JP2012070932A - Anastomosis device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an anastomosis device for facilitating arrangement work of a needle to be used for anastomosis.SOLUTION: The anastomosis device includes: a needle-like member 11 for puncturing an object; a pair of grip parts 2M, 2F for holding the object in-between; pipe members 4a, 4b for guiding the needle-like member 11; puncture member arrangement parts 2Ha, 2Hb for arranging the needle-like member 11 inside the pipe members 4a, 4b; and a sending member 13 for sending out the needle-like member 11 arranged inside the pipe members 4a, 4b to the object. The pair of grip parts is constituted of the movable grip part 2M and the fixed grip part 2F. The movable grip part 2M is arranged so as to be movable toward the fixed grip part 2F. One end each of the pipe members 4a, 4b is fixed to the mobile grip part 2M, and thereby the pipe members 4a, 4b are moved accompanied with the movement of the movable grip part 2M.

Description

  The present invention relates to an anastomosis apparatus for anastomosing, for example, living tissue.

Conventionally, an apparatus for anastomosing a tissue with a suture is used in a surgical operation or the like. As a technique related to such an apparatus, for example, Patent Document 1 discloses the following technique.
That is, Patent Document 1 discloses an instrument including a pair of gripping parts each including a movable part and a fixed part. The fixed part of the pair of gripping parts is provided with a curved passage for receiving a suture needle to which a thread is attached. In the curved passage provided in the fixed portion, an opening is formed on the upper side of the fixed portion. From this opening, a curved suture needle or a linear suture needle made of an elastic material is inserted and disposed.

  In the state where the suture needle is arranged in this way, the puncture portion of the suture needle is exposed from the opening formed in the fixing portion. On the other hand, an anastomosis object is disposed in the movable part. Then, the movable part is moved and the anastomosis object is gripped by the fixed part and the movable part, so that the puncture part of the suture needle is inserted into the anastomosis object. Further, the suture needle is pushed out of the opening by the drive rod and passes through the anastomosis object. Here, the tip of the suture needle is engaged with the opening provided in the movable portion, and then the movable portion is moved so as to release the gripping state, so that the thread attached to the suture needle causes the anastomosis target to move. pass.

JP 2005-13732 A

  By the way, in the instrument disclosed in Patent Document 1, the operation of disposing the suture needle in the passage provided in the fixing portion is not an easy operation. This is due to the curved shape of the passage. For example, when the suturing needle has a curved shape, it becomes an even more difficult task if the suturing needle and the passage have curved shapes with different curvatures. In addition, when the suture needle has a linear shape, it is naturally difficult to arrange the suture needle in the curved passage.

  The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an anastomosis device in which a needle used for anastomosis can be easily arranged.

In order to achieve the above object, an anastomosis device according to one aspect of the present invention comprises:
A puncture member for puncturing an object;
A pair of gripping members for sandwiching the object;
A tubular passage member for guiding the puncture member;
An arrangement portion for arranging the puncture member in the passage member;
A delivery member for delivering the puncture member disposed in the passage member to the object;
Comprising
One gripping member of the pair of gripping members is provided to be movable toward the other gripping member,
One end of the passage member is fixed with respect to the one gripping member, and the passage member moves with the movement of the one gripping member.

  ADVANTAGE OF THE INVENTION According to this invention, the anastomosis apparatus with which the arrangement | positioning operation | work of the needle used for anastomosis is easy can be provided.

