JP2009000404A - Loading device for indwelling implement - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To easily load an indwelling implement into an applicator. <P>SOLUTION: This loading device 30 is formed by stacking together a first base and a second base 32. A long narrow needle holder 40, a generally square casing holder 50 containing a casing 12 having a break member, and an arm part 60 that extends from the corner of the casing holder 50 and connects to the needle holder 40 are formed by a generally T-shaped slit 33. A pair of locking members 52 is attached in a freely openable and closable manner to the casing holder 50. Projections are formed facing one another at the edge of locking members 52. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  INDUSTRIAL APPLICABILITY The present invention is used when a living body tissue is sutured or tied and loaded with an indwelling device for loading an applicator with a treatment device of the type indwelled in the living body (hereinafter referred to as an indwelling device). Relates to the device.

As a method of performing medical treatments on human organs, etc., laparoscopic surgery in which the abdominal wall is cut open and medical treatment is performed, laparoscopic surgery in which medical treatment is performed by approaching the abdominal cavity from the opening formed in the abdominal wall, or mouth or An endoscopic technique or the like for performing a desired treatment by inserting a flexible endoscope into the body from the anus or the like is performed.
In medical practice using these methods, treatments such as tissue suturing, binding, and ligation are performed. When performing such a treatment, an indwelling device that is often placed in the body may be used. Such an indwelling device is attached to an applicator, and is placed at a desired site in the body by operating the applicator from outside the body (see, for example, Patent Document 1).
JP 2005-161050 A

However, in the state where rubber gloves are worn when performing a procedure, when attaching the indwelling device to the applicator, the operation of attaching the needle and hooking the suture thread on the hook is complicated. In particular, the procedure time becomes long when a plurality of locations are continuously stitched.
This invention is made | formed in view of such a situation, and makes it a main objective to enable it to mount an indwelling tool easily.

  The invention according to claim 1 of the present invention for solving the above-mentioned problems is an indwelling device loading device for attaching an indwelling device having a linear member to an applicator, and is provided in a tip tip accommodating portion of the applicator. A tip chip holding portion having a receiving portion that holds a center tip provided on one end side of the linear member that is detachable from the linear member and guides the tip tip accommodating portion of the applicator to the tip tip, and the tip tip A first position that is abutted against the distal tip so as to substantially match an axis of the distal tip and an axis of the receiving portion within the holding portion and restricts the movement of the distal tip; and A tip tip lock member disposed so as to be movable between a second position retracted from a movement path of the tip tip housing portion when the tip tip is mounted; and the tip tip A casing holding part that is provided on the other end side of the linear member and holds the casing that accommodates the tip chip so that the axis of the casing mounting part of the applicator to which the casing is mounted is substantially aligned. It was set as the loading apparatus of the indwelling tool containing.

  The invention according to claim 2 is the indwelling device loading apparatus according to claim 1, wherein the casing holding portion and the tip end holding portion are connected by an arm portion that is elastically deformed so as to be relatively movable. In addition, each of the casing holding portion and the tip tip holding portion is provided with a restricting portion for restricting the moving direction of the tip tip holding portion to be the mounting direction of the tip tip.

  The invention according to claim 3 is the indwelling device loading apparatus according to claim 1, wherein the casing holding part is held by the holder including a holding part that holds the casing so that the casing can be pushed in, and the holder. A biasing device for pulling the linear member tied to the casing.

  The invention according to claim 4 is the indwelling device loading device according to claim 3, wherein the biasing device has a cylindrical body having a groove for engaging the linear member, and the cylindrical body is the casing. And an urging member that urges the rotation with a rotation axis substantially parallel to the direction in which the is pushed.

  The invention according to claim 5 is the indwelling device loading apparatus according to claim 3, wherein the holder has a pair of openable and closable holder pieces, and the casing is pulled by the holder pieces. And an opening / closing control section for opening the holding section.

  The invention according to claim 6 is a loading device for an indwelling device in which an indwelling device for tightening a tissue by moving a casing through which a linear member is passed is attached to an applicator, the holder holding the casing in a pushable manner. And an urging device for pulling the linear member tied to the casing held by the holder, an axis of the casing that engages with a part of the applicator, and an axis of the sheath for mounting the casing The indwelling device loading apparatus includes a guide unit for matching the two.

  The invention according to claim 7 is the loading device for an indwelling device according to claim 6, wherein the casing holding portion includes a holder including a holding portion that holds the casing so that the casing can be pushed in, and the holder is held by the holder. A biasing device for pulling the linear member tied to the casing.

  The invention according to claim 8 is the indwelling device loading apparatus according to claim 7, wherein the biasing device has a cylindrical body having a groove for engaging the linear member, and the cylindrical body is the casing. And a biasing member that biases the rotation with a rotation axis that is substantially parallel to the direction of pushing in.

  The invention according to claim 9 is the loading device for an indwelling device according to claim 7, wherein the holder has a pair of openable and closable holder pieces, and the casing is pulled by the holder pieces. And an opening / closing control section for opening the holding section.

