JP2013027569A - Medical suture instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical suture instrument wherein workability and operability is drastically improved.SOLUTION: This suture instrument 100 transmits movement of an operation part 10 to a loop formation part 80 and a suture 1 with a time difference by a loop feeding/returning mechanism 30 and a suture feeding mechanism 40, and feeds out the suture 1 from the tip of a suture-introducing needle 70 after a loop 82 is fed out from the tip of a loop-introducing needle 60.

Description

  TECHNICAL FIELD The present invention relates to a medical suturing device used when a suture for holding a visceral wall of an organ such as a stomach or a bladder from the outside of the body to the body surface such as an abdominal wall is introduced into the internal organ or pulled out from the internal organ. .

  Conventionally, enteral nutritional administration that supplies liquid foods, nutrients, etc. using a fistula catheter to people who have the ability to ingest food by mouth due to aging or illness (hereinafter referred to as patients) has been Has been done. For example, in the case of using percutaneous endoscopic gastrostomy (PEG), a through-hole (for example, a fistula such as a gastrostoma) penetrating the patient's abdominal wall and visceral wall (gastric wall) is created. Then, a fistula catheter is attached to the through hole, and liquid food or the like is supplied to the patient through the fistula catheter.

  When constructing a through hole, in order to easily form the through hole, the visceral wall and the abdominal wall which are easy to move are usually sutured and fixed percutaneously using sutures. Various types of medical suturing tools have been proposed that are used for securing the visceral wall and the abdominal wall together.

  As such, “inside the case body, it is housed in the inside of the puncture needle 30 for feeding and the sending mechanism for sequentially sending the sutures inserted from the proximal end of the puncture needle 20 for inserting the suture in the distal direction. A medical device that houses a protruding mechanism that causes the annular member of the stylet to protrude from the distal end of the puncture needle 30 for grasping a suture thread is disclosed (for example, see Patent Documents 1 and 2). This medical instrument is designed so that ligation in a living body can be carried out efficiently and safely by only one operator or two operators and an assistant.

JP 2009-213763 (for example, FIG. 5 and FIG. 6) JP 2009-213764 A (for example, FIG. 5 and FIG. 6)

  In a medical instrument as described in Patent Documents 1 and 2, an operator has to insert a suture into the medical instrument, which increases the labor of the operator. In addition, the work related to the insertion of the suture is often complicated, and the workability is low. Further, in the medical instruments described in Patent Documents 1 and 2, in order to form the annular member in an annular shape after puncturing the suture insertion puncture needle and the suture grasping puncture needle from the abdominal wall into the stomach. The operation that pushes the stylet into the stomach, the operation of turning the operation roller to insert the suture into the stomach, and the operation of pressing the release button to grip the suture with the annular member are required, and the operability is low It was.

  The present invention has been made in order to solve the above-described problems, and provides a medical suturing tool with greatly improved workability and operability.

  The medical suturing device according to the present invention is provided on the distal end side of the housing, substantially parallel to the loop, the loop introduction needle provided on the distal end side of the housing, and at a predetermined distance from the loop introduction needle. A suture introduction needle that accommodates a thread, a loop formed at the tip of the suture introduction needle and movably inserted into the loop introduction needle, and provided in the housing to move the loop formation portion A loop feed-back mechanism, a suture feed mechanism that is provided in the housing and feeds out the suture, and an operation unit that is provided in the housing or protrudes from the housing and operates the loop feed-back mechanism and the suture feed mechanism. The suture feed mechanism is provided with means for guiding the inserted suture to the suture introduction needle in a substantially straight state, and the movement of the operation portion toward the distal end side is controlled. The loop is sent back from the tip of the loop introduction needle, and the movement of the operation portion toward the tip side is transmitted to the suture feed mechanism simultaneously with the loop feed back mechanism or after the loop starts to be sent, The suture is delivered from the tip of the suture introduction needle.

  According to the medical suturing device according to the present invention, the suture can be introduced into the internal organs or pulled out from the internal organs only by pushing and pulling the operation portion, so that the operation burden on the operator can be greatly reduced. Workability will be significantly improved. In addition, according to the medical suturing device of the present invention, since the means for guiding the inserted suture to the suture introduction needle in a substantially straight state is provided, the suture can be easily set. The operation burden on the operator can be greatly reduced.

It is a schematic external view which shows one of the structural examples of the medical suturing device which concerns on embodiment of this invention. It is a schematic perspective view which shows the external appearance structure of the medical suturing tool which concerns on embodiment of this invention. It is a schematic internal block diagram which shows one of the internal structural examples of the medical suturing tool which concerns on embodiment of this invention. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is the schematic sectional drawing which showed simply the operation procedure of the medical suture tool which concerns on embodiment of this invention. It is explanatory drawing for demonstrating the effect | action of the medical suturing tool which concerns on embodiment of this invention.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a schematic external view showing one configuration example of a medical suturing device (hereinafter simply referred to as a suturing device 100) according to an embodiment of the present invention. FIG. 2 is a schematic perspective view showing an external configuration of the suturing tool 100. FIG. 3 is a schematic internal configuration diagram showing one internal configuration example of the suturing tool 100. The configuration and operation of the suturing tool 100 will be described with reference to FIGS. The suture instrument 100 is used to introduce a suture thread that holds and holds the visceral wall of an organ such as the stomach or bladder from the outside of the abdominal wall to facilitate the formation of a fistula for inserting a fistula catheter. It is what In addition, in the following drawings including FIG. 1, the relationship of the size of each component may be different from the actual one.

[Overall Configuration of Suture 100]
The appearance of the suturing tool 100 is a predetermined distance from the housing 50, the operation unit 10 operated by the operator, the loop introduction needle 60 provided on the distal end side of the housing 50, and the loop introduction needle 60. And a suture introduction needle 70 provided on the distal end side of the housing 50 substantially parallel to each other. In addition, the suture tool 100 includes a loop feed-back mechanism 30 that operates in conjunction with the movement of the operation unit 10 and a suture feed mechanism 40 that operates in conjunction with the movement of the operation unit 10 in the housing 50. ing. Furthermore, the suturing tool 100 includes a loop forming portion 80 that is movably inserted inside the loop introduction needle 60.

  1 to 3 also illustrate the suture 1 that is fed from the distal end (blade edge) of the suture introduction needle 70 by the suture feed mechanism 40. Moreover, the distal end side refers to the side (patient side) inserted into the patient, and the proximal end side refers to the side operated by the operator (operating side). In the following description, the distal end side may be referred to as the front direction and the proximal end side may be referred to as the rear direction. Furthermore, the suture thread 1 has a length corresponding to a plurality of times.

(Suture 1)
Although the suture thread 1 does not constitute the suture tool 100, it functions as an organ fixing tool and will be briefly described. The suture thread 1 is made of a material (for example, nylon thread or the like) having a flexibility that can be bent along a living tissue when inserted into a living body and a tensile strength that can lift an organ. Configure. The suture 1 is cut when it is attached to or removed from the patient. For this reason, it is preferable that the suture thread 1 is composed of a material and a diameter dimension that can be cut with a tool provided at a medical site such as scissors. In addition, the suture instrument 100 is punctured into the patient with the suture thread 1 inserted to the tip of the suture thread introduction needle 70.

(Housing 50)
The housing 50 is hollow and has a substantially rectangular parallelepiped shape in which the longitudinal direction is the longitudinal direction. The housing 50 stores the loop feed back mechanism 30 and the suture feed mechanism 40. The loop feed-back mechanism 30 and the suture feed mechanism 40 are stored so as to be arranged substantially in parallel in the housing 50, and are movable in the front-rear direction in the housing 50. The housing 50 unitizes the entire suturing tool 100 and also serves as a portion that is actually gripped when operated by an operator. In addition, the housing 50 may not be a substantially rectangular parallelepiped shape, and the external shape is not particularly limited. Further, the housing 50 may be configured with only a framework. That is, the housing 50 only needs to be configured so that other configurations described below can function.

  A loop introduction needle 60 and a suture introduction needle 70 are attached to the distal end side of the housing 50 so as to be substantially parallel with a predetermined distance therebetween. For example, as shown in FIG. 3, a support portion (support portion 52, support portion 53) is provided on the distal end side of the housing 50, and the base end portions of the loop introduction needle 60 and the suture introduction needle 70 are provided on the support portion. The loop introduction needle 60 and the suture thread introduction needle 70 may be detachably supported. For example, the support portion may be formed of a material such as synthetic resin into a rectangular parallelepiped. Note that the support portion may protrude toward the distal end side of the housing 50.

