JP2010082284A - Suture system, suture device, and suture method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To prevent a member for fastening suture thread, etc., from being left in a body cavity concerning a suture device to be used in combination with an endoscope. <P>SOLUTION: The suture device includes: a sheath to be inserted to the forceps channel of the endoscope; a hand operation part 22 successively arranged from the proximal end of the sheath; and a main suture needle 24 arranged at the distal end of the sheath. The main suture needle 24 has a sub-suture needle 54. The sub-suture needle 54 is freely rockably supported by the main suture needle 24 and is rocked between a storage position, where the distal end is directed in the opposite direction of the distal end of the main suture needle 24 and stored inside the main suture needle 24, and a projection position, where the distal end is projected to the outer part of the main suture needle 24. The suture device puts the suture thread 4 through a biological tissue, so as to expose both the ends of the suture thread 4 onto one and the same surface of the biological tissue by inserting the respective suture needles 24, 54 to the biological tissue. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a suturing system for suturing biological tissue in a body cavity by being used in combination with an endoscope having a forceps channel, a suturing device used in the suturing system, and a suturing method for the suturing system. .

  In recent years, endoscopes for observing a patient's body cavity have been widely used in medical practice. Endoscopes are provided with channels called forceps channels for inserting treatment tools such as forceps and snares. By using these treatment tools in combination, excision of lesions and recovery of biological tissue are performed. Various treatments such as these can be performed.

One of the treatment tools used for an endoscope is a suturing device for suturing a wound formed in a body cavity (see Patent Documents 1 and 2). The suturing apparatus has a hollow suturing needle, and stores a suturing thread having a fixing member at one end inside the suturing needle. When a biological tissue is sutured with the suturing device, first, a suture needle is inserted into the biological tissue and penetrated. Then, the fixing member is released from the tip of the suture needle, and the suture needle is pulled out from the living tissue. Thereby, the fixing member is engaged with the living tissue, and the suture thread is passed through the living tissue. Thereafter, another fixing member is inserted from the other end of the suture thread, and the living tissue is clamped by each fixing member to complete the suturing.
JP 2005-329238 A JP-A-2005-329240

  When membrane-like living tissues are stitched together with the above-described suturing device, each fixing member is positioned on the opposite side across each living tissue. For this reason, there is a problem that one of the fixing members may not be recovered when the stitching is released.

  For example, the stomach wall and the gallbladder wall may be incised from the inside of the stomach, and the inside of the gallbladder may be observed by allowing the distal end of the endoscope to enter the gallbladder through these incisions. At this time, if the stomach wall and the gallbladder wall are separated, there is a concern that filth and the like may enter each organ. For this reason, when observing the inside of the gallbladder as described above, the gastric wall and the gallbladder wall, which are membrane-like living tissues, are stitched together at a plurality of locations so that they are brought into close contact with each other.

  When the inside of the gallbladder is observed as described above, the suture between the stomach wall and the gallbladder wall is released after each incision is sutured. For this reason, when each fixing member is on both sides of the stomach wall and the gallbladder wall, the fixing member on the gallbladder side cannot be collected and remains in the gallbladder. Since a resin material or the like is used for the fixing member, if such a fixing member remains in the body cavity without being fixed, an unexpected accident may occur.

  The present invention has been made in view of the above problems, and an object of the present invention is to prevent a member for tightening a suture from remaining in a body cavity in a suturing device used in combination with an endoscope.

  In order to achieve the above object, the present invention is used in combination with an endoscope having a forceps channel, and an engagement tool that engages a living tissue in a suturing system for suturing a living tissue in a body cavity. A suture device for passing a suture thread provided at one end through a biological tissue, and the suture device is inserted through the suture thread after passing through the biological tissue, and the suture is completed by tightening the biological tissue together with the engagement tool. An insertion portion that is inserted into the forceps channel, a proximal operation portion that is connected to the proximal end of the insertion portion, and a substantially rod-like shape that is provided at the distal end of the insertion portion. A main suture needle, a recess formed in a side surface of the main suture needle along the axial direction of the main suture needle, a swingable support supported by the main suture needle, and a distal end of the main suture needle with a tip of the main suture needle Stored in the recess in the opposite direction A substantially rod-shaped sub-suture needle provided with a mounting portion for moving the engagement position to the distal end and a position where the engagement tool is attached to the distal end. And swinging means for swinging the sub-suture needle to the storage position and the protruding position in response to an operation of an operation means provided in the hand operation section, and the sub-suture needle is moved to the storage position In this state, the main suture needle is inserted into the living tissue, and the main suture needle is inserted until the tip of the auxiliary suture needle passes the surface of the living tissue, and then the auxiliary suture needle is moved to the protruding position. The secondary suture needle is inserted into the living tissue until the distal end of the secondary suture needle is exposed to the outside of the living tissue, and the engagement tool is removed from the attachment portion. The tip of the auxiliary suture needle is engaged with the living tissue. After inserting the main suture needle again until it passes through the surface of the weave, the sub-suture needle is moved to the storage position, and the main suture needle is pulled out of the living tissue, so that the same surface of the living tissue is The suture thread can be passed through a living tissue so that both ends of the suture thread are exposed.

  It is more preferable to have a cylindrical member for pushing the fastener that has entered the forceps channel toward the biological tissue in the body cavity.

  It is preferable that the attachment portion is configured so that the attached engagement tool is detached when a predetermined tension is applied to the suture thread.

  The fastener is preferably provided with a retaining means for preventing the suture thread from coming off. Further, the retaining means limits the suture feeding direction to one direction by changing the degree of friction against the suture according to the feeding direction of the inserted suture. More preferred.

