagement with the pusher 14. The suturing / ligating tool 12 of the present embodiment is formed of a titanium material such as a Ti alloy as will be described later. The suturing / ligating tool 12 has two leg portions 121 in a substantially parallel state and a base end portion 122 that connects the leg portions 121 and is formed in a substantially U-shape.

  A protrusion 40 having a substantially semicircular cross section is formed on the inner edge portion of the concave portion 16 of the pusher 14 in the longitudinal direction, and the suturing / ligating tool 12 is formed on the proximal end portion 122 of the suturing / ligating tool 12. An engagement groove 41 is formed at a position to engage with the protrusion 40 when the is deformed. Thus, when the suturing / ligating tool 12 is released from the guide member 13 in the middle of deformation, the suturing / ligating tool 12 is prevented from falling off or changing its direction due to disturbance. Further, in such a sewing / ligating tool 12 that is generally manufactured by press-molding a wire, the same cross-sectional shape is easier to manufacture over the entire length of the material. In such a case, the sewing / ligating tool is used. The engaging groove 41 may be formed over the entire outer periphery of the outer periphery 12 (the outer periphery of the leg 121).

  Titanium material, which is the material of the suture / ligator 12, is known to be very hard and high in strength, and has a very strong force for plastic deformation. Therefore, the leg portion 121 and the base end portion 122 are provided with notches 42 so that the suturing / ligating device 12 of the present embodiment is easily deformed into a predetermined shape when being deformed by the pusher 14. It is designed to bend from this part. Since the notch 42 should be easy to bend with respect to the other parts, the Young's modulus can be increased by processing on the material surface such as locally annealing instead of the notch 42. It may be formed so that it is relatively larger than the other part to be easily bent, or the section modulus is relatively smaller than the other part in the bending direction.

  Next, the operation of the applier 1 will be described with reference to FIGS. FIG. 17 shows a state in which the suturing / ligating tool 12a is loaded on the guide member 13 and the movable handle 9 is operated up to the first stage. At this time, the movable handle 9 of the operating means 4 is in the position of the solid line in FIG. In this state, the pusher 14 holds the suturing / ligating tool 12a with the support pin 15 and is held by the guide member 13 in the vertical direction. Further, of the suturing / ligating tool 12 inside the storage means 19, the suturing / ligating tool 12 b is an opening in front of the partition plate 18 against the clip restraining spring 22 by a latching portion 20 provided on the pusher 14. 43 is moving.

  In the permutation of the suturing / ligating tool 12, the suturing / ligating tool 12c following the suturing / ligating tool 12b is sutured / ligating tool 12d or less. Move to the position to move over the position. The one-way clutch 21 is formed of an elastic member such as a metal plate, and in combination with the shape, the suturing / ligating tool 12 can be moved in the forward direction. It has become.

  FIG. 18 shows the next second operation stage. In this state, when the movable handle 9 is operated in the closing direction as compared with the above state, the pusher 14 further advances, and the suturing / ligating tool 12a is pushed forward by the projection 40 of the concave portion 16. Thus, since the suture / ligator 12a is supported by the support pin 15, the portion pushed by the pusher 14 bends forward, and is deformed into a predetermined shape by the notch 42, so that the tips of the suture / ligator 12a are aligned with each other. Contact. The suturing / ligating tool 12a is released from the guide member 13, but as it is deformed, the projection 40 of the pusher 14 and the engaging groove 41 of the suturing / ligating tool 12a are engaged as described above. There is no dropout from the attachment means 2 during the attachment operation.

  At this time, the suturing / ligating tool 12 inside the storage means 19 is moved further forward by the urging of the clip pushing spring 24 when the suturing / ligating tool 12 b is moved forward by the latching portion 20.

  Further, as shown in FIGS. 19 to 21, as the movable handle 9 is closed, the pusher 14 moves forward, and the suturing / ligating tool 12 a is gradually deformed, and the suturing / ligating tool 12 inside the storage means 19. Will also be sent forward. Then, at the stage of FIG. 21, the movable handle 9 completely reaches the closed position, the pusher 14 moves to the forefront, and the suturing / ligating tool 12a is changed to the final shape.

  At this stage, the suturing / ligating tool 12 b moves to the upper part of the opening 43 of the partition plate 18 and is loaded on the upper surface of the pusher 14 inside the opening 43 by the clip restraining spring 22. Then, the subsequent suturing / ligating tool 12 continues to move forward.