The side sectional view of the anastomosis device concerning one embodiment of the present invention. The arrow line view of the cross section in the line segment MM shown in FIG. 1 of the anastomosis apparatus which concerns on one Embodiment of this invention. The top view of the anastomosis apparatus concerning one embodiment of the present invention. Side surface sectional drawing which shows a mode that the acicular member arrange | positioned in a pipe member is sent out by a rod member. The figure which shows the mode of alignment with a coronary artery and a graft. The figure which shows a mode that a coronary artery and a graft are anastomosed using the anastomosis apparatus which concerns on one Embodiment of this invention. The enlarged view of the anastomosis location by the anastomosis apparatus concerning one Embodiment of this invention. The figure which shows the coronary artery and the graft which were anastomosed using the anastomosis apparatus which concerns on one Embodiment of this invention. The side view which shows the example of 1 structure of the anastomosis apparatus which concerns on the modification of one Embodiment of this invention.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a side sectional view of an anastomosis device according to the present embodiment. FIG. 2 is an arrow view of the anastomosis device according to the present embodiment taken along the line MM cross section shown in FIG. 1. FIG. 3 is a top view of the anastomosis device according to the present embodiment.

The anastomosis device according to the present embodiment includes a housing 2, a movable gripping portion 2M, a fixed gripping portion 2F, puncture member placement portions 2Ha and 2Hb, pipe members 4a and 4b, and pipe member placement spaces 2Sa and 2Sb. And a rod member 13.
The housing 2 is a long member having a substantially rectangular parallelepiped shape, and pipe member disposing spaces 2Sa and 2Sb, which are spaces for disposing the pipe members 4a and 4b, are provided along the longitudinal direction. Is formed. Further, as shown in FIG. 3, openings 4aa formed on the side peripheral surfaces of the pipe members 4a and 4b in the side wall of the housing 2 in the state shown in FIG. 1 (state before treatment; details will be described later). , 4ba (details will be described later), puncture member placement portions 2Ha, 2Hb, which are holes for placing the needle-like member 11 in the pipe members 4a, 4b, are formed.

Even if the puncture member placement portions 2Ha and 2Hb are not formed, the needles are placed inside the pipe members 4a and 4b via the rear end side opening portions (not shown) or the front end side opening portions 2Ma of the pipe member placement spaces 2Sa and 2Sb. Of course, it is also possible to dispose the member 11.
The movable gripping portion 2M is a substantially plate-like member that forms a pair of gripping portions together with the fixed gripping portion 2F at one end of the housing 2, and has a main plane substantially the same as the outer diameter of the pipe members 4a and 4b. A through hole having a diameter is formed, and one end of each of the pipe members 4a and 4b is inserted into and fixed to the through hole.

  The movable grip portion 2M is provided so as to be rotatable in a direction toward the fixed grip portion 2F (a direction indicated by an arrow R in FIG. 1) (a housing is provided via a rotation mechanism 2r including a rotatable support shaft). 2), the anastomosis object is sandwiched between the movable gripping part 2M and the fixed gripping part 2F during the treatment. Before the treatment, the movable gripping portion 2M is located at a position where the main plane is substantially horizontal with respect to the end surface of the housing 2 (position where the pipe members 4a, 4b are substantially straight) as shown in FIG. (Hereinafter, this state is referred to as “pre-treatment state”).

  As described above, since one end side of the pipe members 4a and 4b is inserted and fixed in the through hole formed in the thickness direction of the movable grip portion 2M, the pipe members 4a and 4b are connected to the movable grip portion 2M. Move with rotation. Specifically, when the movable gripping portion 2M is rotated toward the fixed gripping portion 2F (in the direction indicated by the arrow R in FIG. 1), the pipe members 4a and 4b are also rotated around the rotation mechanism 2r. Elastically deforms. At this time, the pipe members 4a and 4b are pulled out from the pipe member disposition spaces 2Sa and 2Sb by the amount of movement of the pipe members 4a and 4b.

  The fixed grip portion 2F is a substantially plate-like member that forms a pair of grip portions together with the movable grip portion 2M, and is positioned corresponding to the pipe members 4a and 4b disposed in the housing 2 as shown in FIG. When the anastomosis object is clamped together with the movable gripping part 2M, the needle member 11 is cut from the end of the pipe members 4a and 4b embedded in the movable gripping part 2M and passed through the anastomosis target object). Notch portions 2Fca and 2Fcb are formed.