  The fastener is formed in a substantially cylindrical shape or a substantially prismatic shape, and has a main body portion provided with the retaining means, and a cutting portion formed so that a cross-sectional area is smaller than the main body portion. It is preferable.

  The main suture needle is preferably provided with a biasing means for biasing the sub-suture needle so as to press it against the recess and holding the sub-suture needle in the storage position.

  The present invention also relates to a suturing apparatus that is used in combination with an endoscope having a forceps channel to pass a suture thread provided at one end with an engaging tool that engages with a living tissue through the living tissue in a body cavity. An insertion portion to be inserted into the forceps channel, a hand operation portion connected to the proximal end of the insertion portion, a substantially bar-shaped main suture needle provided at the distal end of the insertion portion, and a main suture needle A concave portion formed on the side surface along the axial direction of the main suture needle, and supported by the main suture needle so as to be swingable, and housed in the concave portion with the tip facing away from the tip of the main suture needle. A substantially rod-shaped sub-suture needle provided with a mounting portion for moving the engagement position to the distal end and a position where the engagement tool is attached to the distal end. And according to the operation of the operating means provided in the hand operating section Rocking means for swinging the auxiliary suture needle between the storage position and the protruding position, and inserting the main suture needle into a living tissue with the auxiliary suture needle in the storage position, After the main suture needle is inserted until the tip of the sub-suture needle passes the surface of the living tissue, the sub-suture needle is moved to the projecting position, and the main suture needle is pulled out to remove the main suture needle. The sub-suture needle is inserted into the living tissue until the tip is exposed to the outside of the living tissue, the engagement tool is detached from the attachment portion and engaged with the living tissue, and the tip of the auxiliary suture needle is inserted into the living tissue. The main suture needle is inserted again until it passes the surface of the body, and then the sub-suture needle is moved to the storage position, and the main suture needle is pulled out of the living tissue, so that the suture is placed on the same surface of the living tissue. Organize the suture so that both ends of the thread are exposed Characterized in that it possible to pass.

  Furthermore, the present invention is used in combination with an endoscope having a forceps channel, and a suturing device for passing a suture thread provided at one end with an engagement tool that engages with a living tissue through the living tissue in the body cavity. The suturing device is inserted into the suture thread after passing through the living tissue, and the fastening device completes the suturing by tightening the living tissue together with the engaging tool, and the suturing device includes the forceps channel. An insertion portion that is inserted into the insertion portion, a hand operation portion that is connected to the proximal end of the insertion portion, a substantially bar-shaped main suture needle provided at the distal end of the insertion portion, and the main suture needle on the side surface of the main suture needle. A recess formed along the axial direction of the suturing needle, and a storage position supported in the main suturing needle so as to be swingable and housed in the recess with the tip facing away from the tip of the main suturing needle. , Make the tip protrude outside the main suture needle Depending on the operation of the substantially rod-shaped sub-suture needle provided with an attachment portion to which the engagement tool is attached at the tip and the operating means provided in the hand operation portion while moving / displaced between the protruding position and In a suturing method of a suturing system having a swinging means for swinging the sub-suture needle to the storage position and the protruding position, the main suture needle is placed on a living tissue with the sub-suture needle in the storage position. Inserting the main suture needle until the tip of the sub-suture needle passes the surface of the biological tissue, and then moving the sub-suture needle to the protruding position; and The step of inserting the sub-suture needle into the living tissue until the tip of the sub-suture needle is exposed to the outside of the living tissue so as to be pulled out, and the engagement tool is detached from the attachment portion and engaged with the living tissue Step to make And inserting the main suture needle again until the tip of the secondary suture needle passes the surface of the biological tissue, and then moving the secondary suture needle to the storage position; and The step of passing the suture through the living tissue so that both ends of the suture are exposed on the same surface of the living tissue by pulling out, and the suturing tool from the end opposite to the engaging tool. Passing through the thread, and suturing the living tissue by tightening the living tissue with the engagement tool and the fastening tool.

  In the present invention, a main suture needle and a sub-suture needle are provided in the suturing device, and these are inserted into the living tissue, whereby the suture is attached to the living tissue so that both ends of the suture are exposed on the same surface of the living tissue. Made it possible to pass through. As a result, the engaging tool and the tightening tool are positioned on the same surface of the living tissue, so that they do not remain in the body cavity even when the suture is released.

  FIG. 1 is an explanatory diagram schematically showing a configuration of a suturing system 2 for suturing a biological tissue. The suturing system 2 includes a suturing device 10 for passing the suture 4 through a living tissue, and a tightening that completes suturing by inserting the suturing device 10 after passing the suturing device 10 through the living tissue and tightening the living tissue. It consists of a tool 12 and an insertion tube (tubular member) 14 used when the fastener 12 is passed through the suture thread 4.

  The suturing device 10 includes a sheath (insertion portion) 20 formed in a long flexible tubular shape, a hand operating portion 22 connected to the proximal end of the sheath 20, and a substantially round bar shape provided at the distal end of the sheath 20. And the main suture needle 24. As shown in FIG. 2, the suturing device 10 is a so-called treatment tool that is used by being inserted into a forceps port 42 provided in the operation unit 41 of the electronic endoscope 40. The suturing device 10 inserted through the forceps opening 42 passes through the forceps channel formed in the insertion portion 43, and exposes the main suture needle 24 from the forceps outlet 44 formed in the distal end surface 43 a of the insertion portion 43.

