JP2951659B1 - Automatic suture device for biological tissue resection - Google Patents

Abstract

A suturing device is provided that can perform suturing that enables small pieces to be cut out by a single clamping operation. Kind Code: A1 A suturing device for suturing an outer peripheral portion of a small section containing a tumor in order to resect a small section for biopsy from a living body tissue of a human body, wherein the suturing device surrounds a tumor existing in the living body tissue. A pair of openable and closable holding members for holding the living tissue, a staple attached to one of the holding members, and a staple driving member for driving the staple toward the other holding member and suturing the living tissue, The holding portion of the pair of upper and lower holding members is formed in an annular shape, and the outer circumference of the small biopsy section containing the tumor is sutured in one operation.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an automatic suturing device for excision of a living tissue from a human body, and more particularly, to a method of cutting a small biopsy biopsy from a living tissue. ) With a staple.

[0002]

2. Description of the Related Art A biopsy for pathologically examining the internal organs of a human body is known as
A small section of a living tissue at a site containing a tumor or the like is cut out. When the small section is cut off, the outer periphery of the cut portion of the living tissue remaining on the human body side is stapled with staples. A number of suturing devices used for cutting the small pieces have been proposed, but each of them has a pair of straight bar-shaped holding portions that open and close in the vertical direction at the tip of the handle, and one of the holding portions is provided on one of the holding portions. The cartridge containing the staples is detachably mounted, and after holding the living tissue by the holding portion, the staples of the cartridge are punched out by operating the operation element provided on the handle portion so that the living tissue to be held is sutured. It is configured.
For example, Japanese Patent Application Laid-Open No. H10-195 is mentioned.

However, in the above-described conventional suturing device, the holding portion for holding the living tissue is formed in a straight rod shape. It will be surrounded by multiple operations. That is, when cutting small pieces into a substantially V-shaped plane,
When holding the small section once from the left and right sides of the small section once, a total of two times, and when performing a substantially trapezoidal plane, perform the stitching from the left and right without crossing the tip, and perform the second stitching for the third time Will be connected.

[0004]

Therefore, when a small section for biopsy is to be cut from a living tissue with the above-mentioned conventional suturing device, the suturing device must be cut at least twice or more. Since the outside of the tumor cannot be sutured, it requires a lot of time for the resection operation, and it takes a long time to remove the tumor.
When the position of the small section is deep, there is a problem in that the intrathoracic operation becomes difficult, and the size of the opening becomes large.

Further, staples for suturing living tissues are performed by exchanging a cartridge for each suturing operation.
There are problems in that staples are overlapped or staples are driven into unnecessary portions because they are divided into V-shaped or trapezoidal shapes by three or three operations. SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned problems of the related art, and an object of the present invention is to provide a suturing device capable of performing a suturing operation capable of cutting small pieces by a single staple driving operation. Is to provide. Still another object of the present invention is to provide a suture instrument having a function of easily examining a tumor part or the like.

[0006]

SUMMARY OF THE INVENTION In order to achieve the above object, the present invention has been made to solve the above-mentioned problem by providing an outer peripheral portion of a small section containing a tumor for removing a small biopsy section from a living body tissue of a human body. A pair of openable and closable upper and lower sandwiching members for surrounding the tumor present in the living tissue and sandwiching the living tissue, and a staple attached to one of the sandwiching members, and A cartridge provided with a launching claw for launching staples, a staple launching member for launching the staple to the other holding member side and suturing a living tissue, and a staple launched by operation of the staple launching member has at least a stitching shape defining a staple. It is characterized in that it has a shape surrounding a tumor portion, and the outer periphery of a small biopsy section containing the tumor is sutured in one operation. As the shape in which the staples define the suture shape surrounding at least the tumor portion, not only the closed shape of the periphery (O shape), but also the V shape, the U shape, the C shape, etc. Good thing.

The staple cartridge to be mounted on the one holding member is an annular (O-shaped) formed of a synthetic resin material.
Alternatively, a V-shaped, U-shaped, C-shaped, etc. staple accommodating portion and a mounting handle portion are continuously provided outside the staple accommodating portion, and the mounting handle portion is inserted or fitted into one grip portion of the holding member. It is configured to be fixed.
Then, the staple is accommodated in the staple accommodating portion such as an annular shape.
A row or three rows are alternately arranged and are arranged in a substantially V-shaped plane or a U-shaped plane, and are further provided with a punching claw for punching the staple. In addition, the staples set in the cartridge are such that, when suturing living tissue of the lung, the lung has a thin outer peripheral edge and gradually becomes thicker as it enters from the outer peripheral edge. At the (back side), make a difference between the length of the staple and the length of the staple,
Make the width of the staple wide and narrow. That is, a staple having a short length of the needle leg and a wide width is disposed on the front side, and a staple having a narrow width so that the needle leg is long and can be stitched more curvedly on the curved portion on the distal end side (rear side). To ensure that sutures can be sutured. When suturing in a shape surrounding a tumor portion in one operation of the present invention, it is important to make the width of the staple wider or narrower than the length of the needle leg.