  The final shape of the suturing / ligating tool 12 at this time is such that the length of the portion of the two legs 121 that are close to each other in parallel is approximately 2 with respect to the length of the portion surrounding the support pin 15. The length of the final shape is not unnecessarily increased.

  Next, the process proceeds to the stage shown in FIG. At this stage, the movable handle 9 finishes a series of operations, and is completely moved to the release position by the main spring 29 at the rear end of the insertion portion 3, and the pusher 14 is also moved to the final position.

  Then, the engagement between the suture / ligator 12a and the pusher 14 is released, and the suture / ligator 12a is released to the outside of the side of the guide member 13 by the elastic force of the ejector 15 provided inside the guide member 13. . Generally, when ligating the vessel 50, one suture / ligator 12 is attached on the side to be cut and two on the remaining side. If the applier 1 is not removed from the vessel 50, the suture / ligator 12 could not be released. In this embodiment, the guide members 13 can be sequentially moved sideways in order, so that the ligation can be performed one after another. There is no worry of missing the damaged vessel 50.

  Further, since the pusher 14 moves rearward from the opening 43, the suturing / ligating tool 12b moves to the front of the pusher 14 by the elastic force of the clip restraining spring 22 to prepare for the next operation. The subsequent suturing / ligating tool 12 is moved to a position where the suturing / ligating tool 12b comes into contact with the clip restraining spring 22 by the elastic force of the clip pushing spring 24, and the applier 1 as a whole returns to the initial state.

  By closing the movable handle 9 again from this state, the series of operations shown in FIGS. 17 to 22 are repeated, and the suturing / ligating tool 12 is repeated. When the last suturing / ligating tool 12t is released, the suturing / ligating tool 12 does not exist inside the storage means 19. At this time, the buffer 23 moves to the foremost position as described above. It is confirmed that the suturing / ligating tool 12 has been used up with a color tone that is easy to see. Further, even if the operation is further performed with the suture / ligator 12 used up, the pusher 14 simply moves forward / backward because the applier 1 has no movable part for attaching the suture / ligator 12. As such, there is no risk of damaging living tissue.

  Further, when the treatment is continued when the suture / ligator 12 is used up, the lid 11 of the operation means 4 is opened and the insertion portion 3 is removed from the operation means 4 as described above, and the new insertion portion 3 is removed. The lid 11 is closed by being incorporated in the operation means 4, and the applier 1 is equipped with a new suture / ligator 12.

  Here, when the conventional suturing / ligating tool 51 shown in FIGS. 28 and 29 is compared with the suturing / ligating tool 12 of the present embodiment, the suturing / ligating tool 51 has a diameter D vessel as described above. In order to tie 50, the length of the leg part 52 is required to be about twice as long, and the distance L1 between the two leg parts 52 must be L1 ≧ D. Here, in the case of the prior art, the base end portion 53 has a substantially triangular shape with an angle θ in order to easily deform the suture / ligator 51. Therefore, the total length is L 2 + m cos θ, which is longer than that of the case shown in the present embodiment.

  When the appliers are stored in a permuted state, as shown in FIG. 29, a wasteful length of n is required for each of the two stitching / ligating tools 51, and the number of stitching / ligating tools 51 increases. The length increases, and as a result, the number of stitching / ligating tools 51 that can be stored in the storage section decreases. In this embodiment, since there is no n which is a useless length, for example, 20 can secure a length of 19n, and therefore, approximately 4 stitches and ligature tools 51 can be stored, so that The conventional problem is solved.

  Further, when the suture / ligator 51 is deformed to a predetermined shape, the total length is L2 + m in the prior art, but in this embodiment, it is L2 + l / 2. The size of the substance remaining in the body can be reduced.

  As described above, according to the present embodiment, the applier 1 having a safe and simple mechanism, which is the object of the present invention, can be used, or the size of the suturing / ligating tool 12 can be reduced and the interior of the applier 1 can be reduced. Increase the number that can be stored in, or leave an unnecessarily large residue in vivo. Furthermore, the shape and structure of the applier 1 and the suture / ligator 12 are not particularly limited as long as they are within the range that the vessel 50 can be ligated by the suture / ligator 12. It does n’t matter.