  The invention according to claim 10 is an indwelling device loading device for mounting an indwelling device having a linear member on an applicator, wherein the linear member is detachable with respect to a tip tip accommodating portion of the applicator. A tip chip holding portion that holds a center tip provided on one end side of the applicator and has a receiving portion that guides the tip tip accommodating portion of the applicator to the tip tip, and an axis of the tip tip within the tip tip holding portion. A first position that is abutted against the tip so as to substantially match the axis of the receiving portion and restricts the movement of the tip, and the tip when the tip tip accommodating portion is attached to the tip A tip tip lock member arranged to be movable between a second position retracted from the movement path of the tip accommodating portion, and the other end side of the linear member from the tip tip A casing that is provided and that holds the tip is connected to a casing holding portion that holds the casing mounting portion of the applicator for mounting the casing so that the axes thereof substantially coincide with each other, and the casing held by the casing holding portion. An indwelling device comprising: a biasing device that pulls the linear member formed; and a guide portion that engages with a part of the applicator and aligns the axis of the casing with the axis of the sheath to which the casing is attached. A loading device was used.

  According to the present invention, the indwelling device can be easily attached. In the case where a plurality of locations are continuously sutured, it is sufficient to prepare as many loading devices as the number of times of suturing and sequentially attach them to the suturing device, so that the procedure time can be shortened and the burden on the patient can be reduced.

One embodiment of the invention is described below.
FIG. 1 shows a suturing device as an example of an applicator in the embodiment. The suturing device 1 has a flexible sheath 2 that is inserted into the body together with an endoscope. An operation portion (not shown) operated by the operator is provided at the proximal end portion of the sheath 2. A treatment portion 5 having a pair of forceps members 3 and 4 to be opened and closed is provided at the distal end of the sheath 2. The forceps members 3 and 4 are rotatably supported by the tip cover 6 and are connected to the link mechanism 7. When an operation wire (not shown) is advanced and retracted, the link mechanism 7 is driven to open and close the forceps members 3 and 4. A curved needle 8 is provided at the distal end of the forceps member 4, and a detachable needle 9, also called a distal tip, is detachably attached to the distal end of the curved needle 8. From the proximal end of the detachable needle 9, a suture thread 10 that is a linear member (or also called a thread member) extends. The suture thread 10 is made of, for example, a single wire such as nylon (registered trademark), is pulled out from the slit at the tip of the curved needle 8, and is attached to a hook sheath 11 (casing attachment portion) that can be moved forward and backward with respect to the tip cover 6. It is drawn into the casing 12. The casing 12 is disposed on the axis of the detachable needle 9 when the pair of forceps members 3 and 4 are closed. When the casing 12 is advanced, the detachable needle 9 can be accommodated in the casing 12. . Note that the guide cover 13 is formed in the distal end cover 6 along the direction of insertion into the living body. The guide groove 13 is inserted with a pin 14 that advances and retreats together with the operation wire when the link mechanism 7 is driven.

  Here, the detachable needle 9 and the casing 12 connected by the suture thread 10 constitute an indwelling device 20 that is detachable from the suturing device 1 and is placed in the body. As shown in FIG. 2, in the indwelling tool 20, the suture thread 10 extending from the proximal end of the detachable needle 9 is drawn from the distal end portion 12 </ b> A of the casing 12 and pulled out from the opening of the proximal end portion 12 </ b> B. In this embodiment, the suture thread 10 is unfastened to the proximal end portion 12B by a loose knot 10A. A knot 10 </ b> B is formed at the other end of the suture thread 10.

  As shown in FIG. 3, the casing 12 has a hole 21 that can accommodate the detachable needle 9 on the distal end portion 12 </ b> A side. A locking spring (not shown) is inserted into the hole 21 to engage with the constricted portion 9A (see FIG. 2) of the detachable needle 9 to prevent pulling out. The suture thread 10 is drawn in such a way as to avoid opening the tip of the hole 21, and after being press-fitted into a brake portion 22 that combines an elastic member and a rigid member, the suture thread 10 is drawn out. The brake part 22 is accommodated in the casing 12. The brake member 22 applies a site to be treated by acting on the tissue of the indwelling device 20 in order to perform tissue stitching, binding, ligation, etc., to the tissue (target site), and the suture thread 10 with the brake member 22 sandwiched therebetween. By pulling the end portion of the indwelling device, a predetermined resistance is applied to the suture thread 10 so that the binding portion is not easily released after the action portion of the indwelling device 20 is tightened and tied to the tissue.

  In the following description, the region on the side of the detachable needle 9 sandwiching the brake member 22 (or the casing 12 housing the brake member 22) is the treatment side (site that acts on the tissue) and the opposite side. These areas may be used for convenience and on the non-treatment side (side operated by the applicator to perform treatment).