  Alternatively, the base end portions of the loop introduction needle 60 and the suture thread introduction needle 70 may be supported in advance by a support member, and the support member may be detachably attached to the distal end side of the housing 50. Further, the loop introduction needle 60 and the suture introduction needle 70 may be fixed to the housing 50 in advance. Furthermore, the loop introduction needle 60 and the suture thread introduction needle 70 do not need to be attached to the most distal end of the housing 50, but may be attached to the distal end side of the housing 50. That is, the proximal end sides of the loop introduction needle 60 and the suture introduction needle 70 may extend into the housing 50.

  The inner wall surface (hereinafter simply referred to as the inner wall surface 54) of the housing 50 includes a distal end (a distal end portion 31 a, which will be described later) of the loop feed-back portion 31 constituting the loop feed-back mechanism 30, and the suture feed mechanism 40. The leading end of the second hollow member 42 is configured to come into contact with, that is, abut against. When the distal end of the loop feed-back portion 31 constituting the loop feed-back mechanism 30 and the second hollow member 42 constituting the suture feed mechanism 40 abut against the inner wall surface 54 of the housing 50, they move further forward. No longer.

  Further, a stopper 51a and a stopper 51b are formed on a part of the side surface of the inner wall of the housing 50. The stopper 51 a and the stopper 51 b may be formed by projecting a part of the inner wall side surface of the housing 50 toward the inside of the housing 50 or providing a step on a part of the inner wall surface of the housing 50. The stopper 51a and the stopper 51b have a function of restricting movement of the movement restricting member 47 fixed to the second hollow member 42 in the front-rear direction. However, the distal end of the second hollow member 42 abuts against the inner wall surface 54 of the housing 50, a part of the inner wall of the third hollow member 43 abuts, or the movement restricting member 47 is the proximal end of the third hollow member 43. The stopper 51a is not indispensable when the forward movement of the second hollow member 42 is restricted by abutting on the stopper 51a.

  Similarly, the proximal end of the second hollow member 42 abuts on the outer wall of the first hollow member 41, or the distal end of the second hollow member 42 abuts on the proximal end (inside) of the third hollow member 43. When the backward movement of the second hollow member 42 is restricted, the stopper 51b is not essential. Further, when the distal end of the second hollow member 42 is brought into contact with the proximal end (inner side) of the third hollow member 43, the distal end of the second hollow member 42 is protruded radially outward, and the third hollow member 42 The rearward movement of the second hollow member 42 may be restricted by projecting the proximal end of 43 toward the inside in the radial direction and locking them. The stopper 51a corresponds to the first stopper of the present invention, and the stopper 51b corresponds to the second stopper of the present invention.

  A guide hole 55 through which the operation unit 10 can move in the front-rear direction is formed on the side surface of the housing 50 along the longitudinal direction of the housing 50. The guide hole 55 penetrates the side surface of the housing 50 and is formed with a predetermined length. The constituent material of the housing 50 is not particularly limited, and may be configured using, for example, a polyolefin such as polypropylene or polyethylene, or a synthetic resin such as vinyl chloride or polycarbonate. A flange portion 56 is provided on the outer wall of the front end of the housing 50 so as to protrude in a flange shape outward in the radial direction. The collar portion 56 is for assisting the puncture operation.

  The housing 50 is provided with a support bar 20 that moves the flat plate portion 21 through which the loop introduction needle 60 and the suture introduction needle 70 are passed in the front-rear direction. The flat plate portion 21 is moved to the distal end side when the loop introduction needle 60 and the suture introduction needle 70 are punctured, thereby suppressing a change in the distance between the loop introduction needle 60 and the suture introduction needle 70. It is. By providing such a flat plate portion 21, it is possible to prevent the loop introduction needle 60 and the suture introduction needle 70 from being bent and their distances from being significantly changed. Further, since the flat plate portion 21 is movable in the front-rear direction with respect to the loop introduction needle 60 and the suture thread introduction needle 70 via the support bar 20, the flat plate portion 21 also obstructs the puncturing operation. Don't be.

  The planar shape of the flat plate portion 21 is not particularly limited, but may be a rectangular shape, a circular shape, or a polygonal shape, for example. Moreover, it is good to make the front end side surface (patient side surface) of the flat plate part 21 flat so as not to stimulate the patient's skin. When such a flat plate portion 21 is provided, it is preferable that the tips of the support bars 20 extending in parallel with the loop introduction needle 60 and the suture thread introduction needle 70 are fixed to the flat plate portion 21. By providing the support bar 20, the movement stability of the flat plate portion 21 is improved, and the force transmitted from the flat plate portion 21 to the loop introduction needle 60 and the suture introduction needle 70 can be reduced.

(Operation unit 10)
The operation unit 10 is operated by the operator when the organ fixing tool is introduced into the internal organs using the suture tool 100. The operation unit 10 transmits the force applied by the operator to the loop feed back mechanism 30 and the suture feed mechanism 40. The operation unit 10 is installed between the base end portion 32 a of the first elastic member 32 constituting the loop feed back mechanism 30 and the base end portion 31 b of the loop feed back portion 31. A part of the operation unit 10 is provided in the guide hole 55 of the housing 50 so as to protrude from the housing 50 or from a part of the side surface of the housing 50. The operation unit 10 is movable in the front-rear direction along the guide hole 55. 1 to 3 show an example in which a part of the operation unit 10 is formed so as to protrude from the guide hole 55.

  The constituent material of the operation unit 10 is not particularly limited, and may be made of a synthetic resin similar to that of the housing 50 or may be made of a constituent material different from that of the housing 50. Further, the shape of the operation unit 10 is not particularly limited as long as it is a shape that can receive an operator's operation and transmit the operator's operation to the loop feed-back mechanism 30 and the suture feed mechanism 40. In addition, a guide (for example, a groove 22 as shown in FIG. 3) for moving the operation unit 10 straight back and forth may be formed in the housing 50.

  1-3, the operation part 10 of the shape protruded toward the outer side from the side surface of the housing 50 in the direction orthogonal to the advancing direction is shown as an example. By adopting such a shape, the operator's finger is easily caught and the operability is improved. However, the shape of the operation unit 10 is not limited to the shape shown in FIGS. 1 to 3. For example, a rod in which the base end of the operation unit 10 extends rearward and protrudes from the base end side of the housing 50. The rod may be used as the operation unit 10 so that it can be taken in and out of the housing 50. A button or the like may be provided at the base end of the rod to improve operability. Further, when the operation unit 10 is provided in the housing 50, a finger may be inserted through the guide hole 55 and the operation unit 10 may be operated.

(Loop feed back mechanism 30)
The loop feed-back mechanism 30 sends the loop forming portion 80, which is movably inserted into the loop introduction needle 60, to the distal end side of the loop introduction needle 60 in conjunction with the movement of the operation portion 10, 50 to the inside. The loop feed back mechanism 30 includes a loop feed back portion 31 and a first elastic member 32. The first elastic member 32 corresponds to the elastic member of the present invention.

  The loop feed-back portion 31 includes a distal end portion 31a, a proximal end portion 31b, a side wall portion 31c, a first contact portion 33, and a housing portion 34. Can be moved in the front-rear direction. The loop feed-back portion 31 only needs to be formed with an accommodating portion 34 in which the first elastic member 32 can be installed and movable in the front-rear direction. For example, a hollow cylindrical member (cylindrical member) A prismatic member (square tube member) or the like can be used. In addition, a slit (or a cut) may be formed in the side wall portion 31c of the loop feed back portion 31 so that the accommodating portion 34 and the outside communicate with each other. FIG. 3 shows an example of the loop feed-back portion 31 that releases the suture feed mechanism 40 side.

  The distal end portion 31a constitutes the distal end side portion of the loop sending back portion 31 and the proximal end side fixing portion 83 of the loop forming portion 80 is fixed. The tip portion 31a regulates the movement of the loop sending back portion 31 in the forward direction. That is, when the tip portion 31 a hits the inner wall surface 54 of the housing 50, the loop feed-back portion 31 can no longer move forward. The base end portion 31 b constitutes a base end side portion of the loop sending back portion 31, and the operation unit 10 is installed on the housing portion 34 side. The base end portion 31 b regulates the backward movement of the loop sending back portion 31. In other words, when the base end portion 31b hits the base end side inner wall surface (hereinafter simply referred to as the inner wall surface 57a) of the housing 50, the loop feed-back portion 31 cannot move further rearward. Since the position of the proximal end inner wall surface is different between the loop feed back mechanism 30 side and the suture feed mechanism 40 side, the proximal end inner wall surface on the suture feed mechanism 40 side is referred to as an inner wall surface 57b. .

  The side wall part 31c connects the front end part 31a and the base end part 31b, and slidably contacts the inner wall side surface in the housing 50. However, the side wall portion 31c does not need to cover the entire storage portion 34, and a slit (or a cut) may be formed so that the storage portion 34 and the outside communicate with each other.

