JP2017169941A - Suture equipment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide suture equipment enabling tissues to be more easily sutured in a short period of time.SOLUTION: The suture equipment is provided that comprises: a rear side arm 12 having needle-like members 15, 16; a front side arm 11 which is provided so as to be approachable to and separable from the rear side arm 12 and comprises accommodation spaces 18, 19 into which the needle-like members 15, 16 are inserted; engaging members 21, 21 accommodated in the accommodation spaces 18, 19 of the rear side arm 12 and engageable with the needle-like members 15, 16; a suture instrument 20 having a suture thread 22; arm moving means 13 for moving the front side arm 11 and the rear side arm 12 toward and away from each other; and a connection mechanism 30 for connecting the front side arm 11 and the rear side arm 12 to the arm moving means 13. The connection mechanism 30 comprises: a slide mechanism 40 having a base part 42 provided in the rear side arm 12, and a slide 41 provided movably relative to the base part 42; and a connection piece 31 for detachably connecting the front side arm 11 to the slide 41 of the slide mechanism 40.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a suturing device. More specifically, the present invention relates to a suturing device that is attached to an endoscope and used for suturing tissue in the digestive tract.

  Conventionally, when a tumor or the like is formed in a digestive tract such as a stomach, the removal is generally performed by a surgical operation. In recent years, a laparoscope operation has been performed as a minimally invasive operation that can reduce the burden on the patient and reduce the damage formed on the body surface compared to the surgical operation.

  Recently, a surgery using a flexible endoscope is performed as a less invasive surgery than a surgery using a laparoscope. In the case of early gastric cancer or the like in which the cancer remains in the mucosal layer, the cancer can be excised by peeling the lumen from the digestive tract to the submucosal layer including the mucosal layer with a flexible endoscope. In this case, since the operation can be performed without leaving any wound on the body surface, the burden on the patient is small, and the recovery after the operation is accelerated.

  On the other hand, in the case of a tumor deeper than the submucosa formed in the stomach wall, that is, a tumor that has reached the proper muscle layer, the proper muscle layer must be removed. In this case, when the tumor is removed, an opening is formed in the stomach wall. Therefore, it is necessary to close (sew) the opening after removing the tumor. However, since the opening cannot be closed only with a flexible endoscope, an operation using a flexible endoscope and a laparoscope is also performed. Specifically, a stomach wall tumor is excised with a soft endoscope, and an operation after the tumor is removed is sutured with a laparoscope.

  Surgery using a flexible endoscope and a laparoscope is less invasive compared to surgery, but still requires a hole to be inserted into the abdominal cavity. If a flexible endoscope can be used not only for excision of the tumor but also for suturing from the digestive tract cavity, surgery can be performed without forming a wound on the body surface. For this reason, at present, development of a suture instrument that can be attached to a flexible endoscope that can suture an opening from the inside of the digestive tract cavity has been promoted (for example, Patent Document 1).

  If the suturing device of this patent document 1 is used, the end surface of the opening formed when the tumor is excised can be brought into contact with each other, so that a suturing equivalent to a suturing by a surgical operation can be realized. Moreover, if the suturing device of patent document 1 is used, not only the opening which excised the tumor but also various holes formed in the digestive tract can be sutured and closed.

Japanese Patent No. 5294181

  By the way, in the case of the suturing device of Patent Document 1, since a pair of engaging members are set on the front arm of the suturing device, one stitch is sewn in one operation. When one stitch is sutured, the flexible endoscope is temporarily removed from the digestive tract, a new pair of engaging members are set, and the next stitching is performed.

  When setting a pair of engaging members, in order to reliably engage the pair of engaging members and the suture needle when operating the suturing device, the pair of engaging members are placed in a predetermined posture in the pair of accommodating portions. It must be arranged so that However, since the pair of engaging members is very small and the accommodating portion is small, it takes some skill and time to set a new pair of engaging members. For this reason, even if a single stitching operation itself can be performed quickly, it takes a certain amount of time to set the pair of engaging members. Therefore, the total time for stitching the opening increases as the number of stitches increases. The influence of the time for setting the engaging member increases. In addition, it is possible to prepare a plurality of suturing devices in which the engaging members are set in advance so that it is not necessary to set the engaging members at the time of surgery, but the entire suturing device is removed from the flexible endoscope. It takes a considerable amount of time to attach another suturing device.

  If the time for setting the pair of engaging members can be shortened, the entire time for suturing the opening can be shortened even when a plurality of stitches must be sewn. Therefore, development of a suturing device that can shorten the time for setting a pair of engaging members is desired.

  In view of the circumstances described above, an object of the present invention is to provide a suturing device that can perform tissue suturing more easily and in a short time.

A suturing device according to a first aspect of the present invention is provided with a rear arm having a needle-like member and an accommodation space into which the needle-like member is inserted when the rear arm is approached and separated from the rear arm. A suturing instrument comprising: a front arm provided; an engagement member engageable with the needle-like member housed in a housing space of the front arm; and a suture thread; and the front arm and the rear arm. Arm moving means for approaching and separating, and a connecting mechanism for connecting the front arm and the rear arm to the arm moving means, the connecting mechanism comprising a base portion provided on the rear arm; A slide mechanism that is movably connected to the base portion provided on the front arm, and the front arm moves the arm directly or through a slide of the slide mechanism. Characterized in that it is detachably connected to the stage.
The suturing device of the second invention is provided with a rear arm having a needle-like member, and an accommodation space into which the needle-like member is inserted when the rear arm is approached and separated from the rear arm. A suturing instrument comprising: a front arm provided; an engagement member engageable with the needle-like member housed in a housing space of the front arm; and a suture thread; and the front arm and the rear arm. Arm moving means for approaching and separating, and a connecting mechanism for connecting the front arm and the rear arm to the arm moving means, the connecting mechanism comprising a base portion provided on the rear arm; A slide mechanism having a slide movably connected to the base portion provided on the front arm, and a rear arm connection detachably connecting the base portion of the slide mechanism and the arm moving means. And With which, the front arm via a slide directly or the slide mechanism, characterized in that it is detachably connected to the arm moving means.
According to a third aspect of the present invention, in the first or second aspect of the invention, the front arm is connected to the arm moving means via a slide of the slide mechanism, and the connection mechanism slides the front arm to the slide. A front arm connecting portion that is detachably connected to the slide of the mechanism is provided.
According to a fourth aspect of the present invention, in the first, second or third aspect of the invention, the arm moving means is disposed in the sheath connected to the base portion of the slide mechanism, and the front arm or the A wire portion connected to the slide of the slide mechanism, and a through-hole penetrating the base portion is formed in parallel with a direction in which the front arm and the rear arm approach and separate from each other. The wire portion is connected to the front arm or the slide of the slide mechanism through a hole.
According to a fifth aspect of the present invention, in the fourth aspect of the invention, the slide of the slide mechanism includes a cylindrical member that is inserted into a through hole that penetrates the rear arm, and the cylindrical member includes the wire portion. It is connected with the front-end | tip of.
According to a sixth aspect of the present invention, in the fourth aspect of the invention, the rear arm connecting portion includes a connecting piece that is inserted into a through-hole penetrating the rear arm and connects the distal end of the sheath and the rear arm. The connecting piece is detachably connected to the rear arm.