  The suturing system 2 is used in combination with the electronic endoscope 40 as described above, and is used when suturing a wound formed in a body cavity. In addition to the forceps outlet 44, the distal end surface 43a of the insertion portion 43 has an observation window 45 for capturing image light from the observation site, an illumination window 46 for irradiating illumination light for illuminating the body cavity, and the like. Is provided.

  The sheath 20 is formed in a tubular shape with a circular cross section and has flexibility. The sheath 20 is formed with a diameter that can be inserted into the forceps channel of the electronic endoscope 40. The sheath 20 is configured, for example, by adhering an outer skin layer made of a flexible material such as tetrafluoroethylene to the outer surface of a cylindrical net formed by braiding stainless steel fine wires.

  The hand operation unit 22 includes an operation unit main body 25 formed in a cylindrical shape, and a slider (operation means) 26 slidably attached to the operation unit main body 25. A finger hook portion 27 formed in an annular shape is provided at an end portion of the operation portion main body 25. When operating the suturing device 10, the thumb is passed through the finger-hanging portion 27, and the hand operating portion 22 is held with the index finger and the middle finger of the same hand sandwiching the concave portion 26 a of the slider 26. In this state, the suturing device 10 is operated by sliding the slider 26 back and forth.

  Returning to FIG. 1, the fastening tool 12 has a substantially cylindrical main body 12 a. A through hole 30 into which the suture thread 4 can be inserted is formed in the main body portion 12a. Further, the fastener 12 is provided with a leaf spring (a retaining means) 32 that presses and holds the suture thread 4 inserted through the through hole 30. The leaf spring 32 is attached so as to incline so that the through hole 30 is closed and the front end faces the one opening 30 a side of the through hole 30.

  Thereby, the suture thread 4 can be sent from the other opening 30b of the through hole 30 toward the opening 30a, but between the suture thread 4 and the leaf spring 32 from the opening 30a toward the opening 30b. The generated friction increases and the suture 4 cannot be fed. The leaf spring 32 thus changes the degree of friction with respect to the suture thread 4 in accordance with the feeding direction of the suture thread 4 so that the feeding direction of the suture thread 4 is limited to one direction. After tightening, the suture thread 4 is prevented from loosening or coming off.

  The insertion tube 14 is a cylindrical tube having a through-hole 34 and has flexibility. The insertion tube 14 is formed with a diameter that can be inserted into the forceps channel of the endoscope. Further, the through hole 34 is formed with a diameter smaller than that of the fastener 12 through which the suture thread 4 can be inserted.

  After the suture device 10 passes the suture 4 through the living tissue in the body cavity, the fastener 12 is fed into the body cavity through the suture 4 exposed from the forceps port 42. At this time, since the fastening tool 12 presses the suture thread 4 with the leaf spring 32, the fastening tool 12 cannot be fed by hand from the forceps opening 42. The insertion tube 14 is for solving this problem. After the fastener 12 is inserted into the suture thread 4, the insertion tube 14 is inserted into the suture thread 4, and the insertion tube 14 is inserted into the forceps channel. To go. Thereby, since the fastening tool 12 is pushed forward by the insertion tube 14, the fastening tool 12 can be sent toward the living tissue in the body cavity.

  As shown in FIG. 3, the main suture needle 24 is formed in a hollow shape. The internal space of the main suture needle 24 is connected to the internal space of the sheath 20 formed in a flexible tubular shape. Further, as described above, the operation unit main body 25 is formed in a cylindrical shape. The internal space of the operation unit body 25 is also connected to the internal space of the sheath 20. As a result, an internal conduit from the main suture needle 24 to the hand operation unit 22 is formed in the suturing device 10.

  On the side surface of the main suture needle 24, a recess 50 that is recessed from the periphery is formed. The recess 50 is formed along the axial direction of the main suture needle 24. An opening 52 that exposes the internal space of the main suture needle 24 is formed at the end of the recess 50 on the distal end side of the main suture needle 24.

  The main suture needle 24 is provided with a substantially round bar-like auxiliary suture needle 54. The suturing device 10 thus has two main and sub suture needles 24 and 54, and each suture needle 24 and 54 is inserted into a living tissue, thereby passing the suture 4 through the living tissue. For each of these suture needles 24 and 54, for example, a metal material such as stainless steel is used.

  The sub-suture needle 54 is disposed so as to be housed in the recess 50 with its tip facing away from the tip of the main suture needle 24, and can be swung freely via a swing shaft 55 provided on the base side. The suture needle 24 is supported. The sub-suture needle 54 has an end portion on the base side where the swing shaft 55 is provided bent in an L shape, and the end portion enters the main suture needle 24 through the opening 52. Further, the secondary suture needle 54 is formed in a hollow shape like the main suture needle 24. An opening that exposes the internal space of the sub-suture needle 54 is formed at an end portion on the base side of the sub-suture needle 54 that has entered the main suture needle 24. The internal space of the sub-suture needle 54 is connected to the internal space of the main suture needle 24 through an opening formed at the end on the root side.

  A bar spring (biasing means) 56 formed in a substantially U-shape is attached to the auxiliary suture needle 54. One end of the bar spring 56 is attached near the base of the sub-suture needle 54, and the other end is attached to the inner surface 24 a of the main suture needle 24. As a result, the bar spring 56 biases the sub-suture needle 54 so as to press it against the concave surface 50 a of the recess 50, and holds the sub-suture needle 54 in the storage position stored in the recess 50.

  One end of the suture thread 4 is provided with an engaging tool 6 that engages with the living tissue to prevent the suture thread 4 from coming off when the living tissue is sutured. An attachment portion 70 (see FIG. 5) for attaching the engaging tool 6 is provided at the distal end of the sub-suture needle 54.

