JP2007195698A - Endoscopic surgical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscopic surgical instrument, which enables to perform ligation in a body without pulling out a suture thread outside the body every time in an endoscopic surgery and to perform the operation safely and easily, and further, a user can easily learn how to use the endoscopic surgical instrument. <P>SOLUTION: In the endoscopic surgical instrument having a needle holding part configured by a movable jaw and a fixed jaw at a front end of a tubular shaft that is an insertion part into an abdominal cavity, the movable jaw is disposed so as to be capable of rotating around the fixed jaw through a pivot shaft due to the remote control; the opposite side across the pivot shaft of the movable jaw is formed as a thread locking part; when the movable jaw is opened, the thread locking part slightly protrudes outside a tubular shaft; and when the movable jaw is closed, the thread locking part is prevented from protruding outside the tubular shaft. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an endoscopic surgical instrument, and more particularly to a needle holder having a needle holding portion at the distal end of an insertion portion into an abdominal cavity.

  The basics of surgery are exfoliation, dissection, and suture ligation, and suture ligation is an indispensable technique even in endoscopic surgery. Conventionally, when performing suture ligation with a needle holder in endoscopic surgery, an external ligation method in which a suture is tied outside the body and sent into the abdominal cavity to complete the ligation, and an internal ligation method in which ligation is performed with forceps within the abdominal cavity. Has been done.

  The extracorporeal ligation method is a simple method, but a special device is required for the instrument used for ligation.

  In the extracorporeal ligation method, there is a risk of damaging the tissue due to tension in the sutured tissue because the ligated part formed outside the body is inserted into the abdominal cavity. Therefore, the ideal ligation method is the internal ligation method. However, in-body ligation is a technique that requires advanced techniques to recognize and ligate three-dimensional forceps on a two-dimensional monitor in a limited space within the abdominal cavity.

  When ligation is performed in the body, it is difficult to control the suture using forceps in a limited space, and it is necessary to perform this operation on a two-dimensional monitor where it is difficult to recognize perspective. A device is required for an instrument used for internal suture ligation.

A device for suturing and ligating the body has also been proposed.
JP 2003-220064 A JP-A-6-54855

  However, the method of providing the engaging means separately from the needle holding portion results in inconvenience in handling because the insertion portion becomes thick or the tip portion becomes large, and considerable skill is required to handle the instrument well. In short, the usable range is very limited.

  In other words, in order to perform ligation quickly and easily in the abdominal cavity, there is no major change from the conventional needle holders that everyone is accustomed to, and it can be handled with the same feeling as before. It is necessary to.

  In addition, when ligation is performed in the abdominal cavity, conventionally, in order to cut the suture, instead of the needle holder, a scissor was inserted into the abdominal cavity to cut off the excess suture. Completion is complicated by increasing the task of replacing the device from the needle holder to the scissors into the abdominal cavity.

  If the function of cutting the thread can be added to the needle holder, this complicated task becomes unnecessary, and the risk of organ damage associated with the replacement of the forceps is reduced. However, regardless of the needle holder or auxiliary forceps, the forceps that perform suture and ligation will grasp and control the thread, so adding a thread cutting function to this needle holder and gripping surface will accidentally cut the thread during ligation. There is a risk of losing the needle in the abdominal cavity, and in particular, the latter has a great risk of dropping and losing the needle in the abdominal cavity. Therefore, the cutting function of the needle thread needs to be separated from the needle holding portion and the gripping surface.

Therefore, in order to solve the above-described problem, an endoscopic surgical instrument according to the present invention is an endoscope having a needle holding portion composed of a movable jaw and a fixed jaw at the distal end of a tubular shaft serving as an insertion portion into the abdominal cavity. In the lower surgical instrument, the movable jaw can be rotated with respect to the fixed jaw by a pivot shaft by remote operation, and the opposite side portion of the movable jaw is formed so as to be a thread locking portion. When the movable jaw is opened, the thread locking portion protrudes outside the tubular shaft, when the movable jaw is closed, the thread locking portion does not protrude beyond the tubular shaft , and when the movable jaw is closed, The contact portion between the movable jaw and the tubular shaft functions as a stagnation so that the suture thread is cut between the locking portion and the tubular shaft .

  By hooking the suture thread on the thread locking portion, the suture thread can be easily tied, and the operation time can be shortened and the surgical operation can be facilitated. That is, the suture is easily controlled by hooking the thread on the thread locking portion, and the sense of perspective on the two-dimensional monitor is further facilitated by bringing the thread locking portion into contact with the suture.

In addition , when the movable jaw is closed, the suture is cut between the thread locking portion and the tubular shaft, so that the excess suture can be cut without changing the instrument during ligation.

  A needle holding portion composed of a movable jaw and a fixed jaw is provided at the distal end of the tubular shaft, and the movable jaw can be rotated with respect to the fixed jaw by a pivot shaft by remote control by a handle. Then, a thread locking portion is formed on the opposite side across the pivot shaft of the movable jaw. When the movable jaw is open, the thread locking portion slightly protrudes outside the tubular shaft, and the suture is hooked there. Like that.

Further , when the movable jaw is closed, the contact portion between the movable jaw and the tubular shaft functions as a stagnation so that the suture thread is cut between the thread locking portion and the tubular shaft.

  Next, an embodiment of an endoscopic surgical instrument according to the present invention will be described based on FIGS. Reference numeral 1 denotes an endoscopic surgical instrument, which has a tubular shaft 2 serving as an insertion portion and a needle holding portion 3 at a distal end portion and an operation handle 4 at a proximal side.