  The first abutting portion 33 abuts the distal end surface of the second abutting portion 45a formed on the suture feeding portion 45 constituting the suture feeding mechanism 40 on the base end surface, and moves the suture feeding portion 45 in the backward direction. To move to. For example, the first contact portion 33 may be formed in a protruding shape that protrudes from a part of the side wall portion 31 c located on the suture feed mechanism 40 side of the loop feed-back portion 31. The first contact portion 33 is not limited to the protrusion shape, and may be any shape that can transmit a backward force to the suture thread feeding portion 45.

  The accommodating portion 34 is a space surrounded by the distal end portion 31a, the proximal end portion 31b, and the side wall portion 31c of the loop feed-back portion 31, and the first elastic member 32 is accommodated in an extendable manner.

  The first elastic member 32 is configured by a member (for example, a spring (coil spring, air spring, etc.), rubber, or the like) that has elasticity and expands and contracts in the front-rear direction. The first elastic member 32 is accommodated in the accommodating portion 34 in a compressed state in which a force greater than the frictional force of the loop 82 accommodated in the loop introduction needle 60 is applied. That is, the first elastic member 32 is not deformed unless a force equal to or greater than the frictional force of the loop 82 is applied in the state of being accommodated in the accommodating portion 34. Therefore, in a state where the first elastic member 32 is housed in the housing portion 34, that is, in a state where the operation unit 10 is located between the first elastic member 32 and the base end portion 31 b, It can be moved back and forth.

  A guide (for example, a groove in which the loop feed-back portion 31 fits) for moving the loop feed-back portion 31 straight back and forth may be formed in the housing 50.

(Suture feed mechanism 40)
The suture feed mechanism 40 links a suture thread (the suture thread 1 shown in FIGS. 1 to 3) that is movably inserted into the suture introduction needle 70 in conjunction with the movement of the operation unit 10. The feed needle 70 is fed from the tip (blade edge). The suture feed mechanism 40 includes a first hollow member 41, a second hollow member 42, a third hollow member 43, a suture fastening member 44, a suture feed portion 45, and a second elastic member 46. And a restricting member 47.

  The first hollow member 41 is formed in a hollow shape and is fixed to the proximal end side of the housing 50. The second hollow member 42 is formed in a hollow shape and can move in the front-rear direction in the housing 50 according to the movement of the operation unit 10. The third hollow member 43 is formed in a hollow shape and is fixed to the distal end side of the housing 50. The suture 1 is inserted into the first hollow member 41, the second hollow member 42, and the third hollow member 43 from the outside of the housing 50.

  In particular, the third hollow member 43 also functions as a means for preventing the suture 1 from bending within the housing 50. The third hollow member 43 is interposed between the suture thread introduction needle 70 and the second hollow member 42 and allows the suture thread 1 fed through the first hollow member 41 and the second hollow member 42 to be substantially straight. In this state, it can be fed into the suture thread introduction needle 70. That is, the third hollow member 43 has a function of guiding the inserted suture 1 to the suture introduction needle 70 in a substantially straight state without bending when the suture 1 is inserted into the suture instrument 100. Yes. Therefore, the operator can send the suture 1 to the suture introduction needle 70 in a substantially straight state simply by inserting the suture 1 from the first hollow member 41, and easily attach the suture 1 to the suture tool. 100 can be set.

  The second hollow member 42 has an inner diameter larger than the outer diameter of the first hollow member 41 and an outer diameter smaller than the inner diameter of the third hollow member 43. And the 2nd hollow member 42 moves to the front-back direction in the state inserted in the hollow part of the 3rd hollow member 43 at the front end side. The second hollow member 42 is configured such that the first hollow member 41 is inserted into the hollow portion on the proximal end side according to the position. Further, the axial lengths of the first hollow member 41, the second hollow member 42, and the third hollow member 43 are determined by the size of the housing 50 and the suture thread 1 to be protruded from the distal end of the suture thread introduction needle 70. The length is determined in consideration of the length, and the length is not particularly limited.

  A movement restricting member 47 is fixed to the outer periphery on the proximal end side of the second hollow member 42. The movement restricting member 47 restricts the movement of the second hollow member 42 in the front-rear direction. That is, the second hollow member 42 moves in the front-rear direction while the movement restricting member 47 contacts the stopper 51 a and the stopper 51 b formed on the inner wall side surface of the housing 50. The front end of the second hollow member 42 abuts against the inner wall surface 54 or the movement restricting member 47 abuts against the stopper 51a to restrict the forward movement of the second hollow member 42, and the movement restricting member 47 contacts the stopper 51b. The case where the rearward movement of the second hollow member 42 is formed by hitting will be described below as an example.

  However, when the forward movement of the second hollow member 42 is restricted by the outer peripheral surface on the front end side of the second hollow member 42 being in contact with a part of the inner wall of the third hollow member 43, the movement restricting member 47. Restricts only the backward movement of the second hollow member 42. In addition, the proximal end side inner peripheral surface of the second hollow member 42 abuts on the outer wall of the first hollow member 41, or the distal end of the second hollow member 42 abuts on the proximal end (inside) of the third hollow member 43. Thus, when the backward movement of the second hollow member 42 is restricted, the movement restricting member 47 restricts only the forward movement of the second hollow member 42. That is, the movement restricting member 47 is not indispensable, and it is only necessary to determine whether or not the movement restricting member 47 is installed according to the configuration of the first hollow member 41, the second hollow member 42, the third hollow member 43, the stopper 51a, and the stopper 51b.

  Moreover, since the 1st hollow member 41, the 2nd hollow member 42, and the 3rd hollow member 43 allow the suture thread 1 to be inserted through the inside, the inner diameter thereof is set to such an extent that the suture thread 1 can be inserted. Further, the first hollow member 41 and the second hollow member 42 can be inserted into a suture fastening member 44 described later. Therefore, the outer diameters of the first hollow member 41 and the second hollow member 42 need to be set so as to be able to be inserted into the cut line of the suture thread fastening member 44. Further, here, in order to make the movement toward the base end side smooth, the inner diameters are increased in the order of the first hollow member 41, the second hollow member 42, and the third hollow member 43. Is not particularly limited. However, by increasing the inner diameter in the order of the first hollow member 41, the second hollow member 42, and the third hollow member 43, a step does not occur in a portion where they are connected as viewed from the base end side. Therefore, if the inner diameter is increased in the order of the first hollow member 41, the second hollow member 42, and the third hollow member 43, the suture 1 can be inserted more smoothly when the suture 1 is passed from the proximal end side. it can.

  When the forward movement of the second hollow member 42 is stopped at a part of the inner wall of the third hollow member 43, the tapered shape is such that the inner diameter of the third hollow member 43 is reduced toward the tip side. Or a protrusion or the like may be formed in the inner cavity of the third hollow member 43. Similarly, when the backward movement of the second hollow member 42 is stopped at a part of the outer wall of the first hollow member 41, the outer diameter of the first hollow member 41 increases toward the proximal end. What is necessary is just to make it a taper shape or to form a projection part etc. in the outer periphery of the 1st hollow member 41. Further, when the backward movement of the second hollow member 42 is stopped at the proximal end (inside) of the third hollow member 43, the distal end of the second hollow member 42 is radially outward. The base end of the third hollow member 43 is protruded inward in the radial direction, and these can be locked.

  Note that the base end portion of the first hollow member 41 may protrude from the housing 50. By doing so, it is possible to reduce the burden of the operation of inserting the suture thread 1. However, as shown in FIGS. 1 to 3, the proximal end portion of the first hollow member 41 may not protrude outside the housing 50. If the base end side of the first hollow member 41 is formed in a funnel shape (a shape in which the wall surface is gradually expanded in diameter toward the base end), the suture thread 1 is easily inserted. Alternatively, the first hollow member 41 may be configured to have a length up to the proximal end of the housing 50, and a funnel-shaped member having a lumen may be attached to the proximal end of the first hollow member 41. Further, the first hollow member 41, the second hollow member 42, and the third hollow member 43 only have to be hollow inside, and for example, a hollow columnar member (cylindrical member) or a prismatic member (square tube member). ) And the like. Further, even if slits (or cuts) are formed in a part of the first hollow member 41, the second hollow member 42, and the third hollow member 43 so that the hollow portion and the outside communicate with each other. Good.

  Further, the third hollow member 43 also has a function of guiding the movement of the second hollow member 42 in the front-rear direction. Therefore, the axial length of the third hollow member 43 may be determined in consideration of the length of the second hollow member 42 as well as the length of the suture 1 to be fed from the distal end of the suture introduction needle 70. . That is, the axial length of the third hollow member 43 is such that a part of the second hollow member 42 is located in the hollow portion of the third hollow member 43 even when the second hollow member 42 is moved most backward. It is configured to a length of about.