  By forming the notches 2Fca and 2Fbb corresponding to the pipe members 4a and 4b in this way, the fixed grip portion 2F has a comb-teeth shape in which two notches are arranged side by side as shown in FIG. . With this configuration, when the anastomosis target is punctured by the needle-shaped member 11, the escape of the anastomosis target in the puncture direction is prevented, and the needle-shaped member 11 after puncturing the anastomosis target is It is possible to penetrate through the anastomosis object.

  The pipe members 4a and 4b are respectively disposed in pipe member disposition spaces 2Sa and 2Sb formed in the housing 2, and one end thereof is formed in the thickness direction of the movable gripping portion 2M as shown in FIG. It is a passage member (guide member) inserted through the through hole and fixed to the movable gripping portion 2M. These pipe members 4a and 4b are made of a super elastic material such as Ni-Ti, for example. In addition to the superelastic material, examples of the material of the pipe members 4a and 4b include biocompatible metal materials (for example, stainless steel) and resin materials.

  Openings 4aa and 4ba are formed on the side peripheral surfaces of the pipe members 4a and 4b at positions corresponding to the puncture member placement portions 2Ha and 2Hb formed in the housing 2 in the pre-treatment state described above. Therefore, in the above-mentioned pre-treatment state, the external space of the housing 2 and the internal space of the pipe members 4a and 4b are spatially separated by the puncture member placement portions 2Ha and 2Hb and the openings 4aa and 4ba as shown in FIG. Connected to. Therefore, the operator can arrange the needle-like member 11 inside the pipe members 4a and 4b via the puncture member arrangement portions 2Ha and 2Hb.

In addition, the pipe members 4a and 4b should just be an elongate member which can guide the acicular member 11, and can mention a various aspect. For example, in addition to the cylindrical long member, a coil pipe or a C-shaped long member may be used as the pipe members 4a and 4b.
The needle-like member 11 is a member made of the above-described superelastic material and having a puncture element at one end (tip). A thread-like member 11 s is attached to the other end (rear end) of the needle-like member 11.

  The rod member 13 is a substantially columnar member made of the above-described superelastic material, and pushes the rear end face of the needle-like member 11 arranged in the pipe member arrangement spaces 2Sa and 2Sb to cause the needle-like member 11 to move. It is a delivery member for sending out toward the movable holding part 2M side. FIG. 4 is a side sectional view showing a state in which the needle-like member 11 arranged in the pipe members 4a and 4b is sent out by the rod member 13. As shown in FIG. As shown in the figure, assuming that the diameter of the pipe members 4a and 4b is D0, the diameter of the end face of the needle-like member 11 is D1, and the diameter of the rod member 13 is D2, these D0 to D2 satisfy the following relationship. It is preferable.

D0 <D1 + D2 (Formula 1)
By designing each member so as to satisfy the relationship of (Expression 1), it is possible to prevent the needle-like member 11 and the rod member 13 from being aligned in the radial direction in the pipe members 4a and 4b. (The state in which the needle-like member 11 cannot be pushed by the rod member 13 does not occur). Further, the shape of the rod member 13 is not limited to a substantially cylindrical shape, and may be a prismatic shape or a hollow shape, and the needle-like member 11 can be pushed in the pipe members 4a and 4b. Any shape is acceptable. In addition, when making the shape of the rod member 13 into a hollow shape, the thread-like member 11s can be arrange | positioned in the hollow part.

  As an operation mechanism for rotating the movable grip portion 2M and an operation mechanism for sending out the needle-like member 11 by the rod member 13, for example, an operation mechanism by electrical and / or mechanical means is used. It is provided at a base end side portion of the housing 2 (a portion opposite to the side where the fixed grip portion 2F and the rotation grip portion 2M are provided). Since these operation mechanisms are not the characteristic part of the anastomosis apparatus according to the present embodiment but may use conventional techniques, illustration and detailed description thereof will be omitted.