According to the first invention, since the front arm is detachably connected to the arm moving means directly or through the slide of the slide mechanism, only the front arm or the front arm can be detached from the rear arm together with the slide. Can do. Therefore, if the front arm is removed after the suturing operation is completed, the next suturing operation can be performed only by attaching another front arm on which the engaging member is already set. Then, compared with the case where the engaging member is set in the accommodating portion one by one or when the entire suturing apparatus is detached and replaced, the time until the next suturing is performed after one suturing is completed is shortened. Can do. Therefore, it is possible to shorten the time for the entire suturing operation.
According to the second invention, since the front arm is detachably connected to the arm moving means directly or through the slide of the slide mechanism, only the front arm or the front arm is attached to and detached from the rear arm together with the slide. be able to. Therefore, if the front arm is removed after the suturing operation is completed, the next suturing operation can be performed only by attaching another front arm on which the engaging member is already set. Further, since the rear arm is detachably connected to the arm moving means by the rear arm connecting portion of the connecting mechanism, both the front arm and the rear arm can be attached to and detached from the arm moving means. Therefore, after the suturing operation is completed, the next suturing operation can be performed only by removing the portion in front of the rear arm and attaching a new one. Then, compared with the case where the engaging member is set in the accommodating portion one by one or when the entire suturing apparatus is detached and replaced, the time until the next suturing is performed after one suturing is completed is shortened. Can do. Therefore, it is possible to shorten the time for the entire suturing operation. In addition, if a ligation member to be installed on the rear arm of the suturing device is provided, if the ligation member is set in the rear arm in advance, a part before the rear arm is removed and a new one is attached. A ligating member can also be set. Therefore, since the time for setting the ligating member can be omitted, the time for the suturing operation can be shortened.
According to the third invention, the front arm is detachably coupled to the slide of the slide mechanism by the front arm coupling portion of the coupling mechanism. Therefore, even if a slide is provided so as to be slidable with respect to the base member but cannot be separated from the base member, the front arm can be detached from the rear arm. Then, even if the front arm can be attached to and detached from the rear arm, the movement of the front arm and the rear arm approaching and separating can be maintained in a stable state.
According to the fourth invention, since the wire portion is connected to the slide through the through hole penetrating the base portion, the connection between the wire portion and the slide can be realized with a simple structure.
According to the fifth aspect, since the cylindrical member connected to the slide is inserted into the through-hole penetrating the rear arm, the wire portion can be prevented from becoming an obstacle during the movement of the slide. In addition, since the cylindrical member also serves as a guide when the slide moves, the movement of the slide can be stabilized.
According to the sixth aspect, since the sheath and the base portion are connected via the connecting piece, the operation of connecting the base portion to the sheath is simplified.

1 is a schematic perspective view of a suturing device 10 of the present embodiment in a state attached to a shaft 2 of an endoscope 1. FIG. It is the perspective view which looked at the suturing device 10 of this embodiment in the state attached to the shaft 2 of the endoscope 1 from diagonally downward. It is the perspective view which looked at the suturing device 10 of this embodiment in the state attached to the shaft 2 of the endoscope 1 from the back. It is a single-piece | unit perspective view of the suturing device 10 of this embodiment. It is a fragmentary sectional view of suturing device 10 of this embodiment. (A) is a VIA-VIA line sectional view of Drawing 5, (B) is a VIB-VIB line sectional view of Drawing 5. It is a schematic explanatory drawing of the accommodating part 17 in the front arm 11 of this embodiment. It is a schematic explanatory drawing of the suturing operation | work by the suturing device 10 of this embodiment. FIG. 2 is a schematic perspective view showing a state in which the front arm 11 and the rear arm 12 are separated from each other, in which (A) is the rear arm 12 and (B) is the front arm 11. It is a single figure of the front arm 11, (A) is a schematic sectional drawing, (B) is a top view. It is a single figure of the rear arm 12, (A) is a schematic sectional drawing, (B) is a bottom view. FIG. 3 is a schematic perspective view of the ligating member 50 attached to the needle-like member 14 of the suturing device 10. These are the schematic explanatory drawings of the ligation operation | work by the ligation member 50. FIG. It is a schematic explanatory drawing of the suturing device 10 of other embodiment. (A) is a schematic explanatory drawing of the back side arm 1 in the suturing device 10 of other embodiment, (B) is a schematic explanatory drawing of the slide 41. FIG.

Next, an embodiment of the present invention will be described with reference to the drawings.
The suturing device of the present invention is a device that is attached to a flexible endoscope and performs suturing from the digestive tract cavity, and is characterized in that suturing can be performed easily and quickly.

  The suturing device of the present invention can be used not only for a flexible endoscope but also attached to the distal end of a laparoscope. In particular, when the suturing device of the present invention is used with a flexible endoscope, full-layer stitching of tissue is performed in the digestive tract cavity even when no opening or through-hole is formed in the digestive tract. it can. The full-layer suture means that a suture is sutured so as to penetrate all layers of the digestive tract (serosa, serosa lower layer, intrinsic muscle layer, submucosa, mucous membrane).

Below, the case where the suturing device 10 of this embodiment is attached to a flexible endoscope and used is demonstrated as a representative.
In addition, in order to make the structure of each part of the apparatus easy to understand, the relative size of each part in each drawing does not necessarily correspond to the size in the actual apparatus.

(Description of endoscope 1)
In FIG. 1, the code | symbol 2 has shown the shaft of the endoscope 1 to which the suturing device 10 of this embodiment is attached. The endoscope 1 to which the suturing device 10 of this embodiment is attached is a flexible endoscope used for general endoscopic surgery. As long as the shaft 2 of this endoscope is used by being inserted into the digestive tract of a living body, the diameter, length, material, and the like are not particularly limited. For example, the diameter of the shaft 2 is about 10 mm in a general endoscope, but may be about 5 to 15 mm. The length of the shaft 2 is about 1200 mm in a general endoscope, but may be about 1200 to 3000 mm.

  Next, each part of the suturing device 10 of this embodiment will be described.

First, the arm moving means 13 will be described.
As shown in FIGS. 1 to 4, the arm moving means 13 is a long member extending along the axial direction, and is attached to the shaft 2 of the endoscope 1. The length of the arm moving means 13 is not particularly limited as long as it is approximately the same length as the length of the shaft 2 of the endoscope 1.

  A cylindrical fixing portion 13 d is provided at the tip of the arm moving means 13. By inserting the distal end portion of the shaft 2 of the endoscope 1 into the cylindrical fixing portion 13d, the distal end of the arm moving means 13 is fixed to the distal end portion of the shaft 2 of the endoscope 1.

  Further, the arm moving means 13 is fixed so that the arm moving means 13 extends along the shaft 2 from the tip of the arm moving means 13 to the hand side. For example, the arm moving means 13 can be fixed to the shaft 2 by a belt-shaped member made of polyethylene, polyvinyl chloride, aluminum or the like, or a ring-shaped fastener made of polyethylene, polyvinyl chloride, metal or the like. .

  The arm moving means 13 is formed of a material having such a degree of flexibility that it can be deformed following the bending of the shaft 2 while being fixed to the shaft 2. That is, the arm moving means 13 is formed to have a strength that does not hinder the operation of the endoscope 1 even when attached to the shaft 2 of the endoscope 1.

  The method for fixing the arm moving means 13 to the shaft 2 is not particularly limited, and any method can be used as long as it can be fixed so as not to prevent deformation such as bending of the shaft 2.

  Specifically, the arm moving means 13 includes a sheath 13a, a wire portion 13b inserted into the sheath 13a, and a tube 13c through which the sheath 13a is inserted.

  The tube 13c is a cylindrical member in which a through hole is formed from the distal end to the proximal end, and the tube 13c is fixed to the shaft 2 by a belt-like member or the like as described above. Although the material of this tube 13c is not specifically limited, For example, it is preferable that it is formed with resin, such as polyethylene and polyvinyl chloride.