Next, a loading device used when the indwelling tool 20 is attached to the suturing device 1 as an example of an applicator will be described.
The loading device 30 has an appearance as shown in FIGS. The loading device 30 is formed by overlapping a first base 31 made of a resin molded product and a second base 32, and an elongated needle holding portion 40 (tip tip holding portion) is formed by a substantially T-shaped slit 33. ), And a substantially rectangular casing holding portion 50 that houses the casing 12 provided with the brake member 22, and an arm portion 60 that extends from a corner portion of the casing holding portion 50 and is connected to the needle holding portion 40. A pair of lock members 51 and 52 are attached to the casing holding part 50 so as to be freely opened and closed. Protrusions 53 and 54 are formed at the ends of the lock members 51 and 52 so as to face each other. The loading device 30 is configured so that the suture instrument 1 (applicator) shown in FIG. 1 is entered from the direction indicated by the arrow RD and the indwelling tool 20 is attached to the suture instrument 1. Hereinafter, the loading device 30 will be described with the distal end in the receiving direction as the base end and the proximal end in the receiving direction as the tip.

  FIG. 6 shows a state where the second base 32 is removed. The needle holding portion 40 of the first base 31 is provided with a receiving portion 61 having a tapered surface on the distal end side, and a receiving groove 62 for receiving the removable needle 9 is formed at the tip of the receiving portion 61. Movement of the detachable needle 9 accommodated in the accommodation groove 62 is restricted by being pressed by the needle lock member 70 (tip tip lock member). As shown in FIGS. 6 and 7, the needle lock member 70 has an elongated body portion 81, and two convex portions 83 and 84 are provided on the distal end portion 82 side. The convex portion 83 is abutted against the constricted portion 9 </ b> A of the detachable needle 9. The convex portion 84 is provided with a slit 85, and when the suture thread 10 is passed between the slits 85, the axis line of the detachable needle 9 and the axis line of the suture thread 10 can be matched. The receiving portion 61 is provided with a notch 63 on the casing holding portion 50 side so that the suture thread 10 can be easily pulled out.

  As shown in the state where the needle lock member 70 is removed in FIG. 8, the region where the needle lock member 70 is arranged is greatly cut out except for the support portion 88 corresponding to the portion where the base end portion 87 is arranged. A recess 89 is formed. Therefore, the needle lock member 70 is cantilevered by the needle holding portion 40 at the base end portion 87. A stopper 90 is provided on the first base 31 so that the needle lock member 70 does not bend. The stopper 90 is made of an elastic piece biased in a direction to correct the bending of the needle lock member 70, and the distal end portion 90 </ b> A is in contact with the needle lock member 70 in the initial state. At this time, the position of the needle lock member 70 is the first position for restricting the movement of the detachable needle 9.

  As shown in FIG. 6, the suture thread 10 pulled out from the needle holder 40 is drawn into the casing holder 50. In the casing holding part 50, a holder 71 and a winding cylinder 72 are arranged in parallel in this order from the lock member 51 side. The suture thread 10 is drawn into the holder 71 from a slit 100 formed on the side of the holder 71. A casing 12 is accommodated in the holder 71. In the casing 12, a part of the base end portion 12 </ b> B is exposed outside the holder 71. Furthermore, the suture thread 10 tied to the proximal end portion 12 </ b> B is also exposed to the outside of the holder 71.

  As shown in FIGS. 6, 9, and 10, the holder 71 includes holder pieces 101 and 102 that are divided into two cylinders, and the portions near the base ends 101 </ b> A and 102 </ b> A of the holder pieces 101 and 102 are pinned. 103. A gap 104 is formed by making a notch on the proximal end side of the pin 103, and the distal end portions 101B and 102B can be opened by bringing the proximal end portions 101A and 102A close to each other. On the base end portions 101A and 102A side of the holder pieces 101 and 102, one convex portion 105 (opening / closing control portion) protruding outward is formed one by one. Further, a concave portion 106 is formed on the inner side of the base end portion 101 </ b> A of the one holder piece 101 on the base end side with respect to the convex portion 105.

  A holding portion 110 that holds the casing 12 is formed between the tip portions 101B and 102B of the holder pieces 101 and 102, respectively. The proximal end side of the holding part 110 is partitioned by a stopper 111. The movement of the casing 12 in the holding part 110 is restricted by the stopper 111 and the convex part 112 on the front end side. In the initial state, the front end portion 12 </ b> A of the casing 12 is locked by the elastic convex portion 113 formed integrally with the holder pieces 101 and 102. At this time, the base end portion 12B of the casing 12 protrudes from the front end portions 101B and 102B of the holder 71 by a predetermined length. A region on the non-treatment side of the suture thread 10 is wound around the protruding portion. This wound portion (hereinafter also referred to as “traction portion” for convenience) is hooked on a hook 15 (a pulling member of the applicator) of the suturing device 1 described later. In the initial state, the base end portion 12B of the casing 12 is exposed to the outside of the holder 71, but the distance from the stopper 111 to the tip end portions 101B and 102B of the holder pieces 101 and 102 is longer than the casing 12, and therefore the casing 12 The whole can be pushed into the holder 71.

  Further, a claw portion 114 is extended one by one at the tip portions 101B and 102B of the holder pieces 101 and 102, respectively. The claw portion 114 extends so as to avoid the suture thread 10, contacts the proximal end portion 12 </ b> B of the casing 12, and prevents the suture thread 10 wound around the outer periphery of the casing 12 from dropping.