  FIG. 23 shows a second embodiment. The shape of the suturing / ligating tool 12 is the same as that of the first embodiment, and the features such as the corner portion being easily bent at the time of deformation are the same. The attachment means 55 of the applier 54 is closed and opened when the jaw 56 is driven back and forth by the jaw closing member 57, thereby deforming the suturing / ligating tool 12 loaded in the jaw 56 into a predetermined shape. Can be sutured and ligated.

  In the present embodiment, as in the first embodiment described above, since the shape of the suturing / ligating tool 12 is small, a large number of suturing / ligating tools 12 can be stored inside the applier 1 or not in vivo. There is an advantage that it is not necessary to leave a large residue.

  As described above, a number of sutures and ligatures 12 can be stored inside the applier 1 or the sutures and ligatures 12 can be stored as long as they do not leave unnecessary large residues in the living body. There is no particular limitation on the structure, material, etc. of the ligation tool 12, and any kind of ligation tool 12 may be used.

  24 and 25 show a third embodiment. The basic shape of the suturing / ligating tool 12 is the same as that of the first embodiment. However, in FIG. 24, the protrusion 59 and the recessed portion are engaged with each other at the ends of the opposing surfaces of the two leg portions 58, respectively. 60 is provided. In FIG. 25, the protrusion 59 is made of a pin-shaped member, and the concave portion 60 is a hole opened in the leg portion 58. And when they are engaged with each other, when the suturing / ligating tool 12 is deformed into a predetermined shape, the leg portions 58 can be reliably deformed into a predetermined shape in the vicinity of a substantially parallel state without being displaced, Secure stitching and ligation are possible.

  As described above, the structure and material of the suturing / ligating tool 12 are not particularly limited as long as the object of the present invention is to perform reliable suturing / ligating, and any structure may be used. Absent.

  FIG. 26 shows a fourth embodiment. The basic shape of the suturing / ligating tool 12 is the same as that of the first embodiment, but in FIG. 26, when the suturing / ligating tool 12 is attached to the living tissue on the opposing surfaces of the two legs 58. Further, a slip stopper 61 is provided for preventing the body tissue from slipping and falling off. In the present embodiment, the opposing surfaces are formed in a shape appropriately combining convex or concave shapes. This prevents it from slipping against living tissue.

  FIG. 27 shows a fifth embodiment. The basic shape of the suturing / ligating tool 12 is the same as that of the first embodiment, but a notch 42 is formed inside the corner portions (the leg portion 121 and the base end portion 122) that become corners when deformed into a predetermined shape. Etc., and are easily deformed.

  The anti-slip 61 may have, for example, a matte finish on the opposing surfaces of the two leg portions 58. In such a case, the anti-slip 61 may be formed by sandblasting or chemical surface treatment. it can.

  As described above, the structure and material of the suturing / ligating tool 12 are not particularly limited as long as the object of the present invention is to perform reliable suturing / ligating, and any structure may be used. Absent.

  According to the embodiment, the following configuration is obtained.

  (Supplementary note 1) In a suturing / ligating tool for suturing / ligating a living tissue, it is formed in a substantially U-shape having two legs in a substantially parallel state and a base end for connecting the legs. The two legs are substantially perpendicular to the base end when attached to a living tissue, and the two legs face each other after being deformed. A suturing / ligating tool characterized in that the surfaces are at least partially in contact with each other.

  (Supplementary note 2) A suture / ligator for suturing / ligating biological tissue has a substantially U-shape with two substantially parallel legs and a base end connecting the legs. The deformed shape when attached to the living tissue is such that the faces of the two legs facing each other are close to each other and are substantially parallel, and at least partly on the proximal end side of the two legs. A suturing / ligating tool having a portion where the two leg portions are not close to each other and a space surrounded by the two leg portions and the base end portion.

  (Supplementary Note 3) A suturing / ligating tool for suturing / ligating biological tissue, having two substantially parallel legs and a base end connecting the legs, and having a substantially U-shape. The two leg portions are formed substantially perpendicular to the proximal end portion, and in an applier for attaching the suturing / ligating tool to a living tissue, at least one holding the suturing / ligating tool. Sandwiching the suturing / ligating tool between two holding members and the holding member and pressing the base end of the suturing / ligating tool to deform the suturing / ligating tool into a predetermined shape An applier having a pusher and being deformed so that opposing surfaces of the two legs of the suturing / ligating tool are at least partially in contact with each other.