  Hereinafter, a vascular anastomosis procedure using the anastomosis apparatus according to the present embodiment will be specifically described by taking coronary artery bypass surgery as an example. FIG. 5 is a diagram showing a state of alignment between the coronary artery and the graft. FIG. 6 is a diagram illustrating a state in which the coronary artery and the graft are anastomosed using the anastomosis apparatus according to the present embodiment. FIG. 7 is an enlarged view of an anastomosis site by the anastomosis apparatus according to the present embodiment. FIG. 8 is a diagram showing a coronary artery and a graft that are anastomosed using the anastomosis device according to the present embodiment.

First, the operator cuts through the coronary artery 111 to form the opening 111H. Subsequently, alignment of the opening edge 111h that is the edge of the opening 111H of the coronary artery 111 and the opening edge 113h of the graft 113 that is a bypass blood vessel is performed.
In this alignment, as shown in FIG. 5, the opening edge 111h of the coronary artery 111 and the opening edge 113h of the graft 113 are raised, and the inner surface of the opening edge 111h of the coronary artery 111 exposed by this raising, The inner surface of the opening edge 113h of the graft 113 is brought into contact. Hereinafter, this contact part is referred to as an anastomosis target part.

  Here, the needle-like member 11 having the thread-like member 11s attached to the rear end is connected to the pipe member via the puncture member arrangement portion 2Ha (or from the rear end side opening or the front end side opening of the pipe member arrangement space 2Sa). 4a. Similarly, the needle-like member 11 having the thread-like member 11s attached to the rear end is connected to the pipe member via the puncture member arrangement portion 2Hb (or from the rear end side opening or the front end side opening of the pipe member arrangement space 2Sb). It arrange | positions in 4a, 4b.

  Subsequently, the rear end surfaces of the needle-like members 11 arranged in the pipe members 4a and 4b are respectively pushed by the rod members 13, and the needle-like members 11 are moved toward the movable gripping portion 2M. Specifically, the needle member 11 is pushed forward by the rod member 13 so that the puncture element (tip end) of each needle member 11 is located in a portion of the pipe members 4a and 4b that is inserted into the movable grip portion 2M. To move.

  Further, the anastomosis target site is disposed between the fixed gripping part 2F and the movable gripping part 2M, and the movable gripping part 2M is used as the fixed gripping part 2F with the support shaft constituting the rotating mechanism 2r as the pivot axis. The portion to be anastomosed is sandwiched between the fixed grip portion 2F and the movable grip portion 2M (see FIG. 6).

  Specifically, the fixed grasping portion 2F is applied to the upper side of the opening edge 113h of the graft 113 with respect to the anastomosis target site formed by contacting the inner surface of the opening edge 111h of the coronary artery 111 and the inner surface of the opening edge 113h of the graft 113. In the state of contact, the movable gripping part 2M is rotated so as to be sandwiched by the movable gripping part 2M from below the opening edge 111h of the coronary artery 111.

  At this time, since one end of the pipe members 4a and 4b is fixed to the movable gripping portion 2M, the pipe members 4a and 4b move together with the rotation of the movable gripping portion 2M. And according to this movement amount, the pipe members 4a and 4b are pulled out from the pipe member arrangement spaces 2Sa and 2Sb. At this time, the pipe members 4a and 4b are elastically deformed in accordance with the movement accompanying the rotation of the movable grip portion 2M.

  And the needle-like member 11 is sent out from the pipe members 4a and 4b by further pushing forward the needle-like member 11 with the rod member 13. At this time, the needle-like member 11 pierces the anastomosis target site from the opening edge 111h side of the coronary artery 111, and then penetrates the anastomosis target site and cuts out the notches 2Fca and 2Fcb formed on the fixed grip 2F. It passes through and protrudes from the fixed grip portion 2F (see FIG. 6).