  A sheath 13a is inserted into the tube 13c. The sheath 13a is a hollow tube-like member, and is inserted into the tube 13c so as to be movable along the axial direction of the tube 13c and to be rotatable within the tube 13c. The material of the sheath 13a is not particularly limited, but it can be deformed following the bending of the shaft 2 (in other words, the bending of the tube 13c), but has a strength that does not easily stretch or bend even when a force is applied in the axial direction. It is desirable that it is formed. For example, a metal coil tube formed of stainless steel or a nickel titanium alloy or a resin tube reinforced with a reinforcing material is preferable. The proximal end portion of the rear arm 12 is fixed to the distal end of the sheath 13a (see FIG. 5). On the other hand, the base end of the sheath 13a extends to the vicinity of the operating portion that operates the shaft 2. Therefore, by moving the proximal end of the sheath 13a of the arm moving means 13, the length of the sheath 13a protruding from the distal end of the tube 13c can be changed. In other words, the rear arm 12 can be moved relative to the shaft 2 along the axial direction of the shaft 2. Further, by rotating the proximal end of the sheath 13a, the rear arm 12 can be rotated around the central axis of the sheath 13a. A connecting piece 33 is provided at the distal end of the sheath 13a, and the reason will be described later.

  The wire portion 13b is, for example, a metal wire or the like, and can be deformed following the bending of the shaft 2 (in other words, the bending of the sheath 13a). The wire portion 13b is provided so as to be movable in the sheath 13a along the axial direction and rotatable in the sheath 13a. An insertion member 32 is provided at the distal end of the wire portion 13b, and the insertion member 32 is connected to the proximal end of the front arm 11 via a slide mechanism 40 described later (see FIG. 5). On the other hand, the proximal end of the wire portion 13 b extends to the vicinity of the operation portion that operates the shaft 2. Therefore, by moving the proximal end of the wire portion 13b of the arm moving means 13, the length of the wire portion 13b protruding from the distal end of the sheath 13a can be changed. In other words, the front arm 11 can be moved relative to the rear arm 12 along the axial direction of the shaft 2. Further, when the rear arm 12 and the front arm 12 can rotate with each other, the front arm 12 is rotated relative to the rear arm 12 by rotating the proximal end of the wire portion 13b. be able to.

  Since the configuration is as described above, if the proximal end of the sheath 13a and the proximal end of the wire portion 13b of the arm moving means 13 are operated to move the sheath 13a and the wire portion 13b along the axial direction, the front arm 11 And the rear arm 12 can be moved. That is, the relative positions of the front arm 11 and the rear arm 12 can be changed with respect to the front end surface 2 s of the shaft 2. For example, if the sheath 13a and the wire 13b are moved in the same direction by the same amount, the front arm 11 and the rear arm 12 can be moved in the same direction by the same amount with respect to the tip surface 2s of the shaft 2.

  Moreover, since the sheath 13a and the wire portion 13b can be moved independently, the front arm 11 and the rear arm 12 can be moved closer to and away from each other. For example, if the movement of the wire portion 13 b is fixed and the sheath 13 a is moved, the rear arm 12 can be moved closer to and away from the front arm 11. Conversely, if the movement of the sheath 13 a is fixed and the wire portion 13 b is moved, the front arm 11 can be moved closer to and away from the rear arm 12.

  The outer diameter of the arm moving means 13 (that is, the outer diameter of the tube 13c) is such that the endoscope 1 to which the suturing device 10 of the present embodiment is attached can be inserted into the digestive tract (or into the overtube). There is no particular limitation as long as it is. For example, the outer diameter of the arm moving means 13 is preferably such that the combined diameter of the arm moving means 13 and the shaft 2 is about 11 to 15 mm, and more preferably about 11 to 14 mm.

(Coupling mechanism 30)
As shown in FIGS. 5 and 6, a pair of front and rear arms 11 and 12 are connected to the tip of the arm moving means 13, and the pair of front and rear arms 11 and 12 are connected to the arm moving means 13 by a connecting mechanism 30. Has been. The coupling mechanism 30 includes a slide mechanism 40, and the slide mechanism 40 fixes the mutual rotation in a plane perpendicular to the direction in which the front arm 11 and the rear arm 12 can approach and separate and both approach and separate. It has a structure that can be connected to the state.

  Specifically, a base member 42 of a substantially shaft-like slide mechanism 40 having a substantially square cross section is provided at the proximal end of the rear arm 12. A slide 41 connected to the front arm 11 is engaged with the base member 42. The slide 41 is provided with an engaging groove 41g, and the inner surface of the engaging groove 41g is in a state of being substantially in surface contact with the outer surface of the base member 42 (or in a state in which a portion that is substantially in surface contact is formed). (See FIG. 6).

  Since the structure is as described above, the inner surface of the engagement groove 41g formed on the slide 41 of the slide mechanism 40 is substantially in surface contact with the outer surface of the base member 42 when the pair of front and rear arms 11 and 12 approach and separate. Move with. Therefore, when the front arm 11 and the rear arm 12 approach and separate from each other, the front arm 11 does not rotate with respect to the rear arm 12 (that is, a state in which mutual rotation in a plane perpendicular to the approach and separation direction is fixed). Can be moved).

(Description of the pair of front and rear arms 11 and 12)
Next, the pair of front and rear arms 11 and 12 will be described.

(About the rear arm 12)
First, the rear arm 12 will be described.
As shown in FIG. 5, the rear arm 12 has a substantially strip shape, and the front surface 12a and the back surface 12b are formed on a flat surface parallel to each other. The strip shape here means that the width is short with respect to the length and the thickness is also short with respect to the length, and is slightly curved along the length direction (see FIG. 1 to FIG. 4) and a concept including both straight lines along the length direction.

  The distal end of the aforementioned sheath 13 a is connected to the proximal end of the rear arm 12. Specifically, the connection piece 33 provided at the distal end of the sheath 13a is connected to the connection pipe 42p provided in the base member 42 of the connection mechanism 30 connected to the proximal end portion of the rear arm 12. When the connecting pipe 42p and the connecting piece 33 are connected, the connecting pipe 42p is provided so that the extension line of the central axis of the sheath 13a at that position and the front surface 12a and the back surface 12b of the rear arm 12 are orthogonal to each other. Hereinafter, the direction of the central axis of the sheath 13a at the portion where the connecting pipe 42p and the connecting piece 33 are connected may be simply referred to as the central axis of the sheath 13a.

(Suture needle portion 14)
On the other hand, a suture needle portion 14 is provided at the distal end portion of the rear arm 12. The suture needle portion 14 includes a pair of needle-like members 15 and 16 that are arranged along the axial direction of the rear arm 12. Each of the pair of needle-like members 15 and 16 has a shaft portion b and a portion (a twist-shaped portion a) provided at the tip of the shaft portion b and having a larger outer diameter than the tip. The edge-shaped part a is formed so that the outer diameter of the base end is larger than the outer diameter of the distal end of the shaft part b, and a step is formed at the connecting part with the shaft part b. As will be described later, when the pair of needle-like members 15, 16 are engaged with the pair of engagement members 21, 21, the twist-like portion a is formed from the pair of needle-like members 15, 16. It has a role which prevents 21 and 21 falling off.

  The pair of needle-like members 15 and 16 of the suturing needle portion 14 are both in a state in which the tip thereof is directed to the front arm 11 and the axial direction thereof is orthogonal to the front surface 12a of the rear arm 12. 12 is attached. In other words, each of the pair of needle-like members 15 and 16 is attached to the rear arm 12 so that the central axis thereof is substantially parallel to the axial direction of the base member 42 (that is, the central axis of the sheath 13a).