The holding portion, such as an annular portion, of the holding member for receiving the tip of the needle leg of the staple may have its opening kept open, or the opening may be closed, and the closed bottom plate member may be closed. It may be either transparent or opaque.

According to the above means, there is provided a cartridge having a built-in staple and a punching claw mounted on one of the upper and lower holding members for holding and holding the living tissue and the other holding member. Is formed in an annular shape (O-shape), V-shape, U-shape, C-shape or the like surrounding the tumor portion to be sewn. It can be performed in one operation such as C-shape. In addition, since the holding portion is formed in an annular shape as described above, it is possible to detect a hard, slimy tumor portion by using a suture device by holding the living tissue between the holding members. Then, when the opening of the holding portion of the holding member located at the lowermost side (the holding member located at the lower side of the living tissue) is closed by the bottom plate, the tumor is located in the living tissue if it exists. Because it is supported by the bottom plate, it rises upward in the annular portion of the cartridge mounted on the upper holding member, and it is possible to easily search for a tumor visually.

[0010]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is an external view of an automatic suturing device for resection of a living tissue according to the present invention. The suturing device A includes a pair of openable and closable holding members 1 and 2 made of stainless steel for holding a living tissue. A staple and a staple ejecting member 4 for ejecting staples contained in the cartridge 3 and a cartridge 3 containing a staple and a punching claw detachably attached to the holding member 1 (upper side). The lower holding member 2 and the staple driving member 4 are assembled in a scissors shape with pins 5 and are configured to be openable and closable.

The upper holding member 1 is provided with a lower holding member 2 and a staple driving member 4 at the tip of a grip 1a having a connecting / fixing means for connecting / fixing a mounting handle portion of a cartridge described later. A support rod 1b, which is rotatably supported so as to be able to open and close, is fixedly protruded, and an insertion port 6 of a mounting handle portion of the cartridge 3 is opened at the tip of the grip 1a. The connecting and fixing means built into the grip 1a is an automatic lock type (cancellation is manually released) which is automatically connected and fixed by inserting the mounting handle portion of the cartridge 3 from the insertion port, or a connection fixing and releasing. Any of a manual type performed by a manual operation may be used.

The lower holding member 2 which forms a pair with the holding member 1 is composed of a handle 2a and an annular holding portion 2b connected and fixed to the tip of the handle 2a. The side having a large diameter formed in a shape is connected to the handle 2a. A receiving recess 7 is formed on the upper surface of the annular holding portion 2b to receive the tip of the leg of the staple ejected from the cartridge 3 mounted on the upper holding member 1 and to smoothly bend inward. It is recessed corresponding to the staple to be accommodated. Furthermore, the opening of the inside of the annular holding portion 2b may be left open, but the lower side of the opening of the holding portion 2b may be closed by the bottom plate 8. In addition, since the bottom plate 8 is a receiving material for receiving the cutting edge when the sutured living tissue (small section) is cut with a scalpel or the like, a material that is not cut by the cutting edge, for example, a metal plate (stainless plate) is effective. It is.

The cartridge 3 mounted on the upper holding member 1 includes a mounting handle 3a formed of a synthetic resin material.
An annular staple accommodating case 3b integrally connected and fixed to the tip of the mounting handle 3a; a plurality of (three in the drawing) staples 9 accommodated in the staple accommodating case 3b; The staple storage case 3b has the same planar shape as the holding portion 2b of the holding member 2 described above. In addition, since the dimension of the maximum width in the planar shape of the cartridge 3 (same as the width of the holding portion of the holding member) affects the size of an incision to be made to insert the suture instrument into the body, the incision is made larger. In order to reduce the size, the number of staples arranged in the maximum width portion is reduced to a minimum of two.