  The suture fastening member 44 has a cut that penetrates in the front-rear direction, for example, at the center. The suture fastening member 44 is movable in the front-rear direction by the second hollow member 42. The suture thread fastening member 44 can tighten the first hollow member 41, the suture thread 1 or the second hollow member 42 at the cut. That is, the suture fastening member 44 is configured to fasten any one of the first hollow member 41, the suture thread 1, and the second hollow member 42 according to a position that changes according to the movement of the operation unit 10.

  The suture fastening member 44 is moved in the front-rear direction while being accommodated in the suture feed unit 45. The second abutting portion 45a of the suture thread feeding portion 45 can be moved forward until the second abutting portion 45a hits the first abutting portion 33 of the loop feeding back portion 31, and the proximal end surface of the suture thread feeding portion 45 is a housing. The rearward movement is possible until it hits the inner wall surface 57b on the base end side of 50. The suture 1 is sent out by being fastened to the suture fastening member 44. Therefore, the suture thread 1 is fastened to the suture fastening member 44 and sent out until the suture fastening member 44 is detached from the first hollow member 41 and the second hollow member 42 is fastened.

  The suture fastening member 44 may be formed of an elastic body such as natural rubber or synthetic rubber, or a relatively soft metal ring such as copper. If the suture fastening member 44 is formed of an elastic body, the suture 1 can be fastened using the elastic force. If the suture fastening member 44 is formed of a metal ring or the like, the suture 1 can be tightened by being plastically deformed at the same time as it is detached from the first hollow member 41. Further, the cut formed in the suture fastening member 44 includes not only a simple cut but also a slit shape, a hole having an inner diameter smaller than the outer diameter of the suture thread 1 and the like.

  The suture thread feeding portion 45 includes a second abutting portion 45a, a side wall extending portion 45b, a main body portion 45c, and a mounting portion 45d. The inside of the housing 50 is moved in the front-rear direction according to the movement of the operation portion 10. It can be moved. The suture thread feed section 45 only needs to have a mounting portion 45d in which the suture thread fastening member 44 is mounted, for example, a hollow cylindrical member (cylindrical member) or a prismatic member (square tube member). Or the like. A guide for moving the suture feed portion 45 straight back and forth (for example, a groove into which the suture feed portion 45 fits) may be formed in the housing 50. At this time, it is preferable that the formed guide does not generate a frictional resistance against the movement of the suture thread feeding portion 45.

  The second contact portion 45a is provided at the tip of the side wall extending portion 45b, for example, and is formed in a protruding shape that protrudes toward the loop feed-back mechanism 30 side. The second contact portion 45a is in contact with the distal end surface of the operation unit 10 whose base end surface has moved in the forward direction, so that the movement from the operation unit 10 is transmitted. And the 2nd contact part 45a receives the force of the front, and the suture feed part 45 moves to the front. Further, the forward movement of the second contact portion 45 a is restricted by the front end surface coming into contact with the base end surface of the first contact portion 33 formed in the loop feed-back portion 31.

  On the other hand, the rearward movement of the second contact portion 45a is performed by pushing the distal end surface against the proximal end surface of the first contact portion 33 formed on the loop feed-back portion 31, so that the suture feed portion 45 is It will also move backwards. However, the suture thread feeding portion 45 can be automatically moved backward by a repulsive force of a second elastic member 46 described later. The second contact portion 45a is not limited to the protrusion shape, and may be any shape that can contact the first contact portion 33 and the operation portion 10. Further, the movement of the second contact portion 45 a in the front-rear direction is guided by the groove 22 that guides the movement of the operation unit 10.

  The side wall extending portion 45b extends a part of the outer wall of the main body portion 45c toward the distal end side. The side wall extending portion 45b is located on the loop feed back mechanism 30 side. The axial length of the side wall extending portion 45b is determined in consideration of the size of the housing 50 and the length of the suture thread 1 that is desired to protrude from the distal end of the suture thread introduction needle 70. It is not intended to limit. Further, the side wall extending portion 45b only needs to have a strength sufficient to withstand the force applied to the second contact portion 45a, and the thickness is not particularly limited.

  The main body 45c has a mounting portion 45d formed therein and a through-hole through which the suture thread 1 is inserted back and forth through the mounting portion 45d. The main body 45c is installed in the housing 50 so as to be movable in the front-rear direction. As described above, if a guide for moving the suture thread feeding portion 45 straight back and forth is formed in the housing 50, the main body portion 45c may be installed on this guide. Further, the suture thread feeding portion 45 is moved in the rearward direction until the base end surface of the main body portion 45c comes into contact with the inner wall surface 57b of the housing 50.

  The attachment portion 45d is formed in the main body portion 45c, and the suture fastening member 44 is attached to the attachment portion 45d. The suture fastening member 44 is attached to the attachment portion 45d and its movement is restricted. The mounting portion 45d is not particularly limited in size as long as the suture fastening member 44 can be mounted on the mounting portion 45d.

  The second elastic member 46 has an elastic force and is configured by a member (for example, a spring (coil spring, air spring, etc.) or rubber) that expands and contracts in the front-rear direction. The second elastic member 46 is installed between the inner wall surface 54 and the movement restricting member 47 fixed to the second hollow member 42, and expands and contracts between the inner wall surface 54 and the movement restricting member 47. ing. The second elastic member 46 moves the suture thread feeding portion 45 in the backward direction by pushing the movement restricting member 47 using a repulsive force. When the second elastic member 46 is constituted by a spring, the second elastic member 46 may be installed so as to wind the outer peripheral portions of the third hollow member 43 and the second hollow member 42.

(Loop introduction needle 60)
The loop introduction needle 60 has a lumen, and accommodates the loop forming portion 80 in the lumen so as to be movable in the front-rear direction. When the loop introduction needle 60 is attached to the housing 50, the base end portion opens into the housing 50 and communicates with the inside of the housing 50. The loop introduction needle 60 is attached to the distal end side of the housing 50 so that its axis coincides with the axis of the loop feed back mechanism 30. If the loop introduction needle 60 is attached to the housing 50 in this way, the loop forming portion 80 can be fed back linearly. The loop introduction needle 60 may be formed of a metal such as stainless steel.

  The loop introduction needle 60 has a blade surface for puncturing the skin at the tip. The blade surface may be formed by cutting along a plane that obliquely intersects the axis of the loop introduction needle 60. The distal end opening of the loop introduction needle 60 may be directed toward the suture introduction needle 70 in order to ensure that a loop 82 of the loop forming portion 80 described later extends in the direction of the suture introduction needle 70. .

  The loop introduction needle 60 is not particularly limited in shape as long as it can puncture the skin and insert the loop forming portion 80. For example, as the loop introduction needle 60, a needle having an outer diameter of about 21 to 17G (preferably 20 to 18G) and a length of about 70 to 120 mm (preferably 80 to 100 mm) may be used. Further, a chamfered portion may be formed at the tip of the loop introduction needle 60 so that the grasped suture thread 1 is not broken. Further, it is preferable that the position of the tip of the loop introduction needle 60 (relative position with respect to the sent out suture 1) can be adjusted by the position of the support portion 53.

(Suture introduction needle 70)
The suture thread introduction needle 70 has a lumen, and the suture thread 1 is inserted into the lumen so as to be movable in the front-rear direction. When the suture thread introduction needle 70 is attached to the housing 50, the proximal end portion communicates with the hollow portion of the third hollow member 43. The suture introduction needle 70 is attached to the distal end side of the housing 50 so that its axis coincides with the axis of the suture feed mechanism 40. If the suture introduction needle 70 is attached to the housing 50 in this way, the suture 1 can be fed out linearly. The suture thread introduction needle 70 may be formed of a metal such as stainless steel. The proximal end portion of the suture thread introduction needle 70 may function as the third hollow member 43.

  The suture thread introduction needle 70 has a blade surface for puncturing the skin at the tip. The blade surface may be formed by cutting along a plane that obliquely intersects the axis of the suture introduction needle 70. The direction of the distal end opening of the suture thread introduction needle 70 is not particularly limited, but is preferably directed toward the loop introduction needle 60.

  The suture thread introduction needle 70 is not particularly limited in shape as long as it can puncture the skin and insert the suture thread 1. For example, as the suture thread introduction needle 70, one having an outer diameter of about 21 to 17G (preferably 20 to 18G) and a length of about 70 to 120 mm (preferably 80 to 100 mm) may be used. The position of the distal end of the suture thread introduction needle 70 (relative position with respect to the fed loop 82) may be adjusted according to the position of the support portion 52.