(For the front arm 11)
As shown in FIG. 5, the front arm 11 has a substantially strip shape, and the front surface 11a and the back surface 11b are formed on a flat surface parallel to each other. The front arm 11 is formed substantially in the same shape as the rear arm 12. The base end portion of the front arm 11 is connected to the slide 41 of the slide mechanism 40 described above.

The tip of the wire portion 13b is connected to the slide 41. Specifically, the wire portion 13b is inserted into a through hole 42h (a space in the connecting pipe 42p) that penetrates the base member 42 of the rear arm 12, and the insertion member 32 provided at the tip of the wire portion 13b. Are connected to a cylindrical connecting member 41 s fixed to the slide 41.
A suture accommodating pipe 11p fixed to the front arm 11 is inserted into the cylindrical connecting member 41s. The suture accommodation pipe 11p accommodates the suture 22 of the suture instrument 20.

  A housing portion 17 having a pair of housing spaces 18 and 19 is formed at the distal end portion of the front arm 11 (see FIG. 6). As shown in FIG. 7, the pair of housing spaces 18 and 19 of the housing portion 17 are through holes that penetrate between the front surface 11 a and the back surface 11 b of the front arm 11. Each of the pair of accommodating spaces 18 and 19 is formed such that the central axis thereof is parallel to the direction in which the pair of front and rear arms 11 and 12 approach and separate (that is, the direction parallel to the central axis of the sheath 13a). . Each of the pair of storage spaces 18 and 19 is formed with a slit communicating with the side surface of the front arm 11, and a suture 22 of a suturing instrument 20 to be described later passes through the slit into the pair of storage spaces 18 and 19. You can go in and out.

  The pair of housing spaces 18 and 19 are stepped holes whose inner diameter on the back surface 11b side (large diameter portion a) is larger than the inner diameter on the front surface 11a side (small diameter portion b). And each accommodation space 18 and 19 is formed so that the internal diameter of the small diameter part b may become larger than the outer diameter of the edge-shaped part a, The reason formed in this shape is mentioned later.

  The pair of housing spaces 18 and 19 are provided so that their central axes are substantially coaxial with the central axes of the pair of needle-like members 15 and 16, respectively.

  Since it is the above structure, if the pair of front and rear arms 11 and 12 are brought close to each other, the twisted portions a of the pair of needle-like members 15 and 16 can be inserted into the pair of accommodating spaces 18 and 19, respectively. .

  The central axis of the pair of receiving spaces 18 and 19 and the central axis of the pair of needle-like members 15 and 16 are substantially coaxial, respectively, when the pair of front and rear arms 11 and 12 are brought close to each other. , 19 is allowed to be displaced so that the pair of needle-like members 15, 16 of the suture needle portion 14 can be inserted.

  In the above example, the front and back surfaces of the front arm 11 and the rear arm 12 are flat surfaces. However, the front and rear surfaces of the front arm 11 and the rear arm 12 are not necessarily flat surfaces.

  Further, the position at which the pair of needle-like members 15 and 16 are provided on the rear arm 12 is not particularly limited. However, if the size of the rear arm 12 is within a range that does not hinder insertion into the body, the distance between the pair of needle-like members 15 and 16 and the slide mechanism 40 should be some distance away. There is an advantage that the distance from the edge to the stitching position can be increased. From this viewpoint, the rear arm 12 and the front arm 11 from the position of the slide mechanism 40 (in other words, the position where the front arm 11 and the rear arm 12 are connected to the arm moving means 13) to the needle-like member 15 are The distance L (see FIG. 5) along the plane perpendicular to the approaching and separating direction is preferably 5 mm or more, and more preferably 10 to 20 mm.

  Further, the material, length, and shaft diameter of the pair of needle-like members 15 and 16 are not particularly limited. Specifically, the pair of needle-like members 15 and 16 can pierce the target to be stitched and penetrate the target, and can be pulled out of the target by moving the target in the reverse direction. Any material having a certain length and strength may be used. For example, when the stomach wall is sutured by the suturing device 10 of the present embodiment, the length may be any length from the front surface of the rear arm 12 to the tip thereof so as to penetrate the stomach wall. The metal is preferable in terms of strength. More specifically, the length H (see FIG. 5) from the tip of the pair of needle-like members 15 and 16 to the front surface of the rear arm 12 is preferably about 7 to 20 mm, and more preferably about 7 to 10 mm. Further, the shaft diameter of the pair of needle-like members 15 and 16 is preferably about 1 to 2 mm as the shaft diameter of the tip portion of the shaft portion b (the connecting portion with the handle portion a), and the maximum diameter of the handle portion a. Is preferably about 0.1 to 1 mm larger than the shaft diameter of the tip of the shaft portion b.

(About the suture instrument 20)
Further, as shown in FIG. 7, the suturing device 10 of this embodiment includes a suturing instrument 20. The suturing instrument 20 includes a pair of engaging members 21 and 21 formed in an annular shape, and a suture thread 22 that connects the pair of engaging members 21 and 21.

  The pair of engaging members 21, 21 of the suturing instrument 20 are respectively disposed in the pair of housing spaces 18, 19 of the housing portion 17 of the front arm 11.

  When the pair of engaging members 21 and 21 are disposed in the pair of receiving spaces 18 and 19, the through holes that pass through the front and back of the pair of engaging members 21 and 21 are holes that pass through the small diameter portion b of the pair of receiving spaces 18 and 19. It is formed in a size that can be arranged above. Specifically, the pair of engaging members 21, 21 is formed so that the outer diameter is smaller than the inner diameter of the large-diameter portion a of the pair of housing spaces 18, 19 and larger than the inner diameter of the small-diameter portion b ( (See FIG. 7B). That is, when the pair of engaging members 21 and 21 are disposed in the pair of housing spaces 18 and 19, there is only a slight gap between the outer edges of the pair of engaging members 21 and 21 and the inner surface of the large-diameter portion a. The pair of engaging members 21 and 21 are formed in such a size that they are not formed.

  And although the through-hole 21h of a pair of engaging members 21 and 21 can insert the twist-like part a of a pair of needle-like members 15 and 16, when the twist-like part a completely penetrates the through-hole 21h. The pair of engaging members 21 and 21 are formed so as not to fall out from the pair of needle-like members 15 and 16. Specifically, the pair of engaging members 21, 21 has an inner diameter smaller than the outer diameter of the twisted portion a of the pair of needle-like members 15, 16, but the shaft portion b of the pair of needle-like members 15, 16. It is formed so that it may become larger than the shaft diameter of the front-end | tip (namely, connection part with the twist-like part a).

  The material of the pair of engaging members 21 and 21 is not particularly limited. However, even if the through-hole 21h as described above is formed, the state where the pair of needle-like members 15 and 16 are engaged with each other can be maintained while the twisted portions a of the pair of needle-like members 15 and 16 are inserted. A material having various properties is preferable. That is, it is desirable that the pair of engaging members 21 and 21 be formed of a material that can be elastically deformed to some extent. For example, if a metal plate, a shaft member, or the like is used, the pair of engaging members 21 and 21 having the above-described properties can be formed.

(Outline of operation of suturing device 10 of this embodiment)
Since it is the above structure, in the suturing device 10 of this embodiment, if the arm moving means 13 is operated and the front arm 11 and the rear arm 12 are made to approach, a pair of needle-like members 15 and 16 will be made simultaneously. It can be inserted into the pair of receiving spaces 18 and 19.