At the rear of the mounting handle 3a of the cartridge 3, there is provided an engaging portion (not shown) for engaging and disengaging from the connecting and fixing means in the grip 1a of the holding member 1. The staples 9 incorporated in the staple accommodating case 3b are arranged and accommodated in three rows except for approximately one third at the rear side of the accommodating case 3a, and the entire staples 9 accommodated therein have the same wire diameter and width. However, in lung tissue in which the thickness of the living tissue to be sutured is such that the outer peripheral edge is thinner and thicker as it goes inward, the three rows of staples 9 have needle legs in the first half and the second half. Changing the length and width of the staples is effective. In particular, the front half of the housing case 3b is curved in a substantially V-shape, so that leakage tends to occur as compared with the straight part of the rear half. The staples 9b are arranged densely, and the staples 9b having short and wide needle legs are arranged in the rear half (L2). The staples 9 arranged in three rows are respectively housed in independent holes 11 which are opened through the staple housing case 3b in the vertical direction. The staples are also effective even if staples having the same length and the wide and narrow difference as described above are arranged.

The staple accommodating case 3b has holes 11 therein.
Claw 10 for pushing out staple 9 housed inside
Are slidably mounted vertically. Launch nail 10
Are three claw frames 10a, 10b, 10 corresponding to three rows of staples 9 stored in the staple storage case 3b.
c, the claw frame 10a is for staples in the outer row, the claw frame 10b is for staples in the middle row, the claw frame 10c is for staples in the inner row, and the three claw frames are the claw frames 10a.
Is at the bottom, and the claw frame 10b is further stacked thereon, and the claw frame 10c is further stacked and mounted thereon. That is, the slits 12a, 12b through which the claw portions of the claw frame 10b and the claw frame 10c stacked on the upper edge of the claw frame 10a are passed.
Are formed in two rows, and a slit 12c is formed in the upper edge of the claw frame 10b, through which the claw portion of the claw frame 10c stacked thereover penetrates. The claw frames 10a, 10b, and 10c move downward to push out the staples 9 stored in the holes 11. The slits 12a, 12b, 12c formed in the claw frames 10a, 10b are not limited to the independent forms corresponding to the illustrated claw portions, but may be grooves continuous in the circumferential direction. Reference numeral 13 denotes a cover that prevents the ejection claw 10 fitted and set on the upper side of the staple accommodating case 3b from inadvertently moving and extruding the staple 9 due to vibration during conveyance or the like.

The ejection member 4 for ejecting the staples 9 of the cartridge 3 includes a handle 4a and the handle 4a.
And a ring-shaped pressing member 4b supported at the tip of the shaft so as to be vertically swingable. The middle of the handle 4a is coaxial using the pin 5 for assembling the holding member 1 and the holding member 2 in the form of scissors. The handle 4a is opened (moves in the direction away from the grip 1a of the holding member 1) to open and close the handle 4a.
When the b moves away from the cartridge 3 and the handle 4a is closed (movement in the direction of approaching the grip 1a of the holding member 1), the pressing member 4b comes into contact with the cartridge 3 and presses the above-described embossing claw 10. And the pressing member 4b is a handle 4a.
The pressing member 4b, which is in contact with the upper surface of the cartridge 3, is translated downward by the closing operation of the handle 4a in a state in which the entire lower surface of the pressing member 4b is in contact. Since the pushing claws 10 are evenly pressed, an equal force acts on all the staples, and a reliable stitch is performed. It should be noted that it is optional to provide a lock mechanism for holding the ejection member 4 closed.

Next, the use of the suturing device constructed as described above will be described with reference to FIGS. 9 to 13. First, the cartridge 3 is mounted and fixed on the holding member 1, and the preparation is completed. At this time, the cover 13 attached to the cartridge 3 is removed to prevent staples from being ejected by other means.
In the above state, the living tissue B is gripped by the grasping forceps 14 and pulled out from the incised portion where the thoracotomy or laparotomy is performed as shown in FIG. 9, and then the biological tissue B is inserted into the holding member 1 as shown in FIGS. 10 and 11. The tumor portion is searched for while being sandwiched between the mounted cartridge 3 and the holding portion 2b of the holding member 2. At this time, if there is a tumor or the like in the living tissue, the tumor portion protrudes upward in the annular cartridge 3 because it is supported on the bottom plate 8 of the holding portion 2b, thereby causing the tumor portion to be sandwiched between the holding members 1 and 2. In addition to feel, it can be easily recognized visually. Then, when a tumor portion is found, a portion containing the tumor is cut out as a small piece in order to check whether the tumor is malignant or benign, but as shown in FIG.
The ejection member 4 is closed in this state. Due to the closing movement of the ejection member 4, the pressing member 4b is moved downward, and the ejection claw 10 provided on the cartridge 3 is pushed to push out the staple 9, thereby suturing the living tissue B. After the suturing around the small piece is completed, the small piece can be cut off by inserting a scalpel along the inner peripheral edge of the holding portion 2b of the holding member 2, the cartridge 3, and the punching member 4 in a stacked state. At this time, since the opening of the holding portion 2b of the holding member 2 is closed by the bottom plate 8,
There is no fear that the tip of the scalpel penetrates the holding portion 2b, and therefore there is no danger of damaging other living tissues at the time of cutting. still,
Considering that the inner part (small section) partitioned by the above-mentioned suture is cut (cut) with an electric knife, in this case, in order to prevent the living tissue to be clamped from being burnt off, the clamping is performed in contact with the electric knife. Nipping portion 2b of member 2, launching member 4
The inner surface of the pressing portion 4b and the inner surface of the bottom plate 8 may be subjected to insulation treatment.