  As described above, the loop introduction needle 60 and the suture introduction needle 70 are supported on the distal end side of the housing 50 in parallel while being separated from each other by a predetermined distance. The distance between the loop introduction needle 60 and the suture introduction needle 70 is preferably set to a length (for example, about 10 to 30 mm) at which the suture 1 fixes the patient's abdominal wall and visceral wall. . If the distance between the loop introduction needle 60 and the suture introduction needle 70 is within this range, the patient's abdominal wall and visceral wall can be sufficiently fixed by the suture 1.

(Loop formation part 80)
The loop forming portion 80 is inserted into the loop introduction needle 60 so as to be movable in the front-rear direction. The loop forming portion 80 has a proximal end side fixed portion 83 fixed to the distal end portion of the loop sending back portion 31, a loop 82 fixed to the distal end, and an outer diameter smaller than the inner diameter of the loop introduction needle 60, It is comprised by the rod-shaped axial part 81 which connects the base end side fixing | fixed part 83 and the loop 82. As shown in FIG. The loop 82 is formed of an elastic material, and in a state where the loop 82 is fed from the tip of the loop introduction needle 60 (a state where no external force is applied), the loop 82 is restored to an annular shape and is fed from the tip of the loop introduction needle 60. In the absence, it changes almost linearly and can be stored inside the loop introduction needle 60.

  In the state where the loop 82 is delivered from the distal end of the loop introduction needle 60, the suture thread 1 fed from the distal end of the suture introduction needle 70 passes through the loop 82 so that the suture thread 1 delivered from the distal end of the suture introduction needle 70. It extends in the direction. For example, the loop 82 may be fixed to the distal end of the rod-shaped shaft portion 81 at a predetermined angle and formed in a curved shape in a state where the loop 82 is fed from the distal end of the loop introduction needle 60. The curved shape may be a shape in which, for example, the apex portion of the curved portion protrudes in the forward direction when the loop 82 is viewed from the side. If the loop 82 is formed in such a shape, the suture thread 1 can be positioned inside the loop 82 more reliably. Further, when the center of the loop 82 comes on the extension of the suture thread introduction needle 70, the suture thread 1 can be positioned in the loop 82 more reliably when the suture thread 1 is straightly extended.

  Further, although the tip shape of the loop 82 is not particularly limited, the loop 82 has a substantially V shape or a substantially U shape centered on the tip, and a portion for gripping the suture thread 1 (a substantially V shape or a substantially U shape). It is good to narrow the distance of the part. In this way, the suture thread 1 fed from the distal end of the suture thread introduction needle 70 can be gripped more reliably. The loop 82 only needs to be made of a deformable member, for example, a stainless steel wire (high-strength stainless steel for springs), a piano wire (a piano wire with nickel plating or chrome plating), or a superelastic alloy wire. (Alloys of titanium and nickel, alloys of copper and zinc (or alloys including beryllium, silicon, tin, aluminum, gallium, etc.) and alloys of nickel and aluminum).

  The rod-shaped shaft portion 81 can be configured using a metal (for example, stainless steel), a synthetic resin (for example, a polyolefin such as polypropylene or polyethylene, a fluororesin such as PTFE or ETFE), or the like. The rod-shaped shaft portion 81 can be configured using a stylet or the like. Moreover, the base end side fixing | fixed part 83 should just be fixed to the front-end | tip part of the loop sending back part 31, and the method of fixing is not specifically limited. For example, it may be fixed using an adhesive or the like, or a notch or the like may be provided at the tip of the loop feed-back portion 31 and fixed so as to be fitted into the notch. In the case where the loop 82 is made of a relatively rigid material, the rod-shaped shaft portion 81 and the loop 82 may be made of the same material. In this case, the rod-shaped shaft portion 81 and the loop 82 may be formed integrally or separately.

[Operation of Suture 100]
In the suture instrument 100, the operation unit 10, the loop feed-back mechanism 30, and the suture feed mechanism 40 are not connected. In addition, the loop feed back mechanism 30 and the suture feed mechanism 40 are not connected. That is, the operation unit 10, the loop feed back mechanism 30, and the suture feed mechanism 40 are independent from each other. However, the suturing tool 100 can provide a time difference between the delivery timing of the loop 82 and the delivery timing of the suture 1 with a simple operation without requiring an excessive operation burden on the operator. The suture thread 1 can be put through the visceral wall and the abdominal wall. The mechanism will be described in detail.

  As a preliminary operation of the suture tool 100, the surgeon first inserts the suture 1 into the first hollow member 41 of the suture feed mechanism 40. At this time, the surgeon feeds the suture 1 into the suture introduction needle 70 with such a length that the suture 1 does not protrude from the tip of the suture introduction needle 70. After the suture instrument 100 is punctured into the internal organs, in this state, when the operation unit 10 is moved in the forward direction, the forward movement of the operation unit 10 is first transmitted to the loop feed-back mechanism 30 and then the suture thread. It is transmitted to the feed mechanism 40. Note that the operator may use the suture thread 1 that is set in the suture tool 100 in advance.

(Operation of loop feed back mechanism 30)
In the initial state where the operation unit 10 is not operated (or the state before the second and subsequent operations), on the loop feed back mechanism 30 side, the base end portion 31b of the loop feed back portion 31 contacts the inner wall surface 57a of the housing 50. It is in contact. At this time, the first elastic member 32 in a compressed state to which a predetermined force is applied is accommodated in the accommodating portion 34. In addition, the operation unit 10 is sandwiched between the first elastic member 32 and the base end portion 31 b of the loop feed-back unit 31.

  When the operation unit 10 is moved forward by the operator, the force is transmitted to the first elastic member 32. Since the first elastic member 32 is compressed with a predetermined force, the distal end portion 31 a of the loop feed-back portion 31 is pushed on the distal end side of the first elastic member 32. That is, the operation unit 10, the loop feed-back unit 31, and the first elastic member 32 move in the forward direction while maintaining their respective positions. Then, the loop forming portion 80 fixed to the tip end portion 31 a of the loop sending back portion 31 also moves in the forward direction, and the loop 82 positioned at the tip end of the loop forming portion 80 moves from the tip of the loop introduction needle 60. It pops out and opens in a ring.

  Further, when the operation unit 10 is moved in the forward direction, the distal end portion 31 a of the loop feed-back unit 31 hits the inner wall surface 54 of the housing 50. In this state, when a force larger than the force applied to the first elastic member 32 is transmitted to the first elastic member 32 via the operation unit 10, the first elastic member 32 is further compressed. become. That is, the loop 82 fed from the tip of the loop introduction needle 60 can be held in an open state. With such a configuration, it is possible to delay the delivery timing of the suture thread 1 from the delivery timing of the loop 82. That is, the loop shape of the loop 82 can be maintained while continuing to move the operation unit 10 in the forward direction.

  Next, when the operation toward the distal end side of the operation unit 10 is released, the compressive force of the first elastic member 32 is released, and the loop feed-back unit 31 starts moving backward. That is, the operation unit 10 moves backward by the repulsive force of the first elastic member 32 until it comes into contact with the proximal end portion 31 b of the loop feed-back unit 31. When the operator further moves the operation unit 10 in the backward direction, the force in the backward direction of the operation unit 10 that is in contact with the proximal end portion 31 b of the loop feed-back unit 31 is transmitted to the loop feed-back unit 31. The As a result, the base end portion 31b of the loop feed-back portion 31 is pushed backward, and the loop feed-back portion 31 moves backward.

  In addition to the first elastic member 32, another elastic body such as a spring or rubber may be provided, and the operation unit 10 may be moved backward using the repulsive force of the elastic body. If such an elastic body is provided, the operation when moving the operation unit 10 in the backward direction is simplified, and the operation burden on the operator is further reduced. That is, it is not necessary for the operator to perform a return operation, which will be described later, and the suture thread 1 can be passed through the visceral wall and the abdominal wall with a substantially one-touch operation.

  When the loop sending back portion 31 moves backward, the loop 82 also starts moving backward. At this time, the suture thread 1 delivered from the distal end of the suture thread introduction needle 70 is penetrated through the loop 82. Therefore, when the loop 82 starts moving backward, the loop shape of the loop 82 gradually decreases, and the suture 1 is gripped by the loop 82. Further, when the loop 82 moves in the backward direction, the suture thread 1 is gripped by the tip of the loop introduction needle 60.

(Operation of suture thread feeding mechanism 40)
In the initial state in which the operation unit 10 is not operated (or the state before the second and subsequent operations), the suture fastening member 44 rides on the first hollow member 41 on the suture feed mechanism 40 side, that is, The first hollow member 41 is in a fastened state, and the suture 1 is not fastened by the suture fastening member 44 and is free to move (the suture 1 is fastened to the suture fastening member 44). Is not).