  (Appendix 4) An applier for attaching a suturing / ligating tool for suturing / ligating a living tissue to the living tissue, wherein an attaching means for attaching the suturing / ligating tool of the applier to the living tissue is the suturing An applier made up of a substantially jaw-shaped movable member that approaches and separates from each other for deforming the ligature tool into a predetermined shape.

  (Appendix 5) The applier according to appendix 4, wherein the predetermined shape of the suturing / ligating tool is formed such that the opposing surfaces of the two leg portions are at least partially in contact with each other.

  (Supplementary note 6) The suturing / ligating tool according to supplementary notes 1 and 2, wherein the length of the leg portion is at least 0.5 times the distance between the leg portions of the two leg portions.

(Appendix 7) In Appendix 6, the predetermined shape is:
a. The surfaces of the two legs facing each other are close to each other and in a substantially parallel state,
b. At least a part of the base end portion side of the two legs, a portion where the two legs are not close to each other,
c. A space surrounded by the two legs and the base end;
Suture and ligature.

(Appendix 8) In Appendix 6, the predetermined shape is:
a. The surfaces of the two legs facing each other are close to each other and in a substantially parallel state,
b. At least a part of the base end portion side of the two legs, a portion where the two legs are not close to each other,
c. A space surrounded by the two legs and the base end;
d. The space is formed so as to surround the holding member.
Suture and ligature.

  (Additional remark 9) In additional remarks 1, 2, 7, and 8, the length of the substantially parallel portion of the leg portion is at least twice as long as the length of the space portion in the longitudinal direction. Ligature.

  (Additional remark 10) In additional remarks 1, 2, and 9, the part which becomes a corner when deforming into the predetermined shape is relatively deformed with respect to the other part so that the leg portion is easily deformed into the predetermined shape. Sutures and ligatures that are formed to be easy.

  (Supplementary note 11) The suturing / ligating tool according to supplementary note 10, wherein a Young's modulus of a portion of the leg portion that is relatively easily deformed is relatively larger than that of other portions.

  (Supplementary note 12) The suturing / ligating tool according to supplementary note 10, wherein a cross-sectional area of a relatively deformable portion of the leg portion is formed to be relatively smaller than other portions.

  (Supplementary note 13) The suturing / ligating tool according to supplementary note 10, wherein a section modulus of a portion of the leg portion that is relatively easily deformed with respect to a bending direction is relatively smaller than that of other portions.

  (Additional remark 14) In additional remarks 12, 13, when the said leg part is easy to deform | transform, when the said suturing / ligating tool deform | transforms into a predetermined | prescribed shape, it cuts into the part which becomes the outer part of the said corner, or an inner part. Alternatively, a suturing / ligating tool having a recess.

  (Appendix 15) In appendices 1, 2, 6 to 14, when the leg portion is deformed into a predetermined shape, a protrusion is provided on one leg portion of the two leg portions in contact with each other, A suturing / ligating tool in which a recess engaging with the protrusion is formed on the other leg.

  (Additional remark 16) In additional remarks 1, 2, and 6-15, it is for engaging with the attachment means of the applier for attaching the said suture and ligation tool to a biological tissue at least a part of the outer peripheral surface of the said suture and ligation tool A suturing / ligating tool in which protrusions and / or recesses are formed.

  (Supplementary note 17) The suturing / ligating tool according to supplementary note 16, wherein a portion where the protrusion and / or the concave portion is formed is a base end portion of the leg portion.

  (Supplementary note 18) The suturing / ligating tool according to supplementary note 17, wherein the protrusions and / or the recesses are formed on the entire outer peripheral surface of the stitching / ligating tool.

  (Supplementary note 19) The suturing / ligating tool according to supplementary note 16, wherein at least one convex portion or concave portion for preventing slippage is provided on surfaces of the two leg portions facing each other.

  According to the supplementary notes 1 to 3 and 8, it is possible to solve the problem that the applier has a complicated structure of the applier and the insertion diameter becomes large in the suturing / ligating tool, which is a problem of the prior art, and the vessel can be surely solved.

  According to Addendums 4 and 5, which are problems of the prior art, the overall length of the suturing / ligating tool is unnecessarily long, so that an unnecessarily large residue remains in the living body, or a large number of inside the applier The problem that the clip cannot be stored can be solved.

  The effects of supplementary notes 6 and 7 are the same as those of supplementary notes 1 to 5. The effect of Supplementary Note 8 is the same as that of Supplementary Notes 1, 2, and 4.