  Then, the twisted portions a of the pair of needle-like members 15 and 16 can be simultaneously inserted into the pair of engaging members 21 and 21 of the suturing instrument 20 disposed in the pair of accommodating spaces 18 and 19. Then, if the front arm 11 and the rear arm 12 are brought close to each other until the entire handle portion a of the pair of needle-like members 15 and 16 is inserted into the small diameter portion b of the pair of accommodating spaces 18 and 19, a pair of needles The shaped members 15 and 16 can be passed through the pair of engaging members 21 and 21 up to the shaft portion b.

  In this state, if the arm moving means 13 is operated to separate the front arm 11 and the rear arm 12 from each other, the pair of engaging members 21 and 21 together with the pair of needle-like members 15 and 16 are paired with the accommodating space. 18 and 19 can be separated. The suture thread 22 can be detached from the pair of storage spaces 18 and 19 through the slits described above.

  Then, since the pair of engaging members 21 and 21 are engaged with the pair of needle-like members 15 and 16, the pair of needle-like members 15 are connected by the suture thread 22 that connects the pair of engaging members 21 and 21. 16 can be connected to each other (see FIG. 8C).

  Therefore, according to the suturing device 10 of the present embodiment, the suture thread can be obtained by moving the front arm 11 and the rear arm 12 close to and away from each other only once with the object placed between the front arm 11 and the rear arm 12. 22 can be passed through the object so that both ends are located on the same side of the object. In other words, the suture 22 can be passed through the object so that the portion between both ends of the suture 22 is caught by the object (see FIG. 8C).

(Suture of a living body by the suturing device 10 of the present embodiment)
Since it has the configuration as described above, if the suturing device 10 of this embodiment is attached to the shaft 2 of the endoscope 1, tissue such as the stomach wall can be sutured from the inside of the stomach.

  Hereinafter, a suturing operation in which the suturing apparatus 10 according to the present embodiment is used for suturing in a state in which the stomach wall is inverted will be described with reference to FIG. In FIG. 8, the description of the configuration is appropriately deleted in order to make the movement easy to understand.

  First, the shaft 2 of the endoscope 1 to which the suturing device 10 of this embodiment is attached is inserted into the stomach. Then, the stomach wall at the site to be sutured is recessed inward by a method such as drawing inward with an endoscopic forceps inserted through the endoscope to form a protruding portion (protrusion PP) inside the stomach. .

  In this state, the arm moving means 13 is operated to separate the front arm 11 from the rear arm 12. Then, a gap is formed between the distal ends of the pair of needle-like members 15 and 16 of the suture needle portion 14 and the back surface 11b of the front arm 11 so as to sandwich the protruding portion PP. In this state, the shaft 2 is operated, and the protrusion PP is disposed in the gap between the distal ends of the pair of needle-like members 15 and 16 of the suture needle 14 and the back surface 11b of the front arm 11 (FIG. 8A). )).

  Then, the arm moving means 13 is operated to move the rear arm 12 toward the front arm 11 with the movement of the front arm 11 fixed. Then, the pair of needle-like members 15 and 16 of the suture needle portion 14 penetrates the protrusion PP, and the tips thereof are inserted into the pair of accommodating spaces 18 and 19, so that the pair of needle-like members 15 and 16 are twisted. The part a can be engaged with the pair of engaging members 21 and 21 of the suturing instrument 20 (FIG. 8B).

  In FIG. 8B, the case where the rear arm 12 is brought close to the front arm 11 when the rear arm 12 and the front arm 11 are brought close to each other has been described. You may make it approach, You may move both together and you may make both approach.

  When the pair of engaging members 21, 21 are engaged with the twisted portions a of the pair of needle-like members 15, 16, the arm moving means 13 is operated to separate the rear arm 12 from the front arm 11. At this time, the pair of needle-like members 15 and 16 return to their original positions through the holes penetrating the protrusion PP. Then, the pair of engaging members 21 and 21 to which both ends of the suture thread 22 are fixed are both positioned on one side (the upper side in FIG. 8C) of the protrusion PP. Then, a ring is formed by the suture thread 22 from the needle-like member 15 through the protrusion PP and exiting to the opposite side of the needle-like member 15 and then passing through the protrusion PP and returning to the needle-like member 16 (see FIG. 8 (C)).

  When the loop of the suture thread 22 is formed as described above, the suture thread 22 is ligated in a state where the opposing wall surfaces of the projecting portion PP are in contact with each other. Specifically, in the suture thread 22, a portion extending from the needle-like member 15 (that is, one engagement member 21) toward the protrusion PP, and the needle-like member 16 (that is, the other engagement member 21). The part extending toward the protrusion PP is ligated.

  Finally, in the suture 22, if the portions located on the pair of needle-like members 15, 16 side from the ligated portion are cut, the opposing wall surfaces of the projecting portion PP can be fixed in contact with each other. is there.

  A commercially available clip or the like can be used for ligating the suture thread 22. For example, if a clip or the like is supplied from the forceps opening of the endoscope 1 and attached to the suture thread 22, ligation can be performed. Moreover, you may ligate with the ligation member described in the Japan patent 5294181, and the ligation member which has a function equivalent to this ligation member.

  For example, the case where the ligation member (henceforth only the ligation member 50) which has a function equivalent to the ligation member described in the Japan patent 5294181 has a structure as shown in FIG. 12 is demonstrated.

As shown in FIG. 12, the ligating member 50 includes a hollow tubular member 51 and a linear member 52 inserted through the tubular member.
The linear member 52 is formed in a ring shape and is inserted through the tubular member 51. One end portion of the linear member 52 projects toward one end side of the tubular member 51, and an annular loop portion 52 r is formed on one end side of the tubular member 51. Further, the other end portion of the linear member 52 projects to the other end side of the tubular member 51, and a ring-shaped loop portion 52 a is formed on the other end side of the tubular member 51.

  The tubular member 51 is formed with an inner diameter such that the linear member 52 (that is, two linear members) can be inserted. In other words, the linear member 52 is formed with an inner diameter that can move in the tubular member 51. For example, if the strand diameter of the linear member 52 is about 0.3 to 1.0 mm, the tubular member 51 is formed so that the inner diameter is about 1.5 to 2.5 mm.

Since the structure is as described above, if the loop portion 52a of the linear member 52 is pulled away from the tubular member 51 while fixing the movement of the tubular member 51, the loop portion 52r protruding from the tubular member 51 is tubular. It can be pulled into the member 51. Then, the loop part 52r can be made small.
Conversely, even when the tubular member 51 is pushed toward the loop portion 52r of the linear member 52 in a state where the loop portion 52a of the linear member 52 is held, the loop portion 52r protruding from the tubular member 51 is removed from the tubular member 51. Since it can be accommodated in 51, the loop part 52r can be made small.

  When ligating with the ligating member 50, the suturing needle portion 14 of the suturing device 10 is arranged so as to be inserted into the loop portion 52 r of the linear member 52. And if it is made to show in FIG. 13, the sutured suture 22 can be ligated.

  First, the suturing device 10 including the ligating member 50 is attached to the shaft 2 of the endoscope 1. At this time, the ligating member 50 is arranged so that the pair of needle-like members 15 and 16 of the suture needle portion 14 is inserted into the loop portion 52r of the linear member 52 (see FIG. 12). .

  In this state, the projecting portion PP is sutured by the suturing device 10 by the method described above. That is, both ends of the suture thread 22 of the suturing instrument 20 are arranged so as to be located on the same side with respect to the protrusion PP (FIG. 13A).

  In this state, the loop portion 52r of the linear member 52 of the ligating member 50 is moved using an endoscopic ligation device or the like, and both ends of the suture thread 22 (that is, the tips of the pair of needle-like members 15 and 16). It arrange | positions so that it may be located between protrusion part PP (FIG. 13 (A)).