  When attaching the suture thread 4 to the suturing device 10, first, the end opposite to the side on which the engagement tool 6 is provided is passed through the through hole 76 (see FIG. 5) provided in the attachment portion 70, The internal space of the suture needle 54 is entered. Note that the end of the suture 4 opposite to the engagement tool 6 remains in a state where the suture 4 is cut.

  After the end portion of the suture thread 4 enters the internal space of the sub-suture needle 54, the suture thread 4 is sequentially fed and folded by the swing shaft 55, and the end portion enters the internal space of the main suture needle 24. Let Then, the end portion of the suture thread 4 is caused to enter the internal space of the operation unit main body 25 via the internal conduit of the suturing device 10, and is exposed to the outside from the through hole 57 formed in the operation unit main body 25. Thereafter, the suture thread 4 is further fed, and the engagement tool 6 is attached to the attachment portion 70. Thereby, the suture thread 4 is set to the suturing apparatus 10 as a use state.

  In addition to the through hole 57 for exposing the suture thread 4, the operation unit body 25 is provided with a slit 58 which is a through hole formed long in the axial direction of the operation unit body 25. The slider 26 is formed in a cylindrical shape having an inner diameter substantially the same as the diameter of the operation unit main body 25. A section 26 b is formed on the inner surface of the slider 26 so as to protrude in a substantially plate shape toward the center. The section 26 b enters the slit 58. The sliding amount of the slider 26 is determined by the engagement between the section 26 b and the slit 58.

  One end of an operation wire (swinging means) 60 is connected to the section 26b. The operation wire 60 passes through the internal conduit of the suturing device 10, and the other end is connected to the root side end of the sub-suture needle 54. Further, the length of the operation wire 60 is adjusted so that the auxiliary suture needle 54 is held at the storage position when the slider 26 is positioned on the front end side (the position shown in FIG. 3).

  As a result, when the slider 26 is pulled forward and slid to the rear end side, the operating force is transmitted to the auxiliary suture needle 54 via the operation wire 60, and the swinging shaft 55 resists the bias of the bar spring 56. As shown in FIG. 4, the sub-suture needle 54 moves to the projecting position where the tip projects out of the main suturing needle 24.

  Further, after the auxiliary suture needle 54 is moved to the protruding position, when the slider 26 is pushed and slid to the front end side, the auxiliary suture needle 54 is retracted from the protruding position by being pushed by the operation wire 60 and urging the bar spring 56. Return to position. As described above, the auxiliary suture needle 54 swings between the storage position and the protruding position in accordance with the slide of the slider 26.

  As shown in FIG. 5, the engaging tool 6 provided at one end of the suture thread 4 is formed in a substantially elliptical plate shape. The attachment portion 70 for attaching the engagement tool 6 includes a recess 72 that is recessed according to the shape of the engagement tool 6, and a frame portion 74 that surrounds the recess 72. The depth of the recess 72 is substantially the same as the thickness of the engagement tool 6. The frame portion 74 is formed in a substantially C shape in which the base side of the auxiliary suture needle 54 is cut out. A through hole 76 through which the suture thread 4 is passed is formed in the recess 72. As described above, the suture thread 4 enters the sub suture needle 54 through the through hole 76. Further, the through hole 76 is formed in a long hole shape that is long in the axial direction of the auxiliary suture needle 54.

  When the engagement tool 6 is attached to the attachment portion 70, the engagement tool 6 is fitted into the recess 72. Then, as shown in FIG. 6, the engaging tool 6 is fitted to the frame part 74, and the engaging tool 6 is attached to the attaching part 70. On the contrary, when removing the engaging tool 6 from the attachment portion 70, the suture 4 is pulled strongly to apply a predetermined tension to the suture 4. Then, a force that moves along the inclined concave portion 72 and the through-hole 76 formed in the shape of a long hole is applied to the engaging tool 6, and as shown in FIG. 7, from the notched end portion of the frame portion 74. The engaging tool 6 comes out. Thereby, the engaging tool 6 is removed from the attachment part 70.

  Next, the operation of the suturing system 2 configured as described above will be described with reference to the operation diagrams shown in FIGS. 8 to 17, taking as an example the case of suturing two membranous biological tissues BT1 and BT2. When suturing each biological tissue BT1, BT2, first, the insertion portion 43 of the electronic endoscope 40 is inserted into the body cavity of the patient, and the distal end surface 43a of the insertion portion 43 faces the biological tissue BT1 to be sutured. Let Thereafter, the main suture needle 24 and the sheath 20 of the suturing device 10 in which the suture thread 4 is set are inserted from the forceps port 42 and fed into the forceps channel, and the main suture needle 24 is exposed from the forceps outlet 44. At this time, the sub-suture needle 54 is kept in the storage position. And as shown in FIG. 8, the main suture needle 24 is made to face biological tissue BT1.

  When the main suture needle 24 faces the living tissue BT1, the insertion portion 43 is further fed into the body cavity, and as shown in FIG. 9, the main suture needle 24 is moved to the main tissue until the auxiliary suture needle 54 passes through each of the living tissues BT1 and BT2. The body tissues BT1 and BT2 are inserted. When the main suture needle 24 is inserted, the slider 26 is pulled forward and slid to the rear end side, and the sub-suture needle 54 is moved from the storage position to the protruding position as shown in FIG. Thereafter, the insertion portion 43 is pulled back from the body cavity, and as shown in FIG. 11, the auxiliary suture needle 54 is inserted into each of the living tissues BT1 and BT2 until the tip is exposed to the outside of the living tissue BT1.