  Even if the operation unit 10 is moved forward by the operator, the operation is not immediately started on the suture feed mechanism 40 side. Furthermore, the operating portion 10 is moved in the forward direction and comes into contact with the second contact portion 45a, whereby the suture thread feeding portion 45 starts moving in the forward direction. That is, the movement of the operation unit 10 is transmitted to the suture feed mechanism 40 side via the second contact portion 45a.

  When the suture feed section 45 moves in the forward direction, the suture fastening member 44 also moves in the forward direction. When the suture fastening member 44 moves by a predetermined distance, the first hollow member 41 comes out of the suture fastening member 44. Then, the suture thread 1 is inserted in the cut of the suture thread fastening member 44, that is, the suture thread fastening member 44 is tightening the suture thread 1. In this state, the fastening force of the suture thread fastening member 44 reaches the suture thread 1, and the suture thread 1 is held by the suture thread fastening member 44.

  At this time, the proximal end of the second hollow member 42 is in contact with the distal end of the suture fastening member 44. Then, the movement of the operation unit 10 is transmitted to the second hollow member 42 through the suture fastening member 44, and the second hollow member 42 is also moved forward by being pushed by the suture fastening member 44. The second elastic member 46 is pushed by the movement restricting member 47 and compressed toward the front by the forward movement of the second hollow member 42.

  Since the suture thread 1 is gripped by the suture thread fastening member 44, the suture thread 1 is fed out from the distal end of the suture thread introduction needle 70 as the second hollow member 42 moves forward. That is, the suture thread 1 is sent out from the distal end of the suture introduction needle 70 at a timing later than the timing at which the loop 82 is fed out from the distal end of the loop introduction needle 60. Therefore, a time difference can be provided between the delivery timing of the loop 82 and the delivery timing of the suture 1, and the suture 1 can be easily inserted into the loop 82. That is, the delivery timing of the loop 82 and the delivery timing of the suture thread 1 can be adjusted. Thereby, in the suturing tool 100, a time difference can be provided between the feed timing of the loop 82 and the feed timing of the suture 1, or the feed timing of the loop 82 and the feed timing of the suture 1 can be made simultaneously. Since the suture 1 is sent to the suture introduction needle 70 in a substantially straight state by the third hollow member 43, the suture 1 does not bend in the housing 50.

  Furthermore, when the operation unit 10 is moved in the forward direction, the tip of the second hollow member 42 hits the inner wall surface 54 or the movement restricting member 47 hits the stopper 51a. As a result, the forward movement of the suture thread feeding portion 45 together with the second hollow member 42 stops. In this state, when a force larger than the force applied to the first elastic member 32 is transmitted to the first elastic member 32 via the operation unit 10 and the operation unit 10 is further moved forward, the suture thread The feed portion 45 moves in the forward direction, and the proximal end side of the second hollow member 42 pierces the suture fastening member 44. Then, the fastening to the suture thread 1 by the suture fastening member 44 is released, and the suture thread 1 becomes free. That is, the suture thread 1 does not move forward. Here, a case will be described as an example in which the movement of the second hollow member 42 is restricted by the movement restricting member 47 abutting against the stopper 51a, but this is not a limitation, as described above. Yes (see paragraph [0019]).

  Next, when the operation toward the distal end side of the operation unit 10 is released, the compressive force of the second elastic member 46 is released, and the suture thread feeding unit 45 moves backward to a position where the movement restricting member 47 hits the stopper 51b. Moving. However, the second hollow member 42 is stuck in the suture fastening member 44. Here, the movement of the second hollow member 42 is restricted by the movement restricting member 47 abutting against the stopper 51b, but this is not limited to this (paragraph [0020]). reference).

  When the operation unit 10 is further moved in the backward direction with the movement restricting member 47 in contact with the stopper 51b, the proximal end surface of the first contact portion 33 of the loop feed back portion 31 and the first end of the suture feed portion 45 are moved. 2 The front end surface of the abutting portion 45 a abuts, and the force of the operation portion 10 is transmitted to the suture thread feeding portion 45 via the loop feeding back portion 31. Since the movement of the second hollow member 42 is stopped by the stopper 51b, only the suture thread feeding portion 45 moves backward. Then, the second hollow member 42 comes out of the cut line of the suture fastening member 44, and the suture fastening member 44 fastens the first hollow member 41. That is, the fastening force of the suture thread fastening member 44 is applied from the second hollow member 42 to the first hollow member 41, and the initial state is restored.

  Through the series of operations described above, each unit (the operation unit 10, the loop feed back mechanism 30, and the suture feed mechanism 40) returns to the same position as in the initial state, but the loop 82 holds the suture 1. It has become. In this state, when the loop introduction needle 60 and the suture introduction needle 70 of the suture instrument 100 are pulled out from the internal organs toward the abdominal wall, the suture 1 is free, so the suture 1 is guided smoothly. Thus, the visceral wall and the abdominal wall are passed through a substantially U-shape. Finally, the suture thread 1 is cut with the cutting edge of the suture thread introduction needle 70 drawn out of the body or other cutting means (such as scissors or a cutter). Then, since the suture thread 1 is the same as the initial state in which the suture thread introduction needle 70 is inserted to the tip, the visceral wall can be fixed by the above procedure any number of times. When the suture thread 1 is cut out from the distal end side of the cutting edge of the suture introduction needle 70 after the suture thread 1 is cut, the suture thread 1 is pulled to the proximal end by hand and is in the same state as the initial state. It is good to.

(Feeding timing of loop 82 and suture 1)
According to the suturing tool 100, the forward movement of the operation unit 10 is first transmitted to the loop 82, and then the forward movement of the operation unit 10 can be transmitted to the suture thread 1. The delivery timing of the suture thread 1 can be delayed from the delivery timing of the loop 82. By doing so, the suture thread 1 can be surely inserted into the loop 82, and the suture thread 1 can be securely gripped.

  Specifically, when the operation unit 10 is moved to the distal end side, the loop sending back mechanism 30 starts to operate, and only the loop 82 is sent out first using the elastic force of the first elastic member 32. Then, the movement of the operation unit 10 is moved only to the first elastic member 32 on the loop feed-back mechanism 30 side so that the suture thread 1 is sent out in a state where the loop 82 is completely sent out and a state where the loop shape of the loop 82 is maintained. And the shape of the loop 82 can be maintained.

  On the other hand, the suture feed mechanism 40 starts operation with a delay from the operation of the loop feed back mechanism 30. Immediately after the movement starts, the suture feed mechanism 40 uses the state in which the suture fastening member 44 rides on the first hollow member 41 and keeps the suture 1 free. Next, on the side of the suture feed mechanism 40, the suture fastening member 44 comes out of the first hollow member 41, tightens the suture 1, and transmits the movement of the operation unit 10 to the suture 1.

  In this manner, in the suturing tool 100, it is possible to provide a time difference between the delivery timing of the loop 82 and the delivery timing of the suture thread 1. Specifically, in the suturing tool 100, the suture thread 1 can be fed out in a state where the loop 82 has been fed out first, and the suture thread 1 can be easily inserted into the loop 82 formed with an annular shape. It will be. Therefore, according to the suturing tool 100, the suture thread 1 can be delivered by adjusting the lengths of the loop feed-back portion 31, the first hollow member 41 and the second hollow member 42, and the positions of the stoppers 51a and 51b. The timing and the delivery timing of the loop 82 can be changed and corrected.

[Specific Operation Procedure of Suture 100]
4 to 6 are schematic cross-sectional views schematically showing the operation procedure of the suturing tool 100. FIG. A specific operation procedure of the suturing tool 100 will be described with reference to FIGS. 4 shows the puncturing operation of the suturing tool 100, FIG. 5 shows the forward movement operation of each part (hereinafter referred to as pushing operation 1 (B1) to pushing operation 3 (B3)), and FIG. 6 shows each part. The backward movement operations (hereinafter referred to as return operations (referred to as return operation 1 (C1) to return operation 3 (C3))) are respectively shown. FIGS. 5 to 6 also show extracted views of the delivery state of the suture thread 1 and the loop 82.

(A) Puncture (represents the initial state of the suture instrument 100 (including the state before the second and subsequent operations))
First, the operator punctures the patient with the suture instrument 100 in a state where the loop 82 of the loop forming portion 80 is accommodated in the loop introduction needle 60 and the suture 1 is accommodated in the suture introduction needle 70. To do. At this time, the suture thread 1 is inserted into the suture thread introduction needle 70 so as not to protrude from the tip of the suture thread introduction needle 70. Since the third hollow member 43 is installed in the suture instrument 100, the operator simply inserts the suture thread 1 from the first hollow member 41, and the suture thread introduction needle in a substantially straight state. 70, and the suture 1 can be set on the suture instrument 100. In addition, the suture fastening member 44 rides on the first hollow member 41, and the suture 1 is free, that is, does not move forward. Further, the base end portion 31b of the loop feed back portion 31 is in contact with the inner wall surface 57a.