  When the loop portion 52r is arranged at a position suitable for ligation, the other end portion of the linear member 52 is pulled away from the tubular member 51 while fixing the movement of the tubular member 51 by an endoscopic ligation device or the like. . Then, the loop portion 52r becomes small, and the both ends of the suture thread 22 are bundled by the loop portion 52r (FIG. 13B).

  When the linear member 52 is further pulled from the state where both ends of the suture thread 22 are bundled by the loop portion 52r, the suture thread 22 is also drawn into the tubular member 51 together with the loop portion 52r (FIG. 13C). ). Then, since the inner diameter of the tubular member 51 is such that two linear members 52 can be inserted, the linear member 52 and the suture thread 22 are accommodated in the tubular member 51 in a compressed state. That is, since the linear member 52 and the suture thread 22 are accommodated in the tubular member 51 in a tightly fitted state, the suture thread 22 and the linear member 52 are fixed so as not to fall out of the tubular member 51. Is done. That is, both ends of the suture thread 22 are ligated.

  As described above, when the ligating member 50 is used, the loop portion 52r of the linear member 52 is disposed so as to surround both ends of the suture thread 22, and the loop member 52r simply pulls the linear member 52. Since the 22 can be bundled and ligated, the suture 22 can be ligated quickly and easily.

(About the coupling mechanism 30)
In the suturing device 10 of the present embodiment, only the front arm 11 or both the front arm 11 and the rear arm 12 are detachably provided on the arm moving means 13. That is, with the arm moving means 13 attached to the shaft 2, only the front arm 11 or both the front arm 11 and the rear arm 12 can be exchanged. By adopting such a configuration, after completion of one suturing operation, only the front arm 11 or both the front arm 11 and the rear arm 12 are removed, and another front arm in which the engaging member 21 is already set is provided. The next stitching operation can be performed simply by attaching 11. Then, compared to the case where the entire suturing device 10 is attached and detached, the time until the next suturing can be performed after one suturing is completed can be shortened. In other words, the next stitching can be performed without attaching or detaching the arm moving means 13 to / from the shaft 2 after one stitching is completed. Therefore, when performing suturing at a plurality of locations, the time for the entire suturing operation can be shortened.

  An example of a configuration in which only the front arm 11 or both the front arm 11 and the rear arm 12 can be attached to and detached from the arm moving means 13 will be described with reference to FIGS.

(When only the front arm 11 is attached / detached)
In the suturing device 10 of this embodiment, the front arm 11 can be attached to and detached from the rear arm 12 and the arm moving means 13 by detachably connecting the slide 41 of the slide mechanism 40 and the front arm 11.

  As shown in FIG. 5, a connecting piece 31 is provided on the base end edge of the front arm 11. The connecting piece 31 is engaged with a groove g formed on the back surface of the slide 41. A claw n is provided at the tip of the connecting piece 31. The claw portion n can be fixed by sandwiching the slide 41 between the claw portion n and the back surface 11 b of the front arm 11 when the connecting piece 31 is engaged with the groove g on the back surface of the slide 41.

  Since the structure is as described above, the front arm 11 can be detached from the rear arm 12 by disengaging the claw portion n of the connecting piece 31 of the front arm 11 and the slide 41.

  On the other hand, if the suture accommodating pipe 11p provided on the front arm 11 is inserted into the cylindrical connecting member 41s and the connecting piece 31 is engaged with the groove g on the back surface of the slide 41, the front arm 11 is fixed to the slide 41. can do.

  On the other hand, the front arm 11 is connected to the wire portion 13b of the arm moving means 13 via the slide 41, and is not directly connected to the wire portion 13b. For this reason, when attaching / detaching the front arm 11, the operation | work which attaches / detaches the wire part 13b and the front arm 11 is unnecessary.

  Therefore, since the front arm 11 can be attached to and detached from the rear arm 12 and the arm moving means 13 simply by engaging and disengaging the connecting piece 31 with the groove g on the back surface of the slide 41, the replacement work of the front arm 11 is simplified. Can be

  Since the relative movement of the front arm 11 and the rear arm 12 is guided by the base member 42 and the slide 41 of the slide mechanism 40, even if the front arm 11 is detachable, the front arm 11 and the rear arm 12 are rearranged. The relative movement of the side arm 12 can be stabilized. In particular, if the base member 42 and the slide 41 are slidable from each other but cannot be separated from each other, the front arm 11 and the rear arm 12 approach each other even if the front arm 11 can be attached to and detached from the rear arm 12. The separated movement can be maintained in a stable state.

  In the above example, the case where the slide 41 is connected to the wire portion 13b has been described. That is, the case where the front arm 11 is connected to the wire portion 13b via the slide 41 has been described. However, the front arm 11 may be directly attached to and detached from the wire portion 13 b of the arm moving means 13. For example, if the following configuration is adopted, the front arm 11 can be directly attached to and detached from the wire portion 13 b of the arm moving means 13.

  The cylindrical connecting member 41s described above is fixed to the front arm 11 instead of the slide 41, and the cylindrical connecting member 41s is inserted into the through hole of the connecting pipe 42p described above (see FIG. 5). The tip of the wire portion 13b is detachably connected to the tip of the cylindrical connecting member 41s in this state. Specifically, an insertion member 32 formed so that the outer diameter thereof is slightly larger than the inner diameter of the cylindrical connecting member 41s is provided at the tip of the wire portion 13b. Then, if the insertion member 32 is inserted in the front-end | tip of the cylindrical connection member 41s, the wire part 13b will be fixed to the cylindrical connection member 41s. That is, the wire portion 13b is fixed to the front arm 11 via the cylindrical connecting member 41s (in other words, directly). On the other hand, if the wire portion 13b is pulled, the wire portion 13b can be detached from the tip of the cylindrical connecting member 41s. That is, the wire portion 13 b can be separated from the front arm 11.

  In addition, the method of connecting the wire part 13b and the cylindrical connection member 41s so that attachment or detachment is possible is not restricted to the above methods, and various methods can be adopted. For example, a male screw may be provided at the tip of the wire portion 13b, and a female screw may be provided at the tip of the cylindrical connecting member 41s. In this case, if the wire part 13b is rotated, the wire part 13b and the cylindrical connecting member 41s can be connected or disconnected.

  Moreover, when it is set as the structure which attaches / detaches the front side arm 11 directly to the wire part 13b of the arm moving means 13, the front side arm 11 and the slide 41 may be provided so that isolation | separation is possible with the mechanism mentioned above, and it is fixed. May be. When the front arm 11 and the slide 41 are fixed, the slide 41 can be detached from the rear arm 12 together with the front arm 11 if the slide 41 can be separated from the base member 42. Note that when the slide 41 is removed from the rear arm 12 together with the front arm 11, the tubular connecting member 41 s may be fixed to the slide 41.

  The groove g on the back surface of the connecting piece 31 and the slide 41 described above corresponds to the front arm connecting portion referred to in the claims. However, the method of fixing the slide 41 and the front arm 11 is not limited to the above method. For example, the slide 41 and the front arm 11 may be fixed with screws or the like. However, a method that allows the slide 41 and the front arm 11 to be detachable without using a tool, such as the connecting piece 31 and the groove g on the back surface of the slide 41 described above, is desirable.

(When attaching and detaching both the front arm 11 and the rear arm 12)
Moreover, what is necessary is just to connect the sheath 13a and the wire part 13b with respect to the slide mechanism 40 so that attachment or detachment is possible when both the front arm 11 and the rear arm 12 are attached or detached. For example, the following configuration can be adopted.