  An end portion (end portion on the non-treatment side) of the suture thread 10 pulled out from the casing 12 is locked to a winding cylinder 72 that is a cylindrical body constituting the biasing device. As shown in FIGS. 6, 10, and 11, the winding cylinder 72 has a groove 120 formed at the distal end portion 72 </ b> A toward the center of the cylinder. The groove 120 has a width that allows the suture 10 to pass therethrough, and has a width that allows one suture thread 10 to pass through the portion closest to the central portion 121. The central portion 121 is widened, and the knot 10A is accommodated here. Further, a hole 122 is formed in a side portion of the distal end portion 72A at a position facing the groove 120. The diameter of the hole 122 is large enough to allow one suture thread 10 to pass through. Furthermore, a through hole 123 that penetrates in the radial direction is formed in the distal end portion 72A. A convex portion 125 and a slit 126 are provided on the base end portion 72 </ b> B side of the winding cylinder 72. One end of a torsion coil spring 127 that is an urging member constituting the urging device is engaged with the slit 126. The torsion coil spring 127 generates a torsional stress in the winding cylinder 72 and applies a desired rotational force to the winding cylinder 72.

  Here, as shown in FIGS. 6 and 8, the first base 31 is formed with an elongated portion 130 in the receiving direction for supporting the lock member 51. In the middle of the opening 130, a groove 131 that supports the lock member 51 is recessed in a direction orthogonal to the receiving direction. Further, a groove 135 for accommodating the holder 71 is formed in an elongated shape in the receiving direction in parallel with the opening 130. From the middle of the groove 135, a long groove 136 that supports the pin 103 of the holder 71 extends in a direction orthogonal to the receiving direction. The long groove 136 has a width in the receiving direction larger than the outer diameter of the pin 103, and can slide the pin 103 in the receiving direction. Further, a convex portion 137 is provided at the base end portion of the groove 135. As shown in FIG. 9, the convex portion 137 is on the distal end side with respect to the convex portion 105 at the proximal end of the holder 71 in the initial state.

  As shown in FIGS. 6 and 8, a groove 140 for accommodating the winding cylinder 72 is formed adjacent to the groove 135. A stepped portion 141 is provided in the groove 140 so that the convex portion 125 of the winding tube 72 can be locked. An elastically deformable claw portion 150 is integrally provided from a corner portion of the casing holding portion 50 on the groove 140 side. The claw portion 150 extends toward the receiving portion 151 protruding from the casing holding portion 50 at the tip end side, and forms a predetermined gap with the receiving portion 151. The receiving portion 151 has a distal end surface that is curved in accordance with the shape of the forceps member 4. Further, as shown in FIG. 9, a guide cylinder portion 152 (guide portion) is formed in the receiving portion 151. The outer diameter of the guide tube portion 152 is substantially equal to the outer diameter of the hook sheath 11 (casing mounting portion) on the suture instrument 1 side shown in FIG. Further, the central axis of the guide tube portion 152 coincides with the axis of the casing 12 held by the holder 71.

  Here, in the slit 33 formed in the first base 31, a portion 33A that partitions the needle holding portion 40 and the casing holding portion 50 is bent, and the needle holding portion 40 and the casing holding portion 50 are in the receiving direction. It bulges alternately along. Convex portions 160 and 161 serving as restricting portions are erected on the bulging portion on the needle holding portion 40 side. A concave portion 162 serving as a restricting portion is formed in the bulging portion on the casing holding portion 50 side. The convex portions 160 and 161 and the concave portion 162 are arranged on a straight line in the receiving direction.

  As shown in FIG. 12, the second base 32 has a shape that is substantially symmetrical with the first base 31. However, the stopper 90 as shown in FIG. Further, the groove 135 that accommodates the holder 71 in the casing holding part 50 is provided with a convex part 138 on the proximal end side with respect to the convex part 137. In the initial state shown in FIG. 9, the convex portion 138 is engaged with the concave portion 106 (opening / closing control portion) of the base end portion 101 </ b> A of the holder piece 101 of the holder 71. Furthermore, in the slit 33, the part 33B which divides the needle holding part 40 and the casing holding part 50 is bent, and the needle holding part 40 and the casing holding part 50 bulge alternately in the receiving direction. A protruding portion 170 serving as a restricting portion is erected on the bulging portion on the needle holding portion 40 side. Concave portions 171 and 172 serving as restricting portions are formed in the bulging portion on the casing holding portion 50 side. The convex part 170 and the concave parts 171 and 172 are arranged on a straight line in the receiving direction. Here, the convex portion 170 is engaged with the concave portion 162 of the first base 31. The concave portion 171 is engaged with the convex portion 160 of the first base 31. The concave portion 172 is meshed with the convex portion 161 of the first base 31.