(B1) Push-in operation 1 (from the start of feeding the loop 82 to the start of sending the suture 1)
When a forward force is applied to the operation unit 10 by the operator, the loop feed-back unit 31 starts moving in the forward direction via the first elastic member 32. When the loop feed-back unit 31 moves in the front-rear direction, the loop forming unit 80 also moves in the front-rear direction. The loop feed-back portion 31 can move in the forward direction until the tip end portion 31 a hits the inner wall surface 54 of the housing 50. When the distal end portion 31a of the loop sending back portion 31 moves forward until it abuts against the inner wall surface 54 of the housing 50, the loop forming portion 80 connected to the distal end portion 31a also moves the lumen of the loop introduction needle 60 toward the distal end side. It moves and is sent out from the tip of the loop introduction needle 60. When the loop 82 is fed out from the tip of the loop introduction needle 60, no external force is applied, and the loop 82 is restored to an annular shape.

  The suture feed mechanism 40 does not move yet when the loop feed back mechanism 30 starts to move. The suture feed mechanism 40 starts to move forward when the operation unit 10 abuts on the second abutment portion 45a of the suture feed mechanism 40. When the second contact portion 45a is pushed forward by the operation portion 10, the suture thread feeding portion 45 starts moving in the forward direction. Since the suture fastening member 44 is attached to the suture feed unit 45, the suture fastening member 44 starts to move forward along the first hollow member 41 together with the suture feed unit 45. In a state where the suture thread fastening member 44 rides on the first hollow member 41, the suture thread 1 remains free. Note that the second elastic member 46 is compressed as the suture thread feeding portion 45 moves in the forward direction.

(B2) Push-in operation 2 (from the start of sending the suture 1 to the completion of sending the suture 1)
When the operator further moves the operation unit 10 in the forward direction, the loop feed-back unit 31 hits the inner wall surface 54 on the loop feed-back mechanism 30 side, and does not move further forward. Then, the movement of the operation unit 10 is transmitted only to the first elastic member 32, and the first elastic member 32 is compressed in the forward direction in the accommodating portion 34 of the loop sending back portion 31. Therefore, only the first elastic member 32 moves forward while maintaining the shape of the loop 82. At this time, due to the action of the first elastic member 32, a load is gradually applied to the operator's hand via the operation unit 10. Therefore, the operation unit 10 can be moved smoothly forward.

  On the other hand, on the suture feed mechanism 40 side, the suture feed section 45 continues to move forward, and the suture fastening member 44 comes off the first hollow member 41 and tightens the suture 1. In this state, when the suture fastening member 44 further moves forward, the suture 1 fastened to the suture fastening member 44 also starts to move forward, and the suture is introduced from the distal end of the suture introduction needle 70. 1 begins to be sent out. Then, the suture thread 1 is penetrated into the loop 82 that has already been fed out. At this time, the second hollow member 42 is also pushed forward by the suture fastening member 44 and moved in the forward direction.

  Thereafter, the suture thread feeding portion 45 continues to move forward until the movement restricting member 47 hits the stopper 51a or the tip of the second hollow member 42 hits the inner wall surface 54. At this time, the suture 1 of a necessary length is sent out from the distal end of the suture introduction needle 70.

  When the distal end portion 31a of the loop feed-back portion 31 hits the inner wall surface 54 of the housing 50, the forward movement of the loop feed-back portion 31 is restricted, but the operation portion 10 is further moved forward. Only the first elastic member 32 moves in the forward direction. The loop feed-back portion 31 can compress only the first elastic member 32 to the tip side without moving further to the tip side. By doing so, the shape of the loop 82 fed from the tip of the loop introduction needle 60 is maintained.

(B3) Push-in operation 3 (clamping release to the sent out suture 1)
When the operation unit 10 is moved further forward by the operator, the compression of the first elastic member 32 and the forward movement of the suture thread feeding unit 45 are continued. However, the second hollow member 42 does not move forward because the movement restricting member 47 hits the stopper 51a or the tip of the second hollow member 42 hits the inner wall surface 54. In this state, when the suture thread feeding portion 45 is further moved in the forward direction, the second hollow member 42 pierces the suture thread fastening member 44. Then, the tightening on the suture thread 1 is released, and the suture thread 1 becomes free again. That is, the suture thread 1 does not move forward. On the other hand, on the loop feed back mechanism 30 side, only the first elastic member 32 is compressed while maintaining the shape of the loop 82. Therefore, the state in which the suture thread 1 is penetrated inside the loop 82 is maintained.

(C1) Return operation 1 (start of backward movement of each part)
When the surgeon releases the force applied to the operating portion 10 to the distal end side, the compressed state of the first elastic member 32 and the second elastic member 46 is released. When the compressed state of the first elastic member 32 is released, the operation unit 10 is pushed by the first elastic member 32 and moves backward. Then, the operation unit 10 comes into contact with the proximal end portion 31 b of the loop sending back portion 31. Since the second hollow member 42 is pierced into the suture fastening member 44, the second hollow member 42 is also moved backward together with the suture fastening member 44. Then, the suture fastening member 44 is temporarily stopped from moving backward together with the second hollow member 42 whose movement is restricted when the movement restricting member 47 hits the stopper 51b. In addition, although the figure has shown as an example the case where the suture thread feeding part 45 is moved backward by releasing the compressed state of the second elastic member 46, the second elastic member 46 will be described below. Even if there is not, the backward movement of the suture thread feeding portion 45 is possible. Hereinafter, description will be made assuming that the second elastic member 46 is not installed.

(C2) Return operation 2 (return start of loop 82)
When the operator further moves the operation unit 10 in the backward direction, the operation unit 10 pushes the proximal end portion 31b of the loop feed-back unit 31, and the loop feed-back unit 31 starts moving in the backward direction. As the loop feed-back portion 31 moves backward, the loop 82 starts to be accommodated in the loop introduction needle 60 so as to draw the suture 1 toward the tip of the loop introduction needle 60.

(C3) Return operation 3 (completion of grasping of the suture thread 1)
After a while after the loop feed-back portion 31 is moved, the first contact portion 33 of the loop feed-back portion 31 comes into contact with the second contact portion 45a of the suture feed portion 45. Then, the backward moving force of the loop feed back portion 31 is transmitted to the suture feed portion 45, and the suture feed portion 45 is also moved backward together.

  When the operation unit 10 is further moved backward from this state, the force is transmitted to the suture feed unit 45 via the first contact portion 33 of the loop feed back unit 31, and the suture feed unit 45 further moves. Move backwards. Then, the suture fastening member 44 comes out of the second hollow member 42 and rides on the first hollow member 41 as in the initial state. The suture 1 remains free. That is, the suture thread 1 does not move. On the other hand, the loop feed-back portion 31 moves backward until the backward movement of the suture feed portion 45 stops due to the force of the first elastic member 32 and the backward force applied to the operation portion 10. . When the suture fastening member 44 returns to the initial state, it returns to the initial state together. At this time, each part returns to the same position as in the initial state, but the loop 82 is holding the suture 1.

  When the suture tool 100 is removed in this state, the suture thread 1 is free, so that the suture thread 1 is smoothly guided and the visceral wall and abdominal wall are passed through a substantially U-shape. That is, the surgeon can put the suture thread 1 through the visceral wall and the abdominal wall in a substantially U-shape only by the push operation (push operations 1 to 3) and the return operation 3. Finally, if the suture thread 1 is cut by the cutting edge of the suture thread introduction needle 70 drawn out of the body or other cutting means, a series of operations for introduction and withdrawal of the suture thread 1 into the internal organs is completed. . Then, since the suture thread 1 is the same as the initial state in which the suture thread introduction needle 70 is inserted to the tip, the visceral wall can be fixed by the above procedure any number of times. When the suture thread 1 is cut out from the distal end side of the cutting edge of the suture introduction needle 70 after the suture thread 1 is cut, the suture thread 1 is pulled to the proximal end by hand and is in the same state as the initial state. It is good to.

[Organ fixation technique using suture tool 100]
FIG. 7 is an explanatory diagram for explaining the operation of the suturing tool 100. Based on FIG. 7, the operation of the suturing tool 100 will be described along the flow of a procedure using the suturing tool 100. Here, fixation of the patient's abdominal wall 101 and visceral wall 102 (for example, stomach wall) using the suturing tool 100 will be described.