[0018]

According to the automatic suturing device for resection of living tissue of the present invention, the suture for cutting a small section from the living tissue can be reliably performed by a single operation. Therefore, the time required for the suturing operation can be significantly reduced as compared with the conventional device, and the insertion of the suturing device from the incised part with the thoracotomy or laparotomy can be performed by inserting it straight into the part to be cut. The width of the incision can be made smaller than the width of the incision when the conventional device is used. That is, even when the small slice is located at a deep portion, the small thoracotomy operation can be applied, and it is not necessary to increase the width of the incision as in the related art. Further, a suturing device that can be easily used can be provided by the configuration described in claim 2. Further, according to the configuration of the third aspect, it is possible to configure a suturing device that can reliably perform hemostasis and prevent air leakage even in a suture having a curved portion. Further, according to the configuration of claim 4, it is possible to easily search for a tumor present in the living tissue, and there is no risk of damaging other organs at the time of cutting after suturing, and the cut small section can be used. Since it acts as a receiving tray, it can prevent malignant cells from being spread into the thoracic cavity or the abdominal cavity.

[Brief description of the drawings]

FIG. 1 is a front view showing an example of an embodiment of an automatic suturing device according to the present invention.

FIG. 2 is a plan view of FIG.

FIG. 3 is an exploded perspective view.

FIG. 4 is an exploded perspective view showing the structure of the cartridge.

FIG. 5 is a perspective view showing a state in which a lower holding member is opened with respect to a holding member equipped with a cartridge.

FIG. 6 is a perspective view showing vertical movement of a launching member in FIG. 5;

FIGS. 7A and 7B show the arrangement of staples in a cartridge, wherein FIG. 7A is a plan view, FIG. 7B is a cross-sectional view showing staples accommodated in the range of the first half (L1), and FIG. It is sectional drawing which shows the staple accommodated in the range.

FIG. 8 is an enlarged sectional view showing a state where a living tissue is sutured.

FIG. 9 is an explanatory view showing a state in which a living tissue is sandwiched by grasping forceps and sandwiched by a pull-out suture device.

FIG. 10 is an explanatory view showing a state in which a living tissue is sandwiched by closing a lower sandwiching member.

FIG. 11 is an explanatory diagram showing a state in which a living tissue is sandwiched by a suturing device to search for a tumor.

FIG. 12 is an explanatory view showing a state in which the launching member is closed for suturing.

FIG. 13 is an explanatory view showing a suturing state.

[Explanation of symbols]

 A: suturing device B: living tissue 1 ... upper holding member 2 ... lower holding member 3 ... cartridge 4 ... ejection member 8 ... bottom plate 9 ... staple 10 ... ejection nail

Claims (4)

(57) [Claims] 1. A suturing device for suturing an outer peripheral portion of a small section containing a tumor in order to resect the small section for biopsy from a living body tissue of a human body, wherein the suturing device surrounds the tumor existing in the living body tissue. A pair of openable and closable holding members for holding the living tissue, and a staple attached to one of the holding members,
A staple driving member for driving the staple toward the other holding member and suturing the living tissue, wherein the staple driven by the operation of the staple driving member defines a stitching shape that surrounds at least a tumor portion; An automatic suturing device for resection of living tissue, wherein the outer periphery of a small section for examination is sutured in one operation. 2. The automatic suturing device according to claim 1, wherein the staple mounted on the one holding member is a cartridge type having a staple and a driving claw for driving the staple in a resin case. 3. The staple set in the cartridge has a staple located on the near side of a suturing portion having a short and wide needle leg, and a staple located on a distal end curved portion has a long and narrow needle leg. The automatic suturing device for resection of living tissue according to claim 2, wherein 4. The automatic suture for resection of living tissue according to claim 1, wherein an annular holding portion of the holding member for receiving the needle leg of the staple is closed by a bottom plate. vessel.