Next, a procedure for attaching the indwelling tool 20 to the loading device 30 will be described.
The detachable needle 9 (tip tip) is inserted into the accommodation groove 62 of the needle holding portion 40 shown in FIG. 6, and the needle lock member 70 is abutted against the constricted portion 9A of the detachable needle 9, thereby holding the posture of the detachable needle 9. At the same time prevent falling out. The suture thread 10 extending from the detachable needle 9 is pulled out through the slit 85 of the needle lock member 70 and pulled into the casing holding unit 50 through the cutout portion 63 of the receiving portion 61. The suture 10 passes between the lock members 51 and 52 and is inserted into the holder 71 from the groove 101 on the side of the holder 71. The casing 12 through which the suture thread 10 is passed is housed in the housing portion 110 of the holder 71. At this time, the base end portion 12 </ b> B of the casing 12 is exposed from the tip of the holder 71. After the suture thread 10 is wound around the portion exposed from the holder 71, the suture thread 10 is pulled out from the holder 71 toward the winding cylinder 72. The knot 10 </ b> B at the end of the suture 10 is accommodated in the central portion 121 at the tip of the winding cylinder 72, and the suture 10 is hooked in the groove 120. Since the winding cylinder 72 is attached to the bases 31 and 32 so as to twist the torsion coil spring 127, the inner diameter of a portion of the suture thread 10 wound around the casing 12 (hereinafter also referred to as a loop portion) may be reduced. The tension is applied to reduce the size. When the bases 31 and 32 are fixed with screws or the like, the installation of the indwelling tool 20 is completed.

Further, a procedure for mounting the indwelling tool 20 on the suturing device 1 (applicator) using the loading device 30 will be described.
As shown in FIG. 13, the forceps members 3 and 4 of the suturing device 1 are pushed into the loading device 30 with the forceps members 3 and 4 fully opened. As shown in FIG. 14, the protrusion 54 of one lock member 52 fits into the guide groove 13 of the distal end cover 6 of the suturing device 1. The protrusion 53 of the other lock member 51 enters the guide groove 13 on the opposite side of the tip cover 6 and is pressed against the pin 14 so that the forceps members 3 and 4 are maintained in the open state. Since the protrusions 53 and 54 of the lock members 51 and 52 have inclined surfaces with a small inclination angle in the receiving direction, the protrusions 53 and 54 push the lock members 51 and 52 open when the suture instrument 1 is inserted. Works. Since the protrusions 53 and 54 have a large inclination angle in the direction opposite to the receiving direction, the engagement cannot be released simply by pulling the suture instrument 1. Further, since the lock members 51 and 52 are urged so that the projections 53 and 54 are closed by the leaf spring 51A on the base end side, the lock members 51 and 52 are interposed between the suture device 1 and the loading device 30 via the lock members 51 and 52. Thus, the engaged state is formed.

  At this time, in the forceps member 3, the curved needle 8 enters the receiving portion 61 of the needle holding portion 40. Since the receiving part 61 has a truncated cone shape such that the opening diameter becomes smaller as it goes deeper, even when there is a slight misalignment between the curved needle 8 (tip tip accommodating part) and the receiving part 61, The curved needle 8 is guided to the detachable needle 9 in the accommodation groove 62 following the taper of the receiving portion 61. The curved needle 8 comes into contact with the inclined surface 84 </ b> A of the end portion 84 of the needle lock member 70, and starts to fit into the detachable needle 9 while pushing away the needle lock member 70. By being pushed away by the curved needle 8, the needle lock member 70 moves beyond the stopper 90, with the cantilevered base end portion 87 as a fulcrum. At this time, the position of the needle lock member 70 is the second position retracted from the movement path of the curved needle 8.

  The distal end portion 90 </ b> A of the stopper 90 enters the recess 89 when the needle lock member 70 is absent. As a result, even if the needle lock member 70 tries to return to the original position, the distal end portion 90A of the stopper 90 cannot interfere and return. Therefore, the bending needle 8 can fit the detachable needle 9 without being obstructed by the needle lock member 70. At this time, the suture thread 10 centered by the needle lock member 70 enters the slit formed in the curved needle 8.

  Here, since the detachable needle 9 is supported slightly toward the tip, the curved needle 8 is fitted to the detachable needle 9 while pushing the needle holding portion 40 in the receiving direction. The needle holding part 40 can move freely with respect to the casing holding part 50 due to the elastic deformation of the arm part 60. However, the needle holding part 40 side convex parts 160, 161, 170 and the casing holding part 50 side concave part are provided. The movement direction is restricted only in the receiving direction by the restriction portion engaged with 163, 171, and 172. Accordingly, the axis of the tip of the curved needle 8 and the axis of the detachable needle 9 are securely mounted without being deviated.

  On the other hand, the forceps member 4 abuts against the casing holding portion 50 so as to follow the curved shape of the distal end surface of the receiving portion 151. Furthermore, the tip of the forceps member 4 is pressed against the claw 150. The forceps member 4 is biased in the opening direction by a repulsive force generated when the claw 150 is pressed against the forceps member 4. As a result, even if there is play or manufacturing error in the forceps member 4, the pair of forceps members 3, 4 is forcibly opened to a state suitable for mounting the indwelling tool 20.

  Next, when the hook sheath 11 (sheath accommodating a pulling member that pulls the non-treatment side of the indwelling device 20) is advanced and inserted into the guide tube portion 152 formed in the receiving portion 151, the hook sheath 11 is moved. As a result, the axis of the hook sheath 11 coincides with the axis of the casing 12. Further, the hook 15 in the hook sheath 11 is advanced. The hook 15 enters the casing 12 and hits the brake portion 22 (see FIG. 3). When the hook 15 is further advanced, the casing 12 is pushed into the holder 71 via the brake portion 22. The casing 12 moves beyond the elastic protrusion 113 until it hits the stopper 111 in the holder 71. As a result, the casing 12 is pushed into the holder 71.