  When the sub-suture needle 54 is inserted, the suture thread 4 exposed from the through-hole 57 formed in the operation portion main body 25 is pulled strongly, and the engaging tool 6 attached to the attachment portion 70 is attached as shown in FIG. A state of coming out of the frame portion 74 is set (see FIG. 7). Thereafter, the insertion portion 43 is again fed into the body cavity, and as shown in FIG. 13, the auxiliary suture needle 54 is pulled out from each of the living tissues BT1 and BT2. Then, the engaging tool 6 that has come out of the frame portion 74 is engaged with the living tissue BT1 and completely detached from the attachment portion 70, and remains on the living tissue BT1 side. Thereby, the suture thread 4 is passed through each of the living tissues BT1 and BT2.

  After the sub suture needle 54 is pulled out from each of the living tissues BT1 and BT2, the slider 26 is moved to the front end side, and as shown in FIG. 14, the sub suture needle 54 is moved from the protruding position to the storage position. When the sub suture needle 54 is moved to the storage position, the insertion portion 43 is pulled back from the body cavity, and the main suture needle 24 is pulled out from each of the living tissues BT1 and BT2, as shown in FIG. Then, the suture thread 4 is passed again through the living tissues BT1 and BT2, and the living tissues BT1 and BT2 are sutured in a substantially U shape so as to be folded back on the living tissue BT2. In this manner, the suturing device 10 can pass the suture 4 through each of the living tissues BT1 and BT2 so that both ends of the suture 4 are exposed on the same surface of the living tissue BT1.

  When the main suture needle 24 is pulled out from each of the living tissues BT1 and BT2, the sheath 20 is pulled back, and the sheath 20 and the main suture needle 24 are pulled out from the forceps channel of the electronic endoscope 40. Thereafter, the suture thread 4 is removed from the suture apparatus 10 by pulling out the suture thread 4 from the internal conduit of the suture apparatus 10 or by cutting the suture thread 4 on the main suture needle 24 side.

  When the suture thread 4 is removed from the suturing apparatus 10, its end is inserted into the opening 30 b of the fastener 12, and the fastener 12 is passed through the suture thread 4. When the fastener 12 is passed through the suture thread 4, the insertion tube 14 is subsequently passed through the suture thread 4, and the insertion tube 14 is sequentially fed into the forceps channel of the electronic endoscope 40, as shown in FIG. The fastener 12 is pushed toward the living tissues BT1 and BT2.

  Then, the tightening tool 12 is pressed against the biological tissue BT1 while applying tension to the suture thread 4, and the biological tissues BT1 and BT2 sutured with the suture thread 4 are fastened to the engaging tool 6 as shown in FIG. Tighten with the tool 12. At this time, since the feeding direction of the suture thread 4 is limited to one direction by the leaf spring 32 in the fastening tool 12, after tightening each living tissue BT 1, BT 2 with the engaging tool 6 and the fastening tool 12. The suture thread 4 is not loosened or pulled out.

  When the biological tissues BT1 and BT2 are tightened, the insertion tube 14 is removed from the forceps channel of the electronic endoscope 40. Thereafter, a known scissors forceps or the like is inserted into the forceps channel of the electronic endoscope 40, and the remaining suture thread 4 is cut in the vicinity of the fastener 12. This completes the suturing of the living tissues BT1 and BT2.

  When releasing the above-described suture, for example, the suture 4 between the fastening tool 12 and the living tissue BT1 is cut using scissors forceps or the like, and the fastening tool 12 is recovered. And the engaging tool 6 is collect | recovered, extracting the suture 4 from each biological tissue BT1 and BT2. Thereby, the sutures of the living tissues BT1 and BT2 are released.

  Thus, according to the present embodiment, when the membrane-like biological tissues BT1 and BT2 are sutured, the engaging tool 6 and the fastening tool 12 are positioned on the one biological tissue BT1 side. Therefore, when releasing this stitching, the engaging tool 6 and the fastening tool 12 can be reliably recovered, and the engaging tool 6 and the fastening tool 12 do not remain in the body cavity.

  In the above embodiment, an example in which the membrane-like biological tissues BT1 and BT2 are sutured has been shown. However, the suture system 2 of the present invention is not limited to this, and as shown in FIG. It can also be used when stitching BT3 and BT4.

  When suturing each of the block-shaped biological tissues BT3 and BT4, first, as shown in FIG. 18A, the contact surface of each biological tissue BT3 and BT4 and the main suture needle 24 are parallel to each other and placed in the storage position. The main suture needle 24 is inserted into one of the living tissues BT3 and BT4 until a certain sub-suture needle 54 is completely buried therein. At this time, the concave portion 50 of the main suture needle 24 is made to face the other living tissue BT3, BT4 side. 18 shows an example in which the main suture needle 24 is inserted into the living tissue BT4. Hereinafter, description will be made in accordance with this example.

  When the main suture needle 24 is inserted into the living tissue BT4, the slider 26 is pulled forward, and as shown in FIG. 18B, the auxiliary suture needle 54 is slightly swung so as to push away the living tissue BT4. Thereafter, the main suture needle 24 is pulled out while the slider 26 is slid to the rear end side and the auxiliary suture needle 54 is moved to the protruding position, and as shown in FIG. 18 (c), the tip is outside the living tissue BT3. The sub-suture needle 54 is inserted into each of the living tissues BT3 and BT4 until it is exposed.