  Here, the exposed needle-like member 11 is gripped by, for example, a gripping tool provided on a manipulator (not shown), and the knot 11s1 (see FIG. 7) provided at the rear end of the thread-like member 11s is the coronary artery 111. The needle-like member 11 is moved until it is pressed against the opening edge 111h.

  Further, a knot 11s2 shown in FIG. 7 is formed on the thread-like member 11s exposed from the opening edge 113h side of the graft 113. That is, a knot 11s2 is formed so as to press against the opening edge 113h of the graft 113 and clamp the anastomosis target site together with the opening edge 111h of the coronary artery 111 (see FIG. 7).

FIG. 8 is a diagram showing a site for anastomosis after coronary artery bypass surgery is completed. As shown in the figure, the anastomosis between the coronary artery 111 and the graft 113 is completed by executing the above-described series of operations at a plurality of locations.
As described above, according to the present embodiment, it is possible to provide an anastomosis device that facilitates the operation of arranging a needle used for anastomosis. Specifically, the anastomosis device according to the present embodiment has the following effects, for example.
The needle-like member 11 is simply placed on the pipe members 4a and 4b via the puncture member placement portions 2Ha and 2Hb or the pipe member placement spaces 2Sa and 2Sb through the rear end side opening or the front end side opening. The arrangement work of the member 11 is completed. That is, the work of disposing the needle-like member 11 is very easy.
The needle-like member 11 can be sent out by the needle-like member feeding mechanism having a very simple configuration including the pipe members 4 a and 4 b and the rod member 13.
The puncture angle can be adjusted when puncturing with the needle-like member 11.
-By arranging the pipe members 4a and 4b along the longitudinal direction of the housing 2, the anastomosis device can be made thin.
-It is possible to perform a puncturing operation at a plurality of locations (two locations in the above example) at the same time in one treatment operation, and work efficiency is increased.

  By the way, the instrument disclosed in Patent Document 1 has a structure in which an operator grasps the puncture element side of a needle and performs the operation of arranging the needle. On the other hand, according to the anastomosis device according to the present embodiment, since the operator does not have to hold the puncture element side of the needle, there is almost no risk related to the puncture element of the needle in the arrangement work, and is high. It has safety.

In the above example, the pipe members 4a, 4b, the needle-like member 11, and the rod member 13 are made of a superelastic material. However, the pipe members 4a, 4b, the needle-like member 11 and the rod member 13 are not limited to superelastic materials. Of course.
In the above-described example, the movement of the movable gripping portion 2M is turned. However, it may be configured to move linearly with respect to the fixed gripping portion 2F instead of turning.

As mentioned above, although this invention was demonstrated based on one Embodiment, this invention is not limited to each embodiment mentioned above, A various deformation | transformation and application are possible within the range of the summary of this invention. Of course.
[Modification]
Hereinafter, an anastomosis device according to a modification of the embodiment will be described. In order to avoid duplication of explanation, differences from the anastomosis device according to the above-described embodiment will be described. This difference is the configuration of the pair of gripping portions. FIG. 9 is a side view showing a configuration example of the anastomosis device according to the present modification.

  In the anastomosis device according to the present modification, the first movable grip portion 2M1 and the second movable grip portion 2M2 constitute a pair of grip portions. Here, the first movable grip portion 2M1 is attached to the housing 2 via a rotation mechanism 2r having a support shaft that can rotate in the direction indicated by the arrow R1 in FIG. 9 (the direction toward the second movable grip portion 2M2). It has been. Similarly, the second movable grip portion 2M2 is attached to the housing 2 via a rotation mechanism 2r having a support shaft that can rotate in a direction indicated by an arrow R2 in FIG. 9 (a direction toward the first movable grip portion 2M1). It has been.