  According to Appendices 10-14, in addition to the effects of Appendices 1-9, the stroke of the applier operating means which is a problem of the prior art tends to be large, or the size of the suturing / ligating tool tends to be unnecessarily large. You can solve the problem.

  The effect of supplementary note 15 is in addition to the effects of supplementary notes 1 to 3 and 5 to 14, and the two legs of the suturing and ligating tool, which are problems of the prior art, are displaced without facing each other. This can be solved.

  The effects of supplementary notes 16 to 18 can be solved in addition to the effects of supplementary notes 1 to 15 in that the suturing / ligating tool, which is a problem of the prior art, falls off from the attachment means.

  In addition to the effects of Supplementary Notes 1 to 18, the effect of Supplementary Note 19 can be solved with respect to the point that the suturing / ligating tool, which is a problem of the prior art, falls off the living tissue.

1 is an overall side view of an applier showing a first embodiment of the present invention. FIG. The vertical section top view and vertical side view of the attachment means of the embodiment. The front view seen from the arrow X direction of FIG. Sectional drawing which follows the AA 'line of FIG. Sectional drawing which follows the BB 'line of FIG. Sectional drawing which follows the CC 'line of FIG. The vertical side view which shows the storage means of the applier of the embodiment. The longitudinal cross-sectional side view which shows the ratchet mechanism of the applier of the embodiment. Sectional drawing which follows the EE 'line of FIG. The longitudinal section on the side of the operation means of the insertion part of the embodiment, and a longitudinal side view. The longitudinal section side view which shows the operation means of the applier of the embodiment. Sectional drawing which follows the II 'line of FIG. Sectional drawing which follows the JJ 'line | wire of FIG. Sectional drawing which follows the KK 'line of FIG. The perspective view of the pusher of the same embodiment, and a suture and a ligation tool. The perspective view of the suturing / ligating tool of the embodiment. The longitudinal section which shows operation | movement of the applier of the embodiment. The longitudinal section which shows operation | movement of the applier of the embodiment. The longitudinal section which shows operation | movement of the applier of the embodiment. The longitudinal section which shows operation | movement of the applier of the embodiment. The longitudinal section which shows operation | movement of the applier of the embodiment. The longitudinal section which shows operation | movement of the applier of the embodiment. The top view which shows the attachment means of the applier of 2nd Embodiment of this invention. The perspective view and longitudinal cross-sectional side view of the suturing / ligating tool of 3rd Embodiment of this invention. The longitudinal side view and end view of the suturing / ligating tool of the embodiment. The side view of the suturing / ligating tool of the 4th Embodiment of this invention. The perspective view of the suturing / ligating tool of the 5th Embodiment of this invention. Explanatory drawing of the conventional suture and ligation tool. Explanatory drawing of the conventional suture and ligation tool.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Applier, 3 ... Insertion part, 4 ... Operation means, 12 ... Suture and ligation tool, 14 ... Pusher (2nd press part), 15 ... Support pin (1st press part), 121 ... Leg part, 122 ... Base end

Claims (4)

An elongated insertion portion having a distal end and a proximal end;
Two elongated legs having a distal end and a proximal end, and a proximal end connected to the proximal end of the leg so that a living tissue can be inserted between the two legs. A suturing / ligating tool having
A pressing means provided so as to be movable with respect to the insertion portion, and pressing the suture / ligator so as to be plastically deformed;
An operating means provided at a proximal end of the insertion portion, and moving the pressing means relative to the insertion portion;
In suture and ligature applier made of
The pressing means presses the suturing / ligating tool so that the distal ends come into contact with each other before the proximal ends of the two leg portions by moving with respect to the insertion portion by operation of the operating means. Suture and ligature appliers.   The pressing means is disposed on the inner side of the proximal end portion of the suturing / ligating tool and presses the substantially central portion of the proximal end portion, and is disposed on the outer side of the proximal end portion. The suture / ligator applier according to claim 1, further comprising a second pressing portion that presses a portion other than the substantially central portion.   The suture / ligator applier according to claim 2, wherein the second pressing portion has a concave portion that abuts on the suture / ligator and is plastically deformed.   The first pressing portion is a support pin fixedly connected to the insertion portion, and the second pressing portion is a pusher that moves forward and backward with respect to the insertion portion by operation of the operation means. The suture / ligator applier according to claim 2 or 3.

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