  When the sub-suture needle 54 is inserted into each of the living tissues BT3 and BT4, the engagement tool 6 is removed, the suture 4 is inserted into each of the living tissues BT3 and BT4, and the suture device 10 is inserted. Removal of the suture thread 4 and tightening of the biological tissues BT3 and BT4 by the fastener 12 are performed to complete the suturing of the biological tissues BT3 and BT4 as shown in FIG. As described above, the suturing system 2 of the present invention can pass the suture thread 4 through the biological tissues BT3 and BT4 so that both ends of the suture thread 4 are exposed on the same surface of the block-shaped biological tissues BT3 and BT4. it can. Therefore, the suturing system 2 of the present invention can be used, for example, when suturing a wound formed on the surface of a body wall.

  In the above embodiment, the leaf spring 32 is shown as the retaining means. However, the retaining means is not limited to this, and a pair of fasteners formed in the through hole 81 as in the fastening tool 80 shown in FIG. The protruding pieces 82 and 83 may be used. Each of the protruding pieces 82 and 83 face each other with the through hole 81 interposed therebetween. Each of the protrusions 82 and 83 is a protrusion having a substantially triangular shape with a sharp tip, and is inclined so that the tip thereof faces the one opening 81 a side of the through hole 81. Each of the projecting pieces 82 and 83 is formed with a predetermined width in a direction orthogonal to the paper surface.

  The distance between the tips of the protrusions 82 and 83 is the same as or slightly narrower than the diameter of the suture thread 4. A plurality of the projecting pieces 82 and 83 are provided along the axial direction of the through hole 81, and are arranged in a sawtooth shape inside the through hole 81.

  As a result, the suture thread 4 can be sent from the other opening 81b of the through hole 81 toward the opening 81a. However, the suture thread 4 and the protruding pieces 82 and 83 can be moved from the opening 81a toward the opening 81b. Friction that occurs during the process increases, and the suture 4 cannot be fed. Therefore, the same effect as that of the fastening tool 12 of the above embodiment can be obtained.

  Further, the retaining means may be a metal tube 86 as in the fastening tool 85 shown in FIG. The fastening tool 85 has a main body portion 87 formed in a substantially cylindrical shape. A through hole 88 through which the suture thread 4 can be inserted is formed in the main body portion 87. The metal tube 86 is formed by winding a metal film such as aluminum or stainless steel into a cylindrical shape. The metal tube 86 is attached to the main body 87 so that the through hole 88 and the internal space are connected.

  As shown in FIG. 20B, the metal tube 86 is crushed after the living tissue is tightened by the fasteners 85. As a result, a large friction is generated between the suture thread 4 and the metal tube 86, and the suture thread 4 is prevented from loosening or coming off.

  Further, the retaining means may be an elastic body 91 as in the fastening tool 90 shown in FIG. The fastening tool 90 has a main body 92 formed in a substantially cylindrical shape. The main body 92 has an inner surface that is tapered. The elastic body 91 is formed in a cylindrical shape having a tapered side surface corresponding to the inner surface of the main body 92, and is housed inside the main body 92. Further, the length of the elastic body 91 is shorter than the internal space of the main body 92. A through hole 93 for inserting the suture thread 4 is formed in the elastic body 91. For the elastic body 91, for example, a resin material having elasticity such as silicone rubber is used.

  At one end of the main body portion 92 on the side where the inner diameter is widened, an engaging portion 92a that engages with the elastic body 91 that has entered the inside and prevents the elastic body 91 from coming off is formed. The elastic body 91 is normally held in contact with the engaging portion 92a as shown in FIG. Further, the through hole 93 is formed so that the diameter thereof is larger than the diameter of the suture thread 4 when the elastic body 91 is in the position of FIG.

  As shown in FIG. 21B, the elastic body 91 is pressed from the engagement portion 92a side after the biological tissue is tightened by the fastener 90, and the inner diameter of the main body portion 92 is narrowed to the side. It is pushed forward. Then, the elastic body 91 is elastically deformed and contracts, and the diameter of the through hole 93 is also narrowed. Accordingly, a large friction is generated between the suture thread 4 and the elastic body 91, and the suture thread 4 is prevented from being loosened or pulled out.

  In the fastening tool 12 of the above embodiment, the feeding direction of the suture thread 4 is limited to one direction. However, the present invention is not limited to this, and the fastening tool 85 of FIG. 20 or the fastening tool 90 of FIG. In addition, after tightening the living tissue, a predetermined operation is performed to increase the friction generated between the suture thread 4 and to inhibit the suture thread 4 from being fed in both directions, so that the suture thread 4 is loosened or pulled out. May be prevented.

  By the way, in each of the above-mentioned fasteners 12, 80, 85, 90, when releasing the suture, an acupuncture forceps or the like is inserted between the fasteners 12, 80, 85, 90 and the living tissue, Since the suture thread 4 has to be cut, an operation for releasing is difficult. For this reason, you may make it provide the cutting part 96 like the fastener 95 shown in FIG. The cutting part 96 is formed with a smaller diameter than the main body part 97 formed in a substantially cylindrical shape, and has a smaller cross-sectional area than the main body part 97. Further, the cutting portion 96 is located closer to the entrance side of the suture thread 4 than the protruding pieces 98 and 99 so that the cutting is performed between the protruding pieces 98 and 99 serving as retaining means and the engaging tool 6. Has been placed. Thus, after the biological tissue is tightened and tightened with the fastener 95, the suture can be easily released by cutting the cutting portion 96 with scissors forceps or the like. it can.