  First, a hollow cylindrical connecting pipe 42 p is provided on the base member 42 of the slide mechanism 40. Specifically, it is provided so that the axial direction of the connecting pipe 42p is parallel to the axial direction of the needle-like members 15 and 16 of the suture needle portion 14. In addition, the connecting pipe 42p is arranged such that a through hole (in other words, a hole penetrating the rear arm 12) is formed in the base member 42 by the connecting pipe 42p.

  The rear arm 12 can be attached to and detached from the arm moving means 13 by removably connecting the distal end of the sheath 13a to the base end (the upper end in FIGS. 5, 9, and 11) of the connecting pipe 42p.

  In this case, the method of detachably connecting the connecting pipe 42p and the distal end of the sheath 13a is not particularly limited. For example, as shown in FIG. 5, a connecting piece 33 is provided with a male screw provided at the tip of the sheath 13a, a female screw provided on the inner surface of the connecting pipe 42p, a male screw formed on the outer surface, and a female screw formed on the inner surface. Can be linked by. In this case, the male screw at the distal end of the sheath 13a is screwed with the female screw on the inner surface of the connecting piece 33, and the male screw on the outer surface of the connecting piece 33 is screwed with the female screw on the connecting tube 42p. Then, the sheath 13a and the connecting pipe 42p (that is, the rear arm 12) can be connected or disconnected via the connecting piece 33. In this case, the sheath 13a and the connecting tube 42p can be attached / detached only by rotating the connecting piece 33 without rotating the sheath 13a, so that the sheath 13a and the connecting tube 42p (that is, the rear arm 12) can be easily attached / detached. can do.

  Further, a male screw may be provided at the tip of the sheath 13a, and a female screw may be provided at the tip of the connecting pipe 42p. In this case, if the connecting pipe 42p is rotated with respect to the sheath 13a, the sheath 13a and the connecting pipe 42p (that is, the rear arm 12) can be connected or disconnected.

On the other hand, as a method of attaching / detaching the front arm 11 to / from the arm moving means 13, the following configuration can be adopted.
A cylindrical connecting member 41s fixed to the slide 41 is inserted into the through hole of the connecting pipe 42p described above (see FIG. 5). The tip of the wire portion 13b is detachably connected to the tip of the cylindrical connecting member 41s. Specifically, an insertion member 32 formed so that the outer diameter thereof is slightly larger than the inner diameter of the cylindrical connecting member 41s is provided at the tip of the wire portion 13b. Then, if the insertion member 32 is inserted in the front-end | tip of the cylindrical connection member 41s, the wire part 13b will be fixed to the cylindrical connection member 41s. That is, the wire portion 13 b is fixed to the slide 41. On the other hand, if the wire portion 13b is pulled, the wire portion 13b can be detached from the tip of the cylindrical member 11d. That is, the wire portion 13 b can be separated from the slide 41.

  In addition, the method of connecting the wire part 13b and the cylindrical connection member 41s so that attachment or detachment is possible is not restricted to the above methods, and various methods can be adopted. For example, a male screw may be provided at the tip of the wire portion 13b, and a female screw may be provided at the tip of the cylindrical connecting member 41s. In this case, if the wire part 13b is rotated, the wire part 13b and the cylindrical connecting member 41s can be connected or disconnected.

  In this way, if both the front arm 11 and the rear arm 12 can be attached and detached, when using the ligating member 50 as described above, there is also an advantage that the time for the suturing operation can be shortened. It is done.

  The ligating member 50 described above is attached in a state where the suture needle portion 14 of the suturing device 10 is inserted into the loop portion 52 of the linear member 52. Therefore, when only the front arm 11 is attached and detached, it is necessary to install the ligating member 50 when the front arm 11 is replaced.

  However, if the rear arm 12 is also detachable and the rear arm 12 is exchanged together with the front arm 11, the ligating member 50 can be attached to the suturing device 10 (that is, the suturing needle portion 14) in advance. Then, since the trouble of installing the ligation member 50 can be saved, the time for the suturing operation can be shortened.

(About the suture needle 14)
The suture needle portion 14 includes a pair of needle-like members 15 and 16, but the distance between the axes of the pair of needle-like members 15 and 16 is not particularly limited. What is necessary is just to be provided in the distance which can stitch | suture a stitching | suture part appropriately by the suture thread 22. For example, if the thickness is set to about 2 to 4 mm, it is possible to realize a sutured state equivalent to a suture in a surgical operation.

  In the above example, a case has been described in which the pair of needle-like members 15 and 16 of the suture needle portion 14 are arranged along the axial direction of the rear arm 12. However, the pair of needle-like members 15 and 16 may not necessarily be arranged along the axial direction. For example, the rear arm 12 may be disposed so as to be inclined with respect to the axial direction or may be disposed so as to be orthogonal to each other. The pair of housing spaces 18 and 19 of the housing portion 17 of the front arm 11 are disposed so as to correspond to the pair of needle-like members 15 and 16 of the suture needle portion 14.

(Other structure of the suturing device 10)
In the above example, the case where the suture needle portion 14 has the pair of needle-like members 15 and 16 has been described. However, as in the suturing device described in Japanese Patent No. 5294181, the suturing needle portion 14 may include only one needle-like member 15 (see FIG. 14). In this case, the front arm 11 is provided with a pair of branch portions 11s and 11s so that the front arm 11 and the rear arm 12 can rotate relative to each other. For example, the slide 41 and the base portion 42 of the slide mechanism 40 are configured to be detachable, and when the slide 41 and the base portion 42 are detached, both can be rotated with each other. Then, if each of the branch portions 11s is provided with a storage space 18 of the storage portion 17, and a pair of engagement members 21 and 21 connected to each storage space 18 by a suture 22 are disposed, The formed opening can be stitched all over.

  That is, the front arm 11 and the rear arm 12 are arranged so that the acicular member 15 and the accommodation space 18 (one accommodation space 18) of the one branch portion 11s face each other, and the front arm 11 and the rear arm 12 are connected. Move closer. Then, the engagement member 21 (one engagement member 21) disposed in the one accommodation space 18 can be engaged with the distal end portion of the needle-like member 15. Further, after the front arm 11 and the rear arm 12 are separated from each other with the one engagement member 21 engaged with the tip of the needle-like member 15, the rear arm 12 is swung to form a needle-like shape. The front arm 11 and the rear arm 12 are arranged so that the member 15 and the accommodation space 18 (the other accommodation space 18) of the other branch portion 11s face each other. If the front arm 11 and the rear arm 12 are brought close to each other in this state, the distal end portion of the needle-like member 15 can be inserted into the other storage space 18. 21 (the other engaging member 21) and the tip of the needle-like member 15 can be engaged. Then, since both of the pair of engaging members 21 and 21 are engaged with the single needle-like member 15, the suture thread 22 that connects the pair of engaging members 21 and 21 can be formed into a ring shape. it can.

  For this reason, the suturing device 10 is inserted into the body while being attached to the endoscope, and in the incision portion such as the stomach wall, one mouth edge portion is disposed so as to be sandwiched between the front arm 11 and the rear arm 12, If the front arm 11 and the rear arm 12 are once brought close to each other and then separated, the suture 22 can be passed through one of the mouth edges. And if the other mouth edge part is arrange | positioned so that it may be pinched | interposed by the front side arm 11 and the rear side arm 12, if the front side arm 11 and the rear side arm 12 are once approached and separated, the other mouth edge part The suture thread 22 can be passed through. Then, a loop of the suture thread 22 is formed in which both ends (portions connected to the pair of engaging members 21 and 21) are inserted through the pair of mouth edges of the incision portion and both are located on the rear arm 12 side. be able to. Therefore, if both ends of the looped suture thread 22 are ligated, the incised portion is sutured in a state where the end surfaces (incision surfaces) of the pair of lip portions are brought into contact with each other in the same manner as in a normal surgical operation. Can do.