The first movable gripping portion 2M1 has a through hole having a diameter substantially the same as the outer diameter of the pipe member 4 in the main plane, and one end of the pipe member 4 is inserted into and fixed to the through hole.
The second movable grip portion 2M2 is located at a position corresponding to the pipe member 4 disposed on the first movable grip portion 2M1 (when the anastomosis target object is sandwiched together with the first movable grip portion 2M1, the first movable grip portion 2M1). A notch (not shown) is formed on the trajectory of the needle-like member that is delivered from the pipe member 4 embedded in the needle and penetrates the anastomosis target.

  In the anastomosis device according to the above-described embodiment, the pipe member 4 is substantially entirely embedded in the housing 2. However, in the anastomosis device according to this modification shown in FIG. It is set as the structure which supports the pipe member 4 in the site | part which concerns on this insertion. However, the configuration other than the pair of gripping portions described above may of course be the same as the configuration of the anastomosis device according to the embodiment.

  As described above, according to this modification, in addition to the same effects as those of the anastomosis apparatus according to the embodiment, an anastomosis apparatus having the following effects can be provided. That is, according to the anastomosis device according to this modification, the angle formed by the housing and the pair of gripping portions can be easily adjusted, and the angle at which the needle-shaped member is delivered can be easily adjusted. That is, it is easy to adjust the positional relationship between the anastomosis device and the anastomosis object.

In the above example, for convenience of explanation, an example in which one pipe member 4 is provided as a pipe member is shown, but a configuration in which a plurality of pipe members are provided may of course be used.
Further, the above-described embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the column of the effect of the invention can be achieved. In the case of being obtained, a configuration from which this configuration requirement is deleted can also be extracted as an invention.

    DESCRIPTION OF SYMBOLS 2 ... Housing, 2M ... Movable holding part, 2F ... Fixed holding part, 2Ha, 2Hb ... Puncture member arrangement | positioning part, 2Sa, 2Sb ... Pipe member arrangement | positioning space, 2Fca, 2Fcb ... Notch part, 2r ... Turning mechanism, 2M1 ... 1st movable grip part, 2M2 ... 2nd movable grip part, 4, 4a, 4b ... Pipe member, 11 ... Needle-like member, 11s ... Thread-like member, 13 ... Rod member.

Claims (9)

A puncture member for puncturing an object;
A pair of gripping members for sandwiching the object;
A tubular passage member for guiding the puncture member;
An arrangement portion for arranging the puncture member in the passage member;
A delivery member for delivering the puncture member disposed in the passage member to the object;
Comprising
One gripping member of the pair of gripping members is provided to be movable toward the other gripping member,
One end of the passage member is fixed with respect to the one gripping member, and moves with the movement of the one gripping member. The anastomosis device according to claim 1, wherein the passage member is a tubular member having elasticity. The anastomosis device according to claim 1, wherein the delivery member is a rod-like member having elasticity. The anastomosis device according to claim 1, wherein the puncture member is a needle-like member having elasticity. Including a housing shaped with a long axis;
The pair of gripping members are provided at one end in the longitudinal direction of the housing,
The one gripping member constituting the pair of gripping members is a fixed gripping member whose position is fixed with respect to the housing, and the other gripping member is movable to be movable toward the one gripping member. The anastomosis device according to claim 1, wherein the anastomosis device is a gripping member. The fixed grip member has a notch formed at a position corresponding to an end portion of the passage member on the side fixed to the movable grip member when the object is clamped together with the movable grip member. The anastomosis device according to claim 5. Including a housing shaped with a long axis;
The anastomosis device according to claim 1, wherein the passage member is a tubular member arranged in parallel along the long axis direction of the housing. The anastomosis according to claim 7, wherein the placement portion is a through hole provided in the passage member and the housing so as to connect an internal space of the passage member and an external space of the housing. apparatus. The anastomosis device according to claim 1, wherein the puncture member, the passage member, the arrangement portion, and the delivery member are provided in the same number.

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