  In the above-described embodiment, the engagement tool 6 formed in a substantially elliptical plate shape is shown. However, as in the engagement tool 105 shown in FIG. The suture thread 4 is connected to the engagement tool 105 in the vicinity of the center of the recessed surface. When this engaging tool 105 is used, a mounting portion comprising a recessed portion 106 that is depressed according to the shape of the engaging tool 105 that is crushed and flattened, and a through hole 107 through which the suture thread 4 is passed. 108 is formed at the tip of the auxiliary suture needle 54.

  The engagement tool 105 is attached to the attachment portion 108 by being fitted into the recess 106 in a state of being stretched flat. When the biological tissue is sutured, tension is applied to the suture thread 4 to attract the engaging tool 105 to the recess 106, and the state where the engaging tool 105 is attached to the attachment portion 108 is maintained. Then, when removing the engagement tool 105 from the attachment portion 108, the tension of the suture thread 4 is loosened. Then, the engaging tool 105 is detached from the attachment portion 108 by the elastic force of the engaging tool 105 itself.

  In the above-described embodiment, the attachment portion 70 is provided with the substantially C-shaped frame portion 74 and the elongated hole-like through hole 76, and the engagement tool is formed from the cut-out end portion of the frame portion 74 by strongly pulling the suture thread 4. The engaging tool 6 is removed from the mounting part 70 by pulling it out of the mounting part 70. However, the present invention is not limited to this, and the mounting part is formed by the elastic force of the engaging tool 105 formed in a leaf spring shape as described above. You may make it remove from 108. The shape of the engagement tool is not limited to the above, and any shape may be used as long as it is a shape that engages with a living tissue.

  In the above embodiment, the slider 26 is used as the operation means, the operation wire 60 is used as the swinging means, and the slide operation of the slider 26 is mechanically transmitted to the sub-suture needle 54 by the operation wire 60. However, the present invention is not limited to this. For example, a button as an operating means is provided on the hand operating unit 22 and a motor as an oscillating means is provided in the main suture needle 24. The auxiliary suture needle 54 may be oscillated by electrical drive such that the motor is driven according to the operation of the button and the auxiliary suture needle 54 is oscillated between the storage position and the protruding position.

  In the above embodiment, the bar spring 56 is shown as the urging means, but the urging means is not limited to this and may be, for example, a plate spring or a torsion spring.

  In the above embodiment, the electronic endoscope 40 is shown as an endoscope having a forceps channel. However, the suturing system 2 of the present invention may be used in combination with other endoscopes such as an ultrasonic endoscope. Good.

It is explanatory drawing which shows the structure of a stitching | suture system schematically. It is explanatory drawing which shows the use condition of a suturing device. It is explanatory drawing which shows the structure of a suturing device roughly. It is explanatory drawing which shows the state which the sub suture needle moved to the protrusion position. It is explanatory drawing which shows the structure of an attaching part roughly. It is explanatory drawing which shows the state by which the engaging tool was attached to the attaching part. It is explanatory drawing which shows the state which the engagement tool slipped out from the edge part by which the frame part was notched. It is an effect | action figure which shows the state which made the main suture needle face the biological tissue. It is an action figure showing the state where the main suture needle was inserted in each living tissue. It is an effect | action figure which shows the state which moved the sub suture needle to the protrusion position. It is an effect | action figure which shows the state which made the sub suture needle pierce each biological tissue. It is an effect | action figure which shows the state which the engaging tool attached to the attaching part pulled out from the frame part. It is an effect | action figure which shows the state which pulled out the sub suture needle from each biological tissue, and passed the suture thread through each biological tissue. It is an effect | action figure which shows the state which returned the sub suture needle to the accommodation position. It is an action figure showing the state where each main tissue was pulled out from each living tissue, and each living tissue was sutured in the shape of a substantial U. It is an operational view showing a state in which a fastener and an insertion tube are passed through a suture and the fastener is pushed toward each biological tissue. It is an effect | action figure which shows the state which clamped each biological tissue with the engaging tool and the fastening tool, and was sewn. It is explanatory drawing which shows the example which sutures each block-shaped biological tissue. It is explanatory drawing which shows the fastener provided with the protrusion piece as a retaining means. It is explanatory drawing which shows the fastener provided with the metal tube as a retaining means. It is explanatory drawing which shows the fastener provided with the elastic body as a retaining means. It is explanatory drawing which shows the example which provided the cutting part in the fastener. It is explanatory drawing which shows the example using a leaf | plate spring-shaped engagement tool.

Explanation of symbols

2 Suture System 4 Suture 6 Engagement Tool 10 Suture Device 12 Fastening Tool 14 Insertion Tube (Tubular Member)
20 Sheath (insertion part)
22 Hand operating section 24 Main suture needle 26 Slider (operating means)
32 Leaf spring (prevention means)
40 Electronic endoscope 50 Recessed portion 54 Sub suture needle 56 Bar spring (biasing means)
60 Operation wire (swinging means)
70 Mounting part 96 Cutting part 97 Body part

Claims (9)