Here, since the tip opening of the holder 71 has a diameter substantially equal to that of the casing 12, the suture thread 10 wound around the casing 12 remains without being drawn into the holder 71. Here, since the suture thread 10 is urged in the tightening direction by the torsion coil spring 127 of the winding cylinder 72, when the casing 12 is pushed in, the winding cylinder 72 is rotated and the portion around which the suture thread 10 is wound ( Pull the loop portion to reduce the inner diameter of 10A. As a result, as shown in FIG. 15, the wound portion 10 </ b> A of the suture thread 10 tightens the body portion of the hook 15.
When the suture thread 10 is tied to the hook 15, the hook 15 is pulled back. As shown in FIG. 16, the wound portion 10 </ b> A (hereinafter also referred to as a loop portion) of the suture thread 10 in the non-treatment side region sandwiching the brake member 22 of the indwelling device 20 is hooked together with the hook 15. It is drawn into the sheath 11. The groove 120 and the central portion 121 of the winding cylinder 72 can hold the suture 10 in the radial direction, but the force to hold the suture 10 in the receiving direction is weak, so that the amount of the suture 10 pulled in is the groove of the winding cylinder 72. When the height of 120 is exceeded, the suture thread 10 comes out of the winding cylinder 72.

  Further, when the hook 15 is pulled back, the casing 12 is pulled in the direction in which the casing 12 is pulled out from the holder 71 so as to be pulled by the suture thread 10. As shown in FIG. 9, since the holder 71 is engaged with the casing 12 by the convex portion 112, the holder 71 is pulled together with the casing 12. In the initial state, since the concave portion 106 on the base end side and the convex portion 138 of the second base 32 are fitted, the holder 71 does not move, but when the tensile force increases, the fitting of the concave portion 106 is released. . As a result, the holder 71 can be slid in the drawing direction by the length of the long groove 136 (see FIG. 6). Further, in the process in which the holder 71 slides in the pulling direction, the convex portion 105 of the holder 71 and the convex portion 137 of the bases 31 and 32 come into contact with each other so that the base end portions 101A and 102A side of the holder pieces 101 and 102 come closer to each other. The holder pieces 101 and 102 rotate about the pin 103 as an axis. As a result, as shown in FIG. 17, the tip portions 101B and 102B of the holder pieces 101 and 102 are opened. Since the engagement of the casing 12 is released, the casing 12 is pulled out from the holder 71. Furthermore, when the hook 15 is pulled, the casing 12 is abutted against the tip of the hook sheath 11.

  When the hook sheath 11 is retracted and the casing 12 is accommodated in the distal end cover 6, the proximal ends of the locking members 51 and 52 of the loading device 30 are pushed with a finger to open the distal end, and the protrusions 53 and 54 of the locking members 51 and 52 The engagement of the tip cover 6 with the guide groove 13 is released. The loading device 30 and the suturing device 1 are separated from each other by the elastic force of the arm portion 60 that returns the needle holding portion 40 and the elastic force of the claw portion 150 of the casing holding portion 50, and the indwelling device 20 is attached as shown in FIG. It will be in the state.

  When the tissue opening or the like is sutured using the indwelling tool 20, the pair of forceps members 3 and 4 are opened to face the opening to be sutured. Next, the suture instrument 1 is operated to close the pair of forceps members 3 and 4. As shown in FIG. 18, one tissue around the opening W1 is pulled by the forceps members 3 and 4 and the curved needle 8 penetrates the tissue from the other tissue side so as to cross the opening W1. Next, the hook sheath 11 is advanced, the removable needle 9 is accommodated in the casing 12, and the removable needle 9 is engaged with the casing 12. Thereafter, when the casing 12 is retracted, the detachable needle 9 is disengaged from the curved needle 8, so that the forceps members 3 and 4 are opened. As shown in FIG. 19, the region on the treatment side of the suture thread 10 penetrates the tissue and forms a loop, so that the hook 15 is retracted and the non-treatment side of the indwelling tool 20 is pulled to treat the suture thread 10. By pulling the suture thread 10 in the region on the side so as to move to the region on the non-treatment side, the inner diameter of the loop formed in the region on the treatment side is reduced. During this operation, tension is generated in the suture thread 10, and the loop portion (the wound portion 10 </ b> A) that is hooked on the hook 15 does not easily come off from the hook 15. When removing the loop portion (the wound portion 10A) from the hook 15 in order to place the indwelling device 20 in the body, the loop hooked on the hook 15 by moving the hook 15 in the direction in which the tension is released. The indwelling tool 20 is detained.

If the suture thread 10 is made of a material having good slipperiness (single wire nylon in this embodiment), the loop portion hooked on the hook 15 is pulled by the hook 15 to the non-treatment side region, and the inner diameter of the loop is pulled by the pulling force. Is easy to open. Therefore, when the indwelling tool 20 is indwelled in the body, the loop portion is more easily detached from the hook 15. However, the present invention is not limited to such a configuration, and the indwelling tool 20 may be placed by cutting the suture 10 after the suture 10 is squeezed to bind the tissue. Moreover, when the site | part on the non-treatment side of a suture becomes long after tying a tissue, you may cut | disconnect to desired length.
As shown in FIG. 20, such an indwelling device 20 is indwelled in a living body in a state where the opening W1 of the tissue is sutured.