  The needle holding portion 2 is composed of a movable jaw 5 and a fixed jaw 6, and concave and convex grooves for needle holding are formed on the contact surfaces of the movable jaw 5 and the fixed jaw 6, respectively. The fixed jaw 6 is fixed to the tubular shaft 2. The fixed jaw 6 may be functionally integrated with the tubular shaft 2 or may be physically integrated. It suffices if the fixed jaw 6 portion functions as the needle holding portion 2 with the movable jaw 5.

  The tubular shaft 2 has a U-shaped space portion 7 formed in the central portion in the vertical direction on the distal end side, and a shaft support portion 8 that extends thinly on the handle 4 side portion of the movable jaw 5 can move the space portion 7. It has become. The movable jaw 5 is pivotally supported by the pivotal support shaft 9 at the pivotal support portion 8. Reference numeral 10 denotes a wire for opening and closing the movable jaw 5 which is connected to the shaft support portion 8 of the movable jaw 5 slightly and whose other end is connected to the handle 4.

  A thread locking portion 11 is provided at the tip of the shaft support portion 8 of the movable jaw 5. When the movable jaw 5 is opened, the thread locking portion 11 protrudes outward from the tubular shaft 2 so that a suture can be hooked. Further, in a state where the movable jaw 5 is closed, the thread locking portion 11 is prevented from jumping out beyond the tubular shaft 2. In order to make the device smoothly inserted into and removed from the body, and to prevent the thread locking portion 11 from inadvertently damaging the body, the thread locking portion 11 protrudes from the tubular shaft 2 only when necessary. Keep it.

  Reference numeral 12 denotes a thread pull-out gap, which is a gap provided so that the suture thread can freely move between the thread locking portion 11 and the tubular shaft 2 with the movable jaw 5 closed. This is because the suture thread can be removed from between the tubular shaft 2 and the thread locking portion 11 while the movable jaw 5 is closed after the ligation is completed.

  Next, a method for using the endoscopic surgical instrument will be described. A needle to which a thread is attached is held between the movable jaw 5 and the fixed jaw 6 of the needle holding portion 3 at the distal end of the tubular shaft 2, and a desired portion is stitched. Then, after the suturing is completed, the suture is hooked at the thread locking portion 11 and the endoscopic surgical instrument 1 is ligated so as to be pulled outside the body. When the knot is formed, the endoscopic surgical instrument 1 is moved to the inside of the body. The suture thread is pulled out from the thread locking portion 11 so as to be pushed in. Then, the same operation is repeated at a new stitching location.

  Next, an embodiment of the endoscopic surgical instrument according to the present invention will be described with reference to FIGS. Since the basic configuration is the same as that of the first embodiment except for the yarn cutting function, only different points will be described.

  Reference numeral 13 denotes a hook having a thread cutting function by the thread locking portion 11 of the tubular shaft 2 and the movable jaw 5. Blade surfaces are formed at locations where the thread locking portion 11 of the movable jaw 5 and the tubular shaft 2 slide, so that the thread can be cut between the thread locking portion 11 and the tubular shaft when the movable jaw 5 is closed. It is configured. In the case of the present embodiment, unlike the first embodiment, the thread removal gap 12 is not provided between the tubular shaft 2 and the thread engaging portion 11.

  Next, a method for using the endoscopic surgical instrument will be described. A needle to which a thread is attached is held between the movable jaw 5 and the fixed jaw 6 of the needle holding portion 3 at the distal end of the tubular shaft 2, and a desired portion is stitched. Then, after completion of the suturing, as shown in FIG. 8, the suture is hooked by the thread engaging portion 11 and the endoscopic surgical instrument 1 is ligated so as to be pulled to the outside of the body. When the movable jaw 5 is closed, the excess suture is cut by the barb 13 constituted by the tubular shaft 2 and the thread engaging portion 11. Then, the same operation is repeated at a new stitching location.

  The suture can be ligated by a simple operation and can be used in various endoscopic surgical operations. Moreover, since the operation method is simple, it can be easily mastered and used at various medical levels.

It is a front view of the endoscopic surgical instrument of the present invention. It is an enlarged view of a needle holding part in the state where a movable jaw was closed. It is an enlarged view of a needle holding part in the state where a movable jaw was opened. It is an enlarged bottom view of a needle holding part. It is the sectional view on the AA line of FIG. It is an enlarged front view of the needle holding part of the other example of the endoscopic surgical instrument of the present invention. FIG. 8 is a bottom view of FIG. 7. It is explanatory drawing which shows the state which locked the suture with the thread | yarn latching | locking part. It is explanatory drawing which shows the state which cut | disconnected the suture with the scissors comprised from the thread | yarn latching | locking part and the tubular shaft.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Endoscopic surgical instrument 2 Tubular shaft 3 Tip part 4 Handle 5 Movable jaw 6 Fixed jaw 7 Space part 8 Axis support part 9 Pivot axis 10 Wire 11 Thread latching part 12 Thread extraction gap 13 １３

Claims (3)

  In an endoscopic surgical instrument having a needle holding portion composed of a movable jaw and a fixed jaw at the distal end of a tubular shaft that is inserted into the abdominal cavity, the movable jaw is rotated relative to the fixed jaw by a pivot shaft by remote control The movable jaw is formed so that the opposite side of the movable jaw is a thread locking portion.When the movable jaw is opened, the thread locking portion protrudes outside the tubular shaft. An endoscopic surgical instrument characterized in that the thread locking portion does not protrude beyond the tubular shaft when closed.   The endoscopic surgical instrument according to claim 1, wherein a gap is provided between the thread locking portion and the tubular shaft so that the suture can freely move with the movable jaw closed. The endoscope according to claim 1, wherein the contact portion between the movable jaw and the tubular shaft functions as a stagnation so that the suture thread is cut between the thread locking portion and the tubular shaft when the movable jaw is closed. Lower surgical instrument.

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