In a suturing system for suturing a biological tissue in a body cavity by being used in combination with an endoscope having a forceps channel,
A suturing device for passing a suture provided at one end with an engagement tool that engages with a living tissue, and the living tissue;
A fastening tool which is inserted into the suture thread after the suturing device has passed through the living tissue and completes the suturing by tightening the living tissue together with the engagement tool;
The suturing device is inserted into the forceps channel;
A hand operating part connected to the proximal end of the insertion part;
A substantially bar-shaped main suture needle provided at the distal end of the insertion portion;
A recess formed on the side surface of the main suture needle along the axial direction of the main suture needle;
A storage position that is supported by the main suture needle so as to be swingable, and that the tip is stored in the recess in a direction opposite to the tip of the main suture needle, and a protrusion that protrudes outside the main suture needle A substantially bar-shaped sub-suture needle provided with an attachment portion to which the engagement tool is attached at the tip,
Rocking means for rocking the sub-suture needle to the storage position and the protruding position in response to an operation of an operation means provided in the hand operation section;
The main suture needle is inserted into a living tissue with the sub-suture needle in the storage position,
After inserting the main suture needle until the tip of the auxiliary suture needle passes the surface of the living tissue, the auxiliary suture needle is moved to the protruding position,
The sub-suture needle is inserted into the living tissue until the tip of the sub-suturing needle is exposed to the outside of the living tissue as the main suturing needle is pulled out,
Removing the engagement tool from the attachment portion and engaging the living tissue;
After inserting the main suture needle again until the tip of the auxiliary suture needle passes the surface of the biological tissue, the auxiliary suture needle is moved to the storage position,
A suturing system that allows the suture to pass through the living tissue so that both ends of the suture are exposed on the same surface of the living tissue by pulling out the main suture needle from the living tissue.   The suturing system according to claim 1, further comprising a cylindrical member for pushing the fastener that has entered the forceps channel toward a living tissue in a body cavity.   The suturing system according to claim 1 or 2, wherein the attachment portion is configured so that the attached engagement tool is detached when a predetermined tension is applied to the suture thread.   The suturing system according to any one of claims 1 to 3, wherein the fastener includes a retaining means for preventing the suture from being detached.   The said retaining means limits the feeding direction of the said suture to one direction by changing the degree of friction with respect to the said suture according to the feeding direction of the said inserted suture. 4. The suturing system according to 4.   The fastener is formed in a substantially cylindrical shape or a substantially prismatic shape, and has a main body portion provided with the retaining means, and a cutting portion formed so that a cross-sectional area is smaller than the main body portion. The suturing system according to claim 4 or 5, wherein the suturing system is provided.   The urging means for urging the main suture needle so as to press the sub-suture needle against the recess and holding the sub-suture needle in the storage position is provided. The suturing system according to claim 6. In a suturing apparatus for passing a suture thread provided at one end with an engagement tool that engages with a living tissue through the living tissue in a body cavity by being used in combination with an endoscope having a forceps channel,
An insertion portion to be inserted into the forceps channel;
A hand operating part connected to the proximal end of the insertion part;
A substantially bar-shaped main suture needle provided at the distal end of the insertion portion;
A recess formed on the side surface of the main suture needle along the axial direction of the main suture needle;
A storage position that is supported by the main suture needle so as to be swingable, and that the tip is stored in the recess in a direction opposite to the tip of the main suture needle, and a protrusion that protrudes outside the main suture needle A substantially bar-shaped sub-suture needle provided with an attachment portion to which the engagement tool is attached at the tip,
Rocking means for rocking the sub-suture needle to the storage position and the protruding position in response to an operation of an operation means provided in the hand operation section;
The main suture needle is inserted into a living tissue with the sub-suture needle in the storage position,
After the main suture needle is inserted until the tip of the secondary suture needle passes the surface of the biological tissue, the secondary suture needle is moved to the protruding position,
The sub-suture needle is inserted into the living tissue until the tip of the sub-suturing needle is exposed to the outside of the living tissue as the main suturing needle is pulled out,
Removing the engagement tool from the attachment portion and engaging the living tissue;
After inserting the main suture needle again until the tip of the auxiliary suture needle passes the surface of the biological tissue, the auxiliary suture needle is moved to the storage position,
A suturing apparatus characterized in that the suture can be passed through the living tissue so that both ends of the suture are exposed on the same surface of the living tissue by pulling out the main suture needle from the living tissue. When used in combination with an endoscope having a forceps channel, a suturing device that passes through a living tissue in a body cavity a suture provided with an engagement tool that engages with the living tissue, and the suturing device A fastener that is inserted through the suture after passing through the tissue and completes the suture by tightening the biological tissue together with the engagement tool; and
The suturing device is inserted into the forceps channel;
A hand operating part connected to the proximal end of the insertion part;
A substantially bar-shaped main suture needle provided at the distal end of the insertion portion;
A recess formed on the side surface of the main suture needle along the axial direction of the main suture needle;
A storage position that is supported by the main suture needle so as to be swingable, and that the tip is stored in the recess in a direction opposite to the tip of the main suture needle, and a protrusion that protrudes outside the main suture needle A substantially bar-shaped sub-suture needle provided with an attachment portion to which the engagement tool is attached at the tip,
In the suturing method of the suturing system, comprising a swinging means for swinging the sub-suture needle to the storage position and the protruding position in accordance with an operation of an operating means provided in the hand operation section.
Inserting the main suture needle into a living tissue with the sub-suture needle in the storage position; and
Moving the sub-suture needle to the protruding position after inserting the main suture needle until the tip of the sub-suture needle passes the surface of the biological tissue;
Inserting the sub-suture needle into the biological tissue until the tip of the sub-suture needle is exposed to the outside of the living tissue so as to pull out the main suturing needle;
Removing the engagement tool from the attachment portion and engaging the biological tissue;
Moving the auxiliary suture needle to the storage position after inserting the main suture needle again until the tip of the auxiliary suture needle passes the surface of the biological tissue;
Passing the suture through the living tissue so that both ends of the suture are exposed on the same surface of the living tissue by pulling out the main suture needle from the living tissue;
Passing through the suture from the end opposite to the engagement tool, and suturing the biological tissue by tightening the biological tissue with the engagement tool and the fastener. Suture method characterized.

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