In this embodiment, the detachable needle 9 (tip tip) and the casing 12 are positioned and held, so that the detachable needle 9 can be attached to the curved needle 8 simply by pushing in the suturing device 1. The axis of the casing 12 can be matched. Furthermore, when the casing 12 is pushed in with the hook 15, the suture thread 10 wound around the casing 12 can be wound around the trunk portion of the hook 15. In particular, in the state of wearing a glove made of rubber when performing the procedure, the operation of attaching the detachable needle 9 and the operation of hooking the suture thread 10 on the hook 15 were complicated, but in this embodiment, such inconvenience is solved. Thus, anyone can easily install the indwelling device 20. In particular, when a plurality of locations are continuously sutured, the loading device 30 is prepared as many times as the number of times of suturing and is sequentially attached to the suturing device 1, so that the procedure time can be shortened and the burden on the patient can be reduced. .
Further, as a means for fastening the suture thread 10 to the hook 15, an urging force is applied so that the suture thread 10 is wound up by the torsion coil spring 127, so that the loading device can be reduced in size as compared with the configuration in which the suture thread 10 is pulled linearly. .

Here, the modification of the aspect which wraps the suture thread 10 around the casing 12 is shown in FIGS.
In the patterns shown in FIGS. 21 and 22, the suture 10 pulled out from the casing 12 is passed through the loop 200. The portion 201 drawn through the loop 200 is hooked on the outer periphery of the claw portion 114 of the holder 71. In this case, when the casing 12 is pushed by the hook 15, the suture thread 10 is pulled by the winding cylinder 72 and the claw portion 114, so that the tightening force can be increased. Therefore, the suture thread 10 is more firmly fixed to the hook 15.

  In the patterns shown in FIG. 23 to FIG. 25, a loop 211 is formed by the double-drawing knot 210. A knot 212 is formed in the loop 211 and a small loop 213 is further formed by using a part of the loop 211. The small loop 213 is wound around the casing 12, and the loop 211 is hooked on the outer periphery of the claw portion 114. A knot 212 of the loop 211 is accommodated in the central portion 121 of the winding cylinder 72. In addition to the groove 120, the winding cylinder 72 is provided with a groove 120 </ b> A continuous with the central portion 121, and a part of the loop 211 is hooked. At the time of mounting, the suture thread 10 is tightened so as to be pulled by the winding cylinder 72 and the claw portion 114, so that the tightening force is increased and the hook 15 can be more firmly fixed.

Although the preferred embodiments of the present invention have been described above, the present invention is not limited to the above embodiments. Additions, omissions, substitutions, and other exchanges can be made without departing from the spirit of the present invention. The present invention is not limited by the above description, but only by the appended claims.
For example, the loading device can be modified according to the configuration of the indwelling tool. For example, the present invention can be applied to an indwelling device of a type in which a loop is formed in advance in a treatment side region, such as an indwelling snare. The tissue is bound by pulling the loop portion formed on the non-treatment side with the hook 15 and reducing the inner diameter of the snare. In the case of such an indwelling device, a holding portion that holds the snare, a casing equivalent portion (a member for forming a wound portion) around which the loop is wound, and a holding portion that holds the casing equivalent portion are provided with the same effect. Can be obtained. In the case of an indwelling device that binds the tissue by squeezing the wire with the hook 15, the structure has only the casing holding part 50.
Moreover, although it was set as the structure which has the detachable needle 9 in the embodiment, you may make it form a loop by providing not only this but the front-end | tip tip other than a needle | hook, and engaging this with a casing.

It is a figure which shows the structure of the front-end | tip part of the applicator used for this embodiment. It is a figure which shows the structure of an indwelling tool. It is sectional drawing along the AA line of FIG. It is a whole block diagram of a loading apparatus. It is a B arrow view of FIG. It is the figure which removed the 2nd base. It is a figure which shows a needle | hook lock member. It is a figure which shows a 1st base. It is sectional drawing along CC line of FIG. It is a figure explaining arrangement | positioning when an indwelling tool is accommodated in the loading apparatus. It is a figure which shows the structure of a winding cylinder. It is a figure which shows a 2nd base. It is a figure explaining the operation | movement which loads an indwelling tool to an applicator. It is the figure which represented the state which pressed the applicator against the loading apparatus in the partial cross section. It is the figure which pushed in the hook and fastened the suture thread to the hook. It is the figure which pulled back the hook. It is a figure when a holder opens from the state shown in FIG. It is a figure explaining the process of suturing a structure | tissue with an indwelling tool, Comprising: It is the figure which penetrated the structure | tissue with the curved needle of the applicator in an embodiment. It is the figure which opened the forceps member after locking the detachable needle of an indwelling device to a casing. It is a figure by which the indwelling device is detained in the state which sutured the tissue. It is a figure which shows the other aspect which wraps a suture thread around a casing. It is a figure which shows arrangement | positioning of the indwelling tool in the aspect shown in FIG. It is a figure which shows the other aspect which wraps a suture thread around a casing. It is a figure for demonstrating how to wind a suture thread. It is a figure which shows arrangement | positioning of the indwelling tool in the aspect shown in FIG.