  As described above, when only one needle-like member 15 of the suture needle portion 14 is provided and a pair of branch portions 11s and 11s are provided on the front arm 11 so that the front arm 11 and the rear arm 12 can rotate relative to each other. Therefore, it is important to align the needle-like member 15 and each accommodation space 18. If the slide 41 and the base portion 42 of the slide mechanism 40 have the following structure, the needle-like member 15 and each storage space 18 can be easily aligned.

  As shown in FIGS. 14 and 15, the base portion 42 of the slide mechanism 40 is formed in a square cross section, and its side surface is formed on a flat surface parallel to the swing axis (in other words, the central axis of the sheath 13a). Specifically, the reference side surface 42a is formed on the base portion 42 so as to be located on the side opposite to the side where the needle-like member 15 is provided and parallel to the axial direction of the swing shaft. Then, a pair of positioning side surfaces 42b and 42c orthogonal to the reference side surface 42a are provided so as to sandwich the reference side surface 42a from both sides (see FIG. 15A).

  On the other hand, the guide groove 41g of the slide 41 is a flat surface parallel to the axial direction of the swing shaft, and its intersection angle is the same as the angle formed by the reference side surface 42a of the base portion 42 and the pair of positioning side surfaces 41b and 41c. A pair of guide surfaces 41a and 41b are formed so as to be. That is, the pair of guide surfaces 41a and 41b are provided so as to be orthogonal to each other (see FIG. 15B).

  Then, when the base portion 42 is engaged with the guide groove 41g so that the reference side surface 42a of the base portion 42 is in surface contact with the guide surface 41a or the guide surface 41b, one of the pair of positioning side surfaces 42b and 42c is guided. It is formed such that the central axis of the needle-like member 15 is coaxial with the central axis of any of the accommodation spaces 18 in surface contact with the surface 41a or the guide surface 41b. In FIG. 14B, when the reference side surface 42a of the base portion 42 is brought into surface contact with the guide surface 41b, the positioning side surface 42b comes into surface contact with the guide surface 41a. Then, the base part 42 is positioned so that the central axis of the needle-like member 15 is coaxial with the central axis of one accommodation space 18 (left accommodation space 18 in FIG. 14B). Conversely, when the reference side surface 42a of the base portion 42 is brought into surface contact with the guide surface 41a, the positioning side surface 42c comes into surface contact with the guide surface 41b. Then, the central axis of the needle-like member 15 is positioned so as to be coaxial with the central axis of the other accommodation space 18 (the right accommodation space 18 in FIG. 14B).

  With the above configuration, when the base portion 42 of the slide mechanism 40 is engaged with the guide groove 41g from the end on the rear arm 12 side of the slide 41, the base portion 42 is moved forward along the guide groove 41g. It can be moved to the arm 11. Then, since the base part 42 and the guide groove 41g can be brought into surface contact with each other on two surfaces, the relative rotation between the rear arm 12 and the front arm 11 is fixed, that is, the rear arm 12 and the front arm 11 are fixed. Can be moved close to each other in a positioned state. Therefore, since the central axis of the needle-like member 15 can be approached while being kept coaxial with the central axis of the accommodation space 18, the needle-like member 15 can be reliably and easily inserted into the accommodation space 18.

  Further, as shown in FIG. 15B, protrusions 41p on the rails extending along the guide surfaces 41a and 41b are formed on the pair of guide surfaces 41a and 41b of the guide groove 41g, respectively. A groove 42g that can be engaged with the protrusion 41p may be formed. In this case, the base part 42 and the slide 41 can be positioned more reliably. In other words, there is an advantage that the rear arm 12 and the front arm 11 can be reliably positioned.

  14B, the normal direction of the reference side surface 42a is arranged so as to be parallel to the line connecting the central axis of the needle-like member 15 and the swing axis (the central axis of the sheath 13a). However, the normal direction of the reference side surface 42a may have a certain angle with respect to the line connecting the central axis of the needle-like member 15 and the swing axis, as long as the above-described function is satisfied. .

  Further, the structure of the slide mechanism is not limited to the structure as described above. In a state where the central axis of the needle-like member 15 and the central axis of the accommodating space 18 are coaxially positioned, the swing of the rear arm 12 with respect to the front arm 11 is fixed, but the movement in the direction in which both approach and separate is allowed. Any structure can be used.

  The suturing device of the present invention is suitable as an instrument for suturing tissues in a digestive tract.

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Shaft 10 Suture apparatus 11 Front side arm 12 Rear side arm 13 Arm moving means 13a Sheath 13b Wire part 14 Needle-like part 15 Needle-like member 16 Needle-like member 17 Accommodation part 18 Accommodation space 19 Accommodation space 20 Suture instrument 21 Engagement member 22 suture 30 connection mechanism 31 connection piece 32 insertion member 33 connection piece 40 connection mechanism 41 slide 41g engagement groove 42 base member 42p connection pipe PP protrusion

Claims (6)

A rear arm having a needle-like member;
A front arm provided with a housing space provided so as to be able to approach and separate from the rear arm, and into which the needle-like member is inserted when approaching the rear arm;
A suturing instrument having an engaging member engageable with the needle-like member housed in the housing space of the front arm, and a suture;
Arm moving means for approaching and separating the front arm and the rear arm;
A connection mechanism for connecting the front arm and the rear arm to the arm moving means,
The coupling mechanism is
A slide mechanism having a base portion provided on the rear arm and a slide movably connected to the base portion provided on the front arm;
The front arm is
A suturing apparatus, which is detachably connected to the arm moving means directly or via a slide of the slide mechanism. A rear arm having a needle-like member;
A front arm provided with a housing space provided so as to be able to approach and separate from the rear arm, and into which the needle-like member is inserted when approaching the rear arm;
A suturing instrument having an engaging member engageable with the needle-like member housed in the housing space of the front arm, and a suture;
Arm moving means for approaching and separating the front arm and the rear arm;
A connection mechanism for connecting the front arm and the rear arm to the arm moving means,
The coupling mechanism is
A slide mechanism having a base portion provided on the rear arm and a slide movably connected to the base portion provided on the front arm;
A rear arm connecting portion that detachably connects the base portion of the slide mechanism and the arm moving means,
The front arm is
A suturing apparatus, which is detachably connected to the arm moving means directly or via a slide of the slide mechanism. The front arm is
It is connected to the arm moving means via a slide of the slide mechanism,
The coupling mechanism is
The suturing device according to claim 1 or 2, further comprising a front arm connecting portion that removably connects the front arm to the slide of the slide mechanism. The arm moving means is
A sheath connected to the base portion of the slide mechanism;
A wire portion disposed in the sheath and connected to the front arm or the slide of the slide mechanism,
A through-hole penetrating the base portion is formed in parallel with a direction in which the front arm and the rear arm approach and separate from each other,
4. The suturing device according to claim 1, wherein the wire portion is connected to the slide of the front arm or the slide mechanism through the through hole. The slide of the slide mechanism is
A cylindrical member inserted into a through-hole penetrating the rear arm;
The tubular member is
The suturing device according to claim 4, wherein the suturing device is connected to a tip of the wire portion. The rear arm connecting portion is
Inserted into a through-hole penetrating the rear arm, comprising a connecting piece for connecting the distal end of the sheath and the rear arm;
The connecting piece is
The suturing device according to claim 4, wherein the suturing device is detachably connected to the rear arm.

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