  First, the operator inserts an endoscope into the internal organs (for example, the stomach) from the mouth or nose of the patient. Thereafter, the surgeon supplies a sufficient gas (for example, carbon dioxide) into the internal organs to expand the internal organs. Then, the visceral wall 102 is brought into close contact with the abdominal wall 101. Then, the skin 103 is sterilized including the portion to be punctured with the loop introduction needle 60 and the suture introduction needle 70. Then, the position of the viscera is confirmed by the light emitted from the endoscope, and local anesthesia is performed on this site.

  Subsequently, the suture tool 100 is prepared in a state in which the loop 82 of the loop forming portion 80 is accommodated in the loop introduction needle 60 and the suture 1 is accommodated in the suture introduction needle 70 (FIG. 4). As shown). At this time, the suture thread 1 is stored in the suture thread introduction needle 70 so as not to protrude from the tip of the suture thread introduction needle 70. Then, the loop introduction needle 60 and the suture introduction needle 70 of the suture instrument 100 are punctured into the abdominal wall 101 of the patient, and the loop introduction needle 60 and the suture introduction needle 70 are projected from the internal organs 102 into the internal organs ( FIG. 7 (a)).

  After confirming this state with the endoscope, the operator moves the operation unit 10 in the front-rear direction. Then, the surgeon executes the series of operations shown in FIGS. 5 and 6 to expose the suture thread 1 to the outside of the body (FIG. 7B). That is, the suture thread 1 is in a state of passing the visceral wall 102 and the abdominal wall 101 in a substantially U shape. Finally, the surgeon cuts the suture 1 drawn out of the body and ligates both ends of the suture 1 (FIG. 7C). By this ligation, the visceral wall 102 and the abdominal wall 101 are fixed.

  Further, the suture instrument 100 is punctured again in parallel with a position separated from the ligated portion by a predetermined distance, for example, about 20 to 30 mm, to fix the visceral wall 102 and the abdominal wall 101. That is, when the suture thread 1 functions as an organ fixing tool, the visceral wall 102 and the abdominal wall 101 are fixed, and a fistula used when a fistula catheter is inserted can be easily formed. At this time, if the length of the suture thread 1 is set to a plurality of times, the suture tool 100 can be used continuously.

[Effects of Suture 100]
According to the suture instrument 100, it is not necessary to insert the suture thread 1 into the suture instrument 100 each time, and the organ can be fixed any number of times until the suture thread 1 is eliminated. Further, according to the suturing tool 100, the suture thread 1 is attached to the visceral wall 102 and the abdominal wall 101 only by pushing and pulling operations (pushing operation (pushing operations 1 to 3) and returning operation (returning operations 1 to 3)) of the operation unit 10. Can be passed through a substantially U-shape. Specifically, the surgeon only performs the operation of moving the operation unit 10 in the forward direction and the operation of moving the operation unit 10 to the initial position, and the suture 1 is applied to the visceral wall 102 and the abdominal wall 101. Since it can be passed, the procedure required by the operator can be greatly simplified. Furthermore, since the suture thread 1 is fed out after the loop 82 is in an annularly open state, the suture thread 1 can be reliably inserted into the loop 82.

  Therefore, the operation burden on the operator can be greatly reduced, and the workability is remarkably improved. Further, since the procedure itself can be executed very simply, not only the workability but also the operability is remarkably improved. Furthermore, since the suture 1 can be reliably grasped while being a simple technique, it is possible to reduce the number of punctures as much as possible, and not only the burden on the operator but also the burden on the patient. Can also contribute. In addition, the operation of the first elastic member 32 allows the pushing operation to be performed smoothly, and the stability during the treatment is further improved.

  Further, since the suturing tool 100 includes the third hollow member 43, the suture thread 1 can be prevented from being bent in the housing 50. That is, the provision of the third hollow member 43 prevents the suture 1 from being bent in the housing 50, and the suture 1 is bent in the housing 50 and does not protrude from the distal end of the suture introduction needle 70. Such a situation can be avoided. Therefore, the operator can reach the suture thread introduction needle 70 only by inserting the suture thread 1 from the first hollow member 41 when setting the suture thread 1 to the suture instrument 100. . As a result, the operation burden on the operator can be further reduced, and it is possible to avoid a situation in which the suture 1 is bent in the housing 50 and does not reach the suture introduction needle 70.

  In the above embodiment, the case where the suturing tool 100 is used repeatedly has been described as an example. However, the suturing tool 100 is not necessarily used repeatedly. That is, the suture thread 1 having a length corresponding to one procedure may be inserted so that the suture tool 100 is not repeatedly used.

  DESCRIPTION OF SYMBOLS 1 Suture thread, 10 Operation part, 20 Support rod, 21 Flat plate part, 22 Groove, 30 Loop feed back mechanism, 31 Loop feed back part, 31a Tip part, 31b Base end part, 31c Side wall part, 32 1st elastic member, 32a Base end portion, 33 First contact portion, 34 receiving portion, 40 Suture feed mechanism, 41 First hollow member, 42 Second hollow member, 43 Third hollow member, 44 Suture fastening member, 45 Suture feed Part, 45a second contact part, 45b side wall extension part, 45c main body part, 45d mounting part, 46 second elastic member, 47 movement restricting member, 50 housing, 51a stopper, 51b stopper, 52 support part, 53 support part 54, distal end inner wall surface, 55 guide hole, 56 collar, 57a proximal end inner wall surface, 57b proximal end inner wall surface, 60 loop introduction needle, 70 suture introduction needle, 8 DESCRIPTION OF SYMBOLS 0 Loop formation part, 81 Bar-shaped axial part, 82 Loop, 83 Base end side fixing | fixed part, 100 Suture tool, 101 Abdominal wall, 102 Visceral wall, 103 Skin.

Claims (5)

A housing;
A loop introduction needle provided on the distal end side of the housing;
A suture introduction needle that is provided on the distal end side of the housing at a predetermined distance from the loop introduction needle and is substantially parallel to the suture introduction needle;
A loop is formed at the tip, and a loop forming portion inserted movably into the loop introduction needle;
A loop feed back mechanism that is provided in the housing and moves the loop forming portion;
A suture feed mechanism provided in the housing and delivering the suture;
An operation portion provided in the housing so as to protrude from the housing and operating the loop feed-back mechanism and the suture feed mechanism;
The suture feed mechanism is provided with means for guiding the inserted suture to the suture introduction needle in a substantially straight state,
The movement of the operation portion toward the distal end side is transmitted to the loop sending back mechanism, and the loop is sent out from the tip of the loop introduction needle,
The movement of the operation portion toward the distal end side is transmitted to the suture feed mechanism simultaneously with the loop feed back mechanism or after the loop starts to be fed, and the suture is fed from the distal end of the suture introduction needle. A medical suturing device. The suture feed mechanism is
A first hollow member fixed at least on the proximal end side of the housing and into which the suture is inserted;
A suture feed section to which movement of the operation section toward the distal end side is transmitted;
A second hollow member having a hollow portion through which the first hollow member can be inserted, and the movement of the operation portion being transmitted through the suture feed portion;
A third hollow member fixed at least on the distal end side of the housing and interposed between the suture introduction needle and the second hollow member, and the suture is inserted and guides the second hollow member; ,
A suture fastening member that is attached to the suture feed section and tightens the first hollow member, the suture thread, or the second hollow member according to the position of the suture feed section;
In the suture feed mechanism,
The movement of the operation portion toward the distal end side is transmitted, the suture fastening member starts moving toward the distal end side together with the suture feed portion, and the second hollow member is pushed by the suture fastening member. It moves to the distal end side while being guided by the third hollow member, and the suture fastening member pulls out from the first hollow member while pressing the second hollow member, tightens the suture, and has already been delivered or delivered. The medical suturing device according to claim 1, wherein the suture is fed out from a distal end of the suture introduction needle so as to be inserted into the loop that has started to be inserted. The inner diameter of the second hollow member is larger than the outer diameter of the first hollow member, and the inner diameter of the third hollow member is larger than the outer diameter of the second hollow member. 2. The medical suturing device according to 2. The suture fastening member is
The second hollow member is formed with a movement regulating member formed on the inner wall surface of the housing until the distal end of the second hollow member abuts against the distal end side of the housing or the movement of the second hollow member is regulated. 1 Move until it hits the stopper,
4. The medical suturing device according to claim 2, wherein when the second hollow member is stopped, the second hollow member rides on the second hollow member to release the tightening of the suture thread. Providing a second stopper against which the movement restricting member abuts a part of a side surface of the housing;
After the movement restricting member moves to the proximal end and hits the second stopper, the suture fastening member comes out of the second hollow member and tightens the first hollow member again. The medical suturing device according to any one of claims 2 to 4, wherein the medical suturing device can be continuously used by returning to an initial state while maintaining an untightened state.

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