Explanation of symbols

1 Suture device (applicator)
9 Detachable needle (tip tip)
10 Suture (Linear member)
12 Casing 20 Indwelling tool 40 Needle holding part (tip tip accommodating part)
50 Casing holding part 60 Arm part 61 Receiving part 70 Needle lock member (tip tip lock member)
71 Holder 72 Winding cylinder (biasing device)
101 Holder piece 105 Convex part (opening / closing control part)
106 Concave part (opening / closing control part)
110 Holding portion 127 Torsion coil spring (biasing device)
152 Guide tube section (guide section)
160, 161 Convex part (regulation part)
162 Concave part (regulation part)
170 Convex part (regulatory part)
171, 172 Recessed part (regulating part)

Claims (10)

A device for loading an indwelling device for mounting an indwelling device having a linear member on an applicator,
A receiving portion configured to hold a center tip provided on one end side of the linear member that is detachable from the tip tip accommodating portion of the applicator and guide the tip tip accommodating portion of the applicator to the tip tip; A tip holding part,
A first position that is abutted against the tip so as to substantially match an axis of the tip with the axis of the receiving portion within the tip holding portion, and restricts the movement of the tip; A tip-tip locking member that is arranged to be movable between a second position retracted from a movement path of the tip-tip receiving portion when attaching a portion to the tip-tip, and
A casing holding part that is provided on the other end side of the linear member with respect to the tip, and holds the casing that houses the tip so that the axis of the casing mounting part of the applicator for mounting the casing is substantially aligned. When,
A loading device for indwelling devices.   The indwelling device loading apparatus according to claim 1, wherein the casing holding portion and the tip end holding portion are connected by an arm portion that is elastically deformed so as to be relatively movable, and the casing holding portion and the An indwelling device loading apparatus provided with a restricting portion for restricting a moving direction of the tip tip holding portion to be a mounting direction of the tip tip in each of the tip tip holding portions.   2. The indwelling device loading apparatus according to claim 1, wherein the casing holding portion includes a holder including a holding portion that holds the casing so that the casing can be pushed in, and the wire tied to the casing held by the holder. And a biasing device for pulling the member.   4. The indwelling device loading apparatus according to claim 3, wherein the biasing device has a cylindrical body having a groove for engaging the linear member, and a rotation substantially parallel to a direction in which the cylindrical body is pushed into the casing. An indwelling device loading apparatus including an urging member that urges rotation with a shaft.   The indwelling device loading apparatus according to claim 3, wherein the holder has a pair of holder pieces that can be freely opened and closed, and the holder pieces are opened and closed to open the holding portion when the casing is pulled. An indwelling device loading device having a control unit. A device for loading an indwelling device for attaching an indwelling device for tightening a tissue by moving a casing through which a linear member is passed to an applicator,
A holder for holding the casing in a pushable manner;
An urging device for pulling the linear member tied to the casing held by the holder;
A guide portion that engages with a part of the applicator and aligns the axis of the casing with the axis of the sheath to which the casing is attached;
A loading device for indwelling devices.   It is a loading apparatus of the indwelling tool of Claim 6, Comprising: The said casing holding | maintenance part is a holder provided with the holding | maintenance part hold | maintained so that the said casing can be pushed in, and the said wire | line tied to the said casing hold | maintained at the said holder. And a biasing device for pulling the member.   8. The indwelling device loading apparatus according to claim 7, wherein the biasing device has a cylindrical body having a groove for engaging the linear member, and a rotation substantially parallel to a direction in which the cylindrical body is pushed into the casing. An indwelling device loading apparatus comprising: a rotation biasing member that biases rotation with a shaft.   8. The indwelling device loading apparatus according to claim 7, wherein the holder has a pair of holder pieces that can be freely opened and closed, and the holder pieces are opened and closed to open the holding portion when the casing is pulled. An indwelling device loading device having a control unit. A device for loading an indwelling device for mounting an indwelling device having a linear member on an applicator,
A receiving portion configured to hold a center tip provided on one end side of the linear member that is detachable from the tip tip accommodating portion of the applicator and guide the tip tip accommodating portion of the applicator to the tip tip; A tip holding part,
A first position that is abutted against the tip so as to substantially match an axis of the tip with the axis of the receiving portion within the tip holding portion, and restricts the movement of the tip; A tip-tip locking member that is arranged to be movable between a second position retracted from a movement path of the tip-tip receiving portion when attaching a portion to the tip-tip, and
A casing holding part that is provided on the other end side of the linear member with respect to the tip, and holds the casing that houses the tip so that the axis of the casing mounting part of the applicator for mounting the casing is substantially aligned. When,
An urging device for pulling the linear member tied to the casing held by the casing holding part;
A guide portion that engages with a part of the applicator and aligns the axis of the casing with the axis of the sheath to which the casing is attached;
A loading device for indwelling devices.

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