JP3384573B2 - Surgery system - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical system for suturing an internal organ of a body cavity by an operation from outside the body cavity.

[0002]

2. Description of the Related Art Generally, a surgical system for suturing an internal organ of a body cavity by an operation from the outside of the body cavity includes an endoscope for observing the inside of the body cavity, and a large number of grasping forceps and scissors forceps for performing the operation in the body cavity. This type of laparoscopic treatment instrument includes a suture needle and a suture thread. When suturing an organ in a body cavity, the operator operates various laparoscopic treatment tools from outside the body cavity while observing the inside of the body cavity with an endoscope, and uses the laparoscopic treatment tool instead of the hand to sew the sutured part. , And hold the suture needle to perform the suturing operation. U.S. Pat. Nos. 4,981,149, 4,901,721, and JP-A-56-163641 disclose, for example, surgical systems for performing such suturing.

Further, instead of performing suturing using a suture needle and a suture, clipping using a stapler is also performed. This is a technique for closing and fixing living tissues at a required site with a metal or plastic stapler, for example, US Pat. No. 4,620,541 and JP-A-3-5.
It is shown in No. 05167. Such an intracorporeal suture surgical system is used when performing intracorporeal surgery using an endoscope, such as laparoscopic partial gastrectomy and laparoscopic partial colon resection, and is minimally invasive to the patient. A surgical operation is realized.

[0004]

However, in the conventional surgical system for performing suturing, since the suturing portion is sutured only from one side, when suturing an organ having a small strength of living tissue, this suturing operation is performed. There is a risk that a large amount of tension acts on the portion, the living tissue is broken from the portion through which the suture thread passes, and the suture breaks after the suture.

Further, when a stapler is used, the stitching is performed with a relatively small metal or plastic piece called a stapler, so that the stitching force is weaker than the case of stitching with a suture thread. In order to compensate for the weakness of the suturing force, it is necessary to perform suturing with a large number of staplers. When such a large number of staplers are used, image noise or artifacts due to the stapler at the time of subsequent X-ray examination or MRI examination. Will become so big that it cannot be ignored. Furthermore, the use of a large number of staplers is not economical, and there is a problem that the treatment cost becomes excessive.

The present invention has been made in view of the above, and an object of the present invention is to provide a surgical system capable of economically performing safe and reliable suturing in which the suture portion does not collapse after surgery.

[0007]

A surgical system according to the present invention is inserted into a body cavity, and an organ is attached to a suture portion of the organ in the body cavity.
This is the first approach that can be approached from the inside.
Is approached to the suture by the first approach means of
Insert the suture thread into the living tissue from the inside of the body cavity organ.
A first treatment tool having at least a permeable suture needle;
The suture needle of the first treatment tool of the above into the living tissue of the organ
The first driving mechanism for piercing and
A second approach that allows the joint to be approached from outside the organ
And a suture by the second approach means.
Inside the body tissue from outside the organ in the body cavity.
At least a suture needle capable of inserting a suture thread
And a suture needle of the second treatment tool.
A second drive mechanism for inserting the living tissue of an organ,
Control means for controlling the first and second approach means,
Have .

The suture needle has an arcuate shape, and the drive mechanism rotates the suture needle around the center of the arc to pierce the suture needle into the living tissue of the organ and insert the suture thread. Is preferred.

[0009]

When the internal organs in the body cavity are sutured by this operation system, the first approach means is inserted into the body cavity and the first approach means is inserted.
From the inside of this internal organ to the sutured part of the internal organ
While approaching the second approach means from outside the body cavity
Through the second treatment tool to the sutured portion from outside the organ.
Contact . Then, the first drive mechanism and the first drive mechanism are controlled by the control means .
The second drive mechanism is operated to operate the first treatment tool and the second treatment.
The respective suture needles with the tool are inserted into the living tissue, and the living tissue of the sutured portion is sutured from both sides thereof.

[0010]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT FIG. 1 is a surgical system 1 according to an embodiment of the present invention.
0 indicates a state in which the living tissues M and m of the organ in the body cavity are sutured. The surgical system 10 includes a small-diameter multifunction endoscope 12 that is close to a sutured site from the inside of an organ, and a trocar 1.
2 and a micromanipulator system 16 that is close to the suture site from the outside of the organ through the device 4.

The active bending portion 18 forming the approaching means of the multi-function endoscope 12 contains the hardness varying means 20 formed of, for example, a shape memory alloy, and the controlling means (not shown) arranged outside the body cavity. By controlling these hardness varying means 20 through, the tip portion can be brought close to the suture portion at an arbitrary angle.

Further, a high-resolution / high-brightness observation means 22 is provided at the tip of the multi-function endoscope 12, and
A plurality of ultrafine active treatment instruments 28 project from this tip. The observing means 22 is provided with an auto-iris focusing means 24 that always forms a clear image with an appropriate light quantity, and a micro wiper 26 that wipes mucus and blood adhered onto the objective glass. Also, each ultrafine active treatment instrument 2
Reference numeral 8 has a multi-joint micromanipulator 30 having a treatment function portion such as a clip or a suture needle at the distal end thereof, and the treatment function portion is brought close to the suture portion while controlling the treatment function portion to a desired posture through a control means (not shown). The functional unit can be operated. Therefore, this articulated micromanipulator 30 also forms the approach means.
Reference numeral 28a is a fine suturing tool having a suture needle for suturing a living tissue at its tip, and reference numeral 28b is a fine grasping forceps having a clip at its tip.

On the other hand, the micromanipulator system 16 for suturing an incision from the outside of an organ comprises an active stereoscopic endoscope 32 and a plurality of ultrafine active treatment instruments 34. The micromanipulator system 16 is inserted into the body cavity through the trocar 14 pierced by the abdominal wall N.

In the present embodiment, the active stereoscopic endoscope 32 has two systems of high-resolution and high-intensity observation means 32a, and a clear stereoscopic image of a required portion can be formed from an arbitrary position and posture. . Further, each ultrafine active treatment instrument 34 is formed by disposing a treatment function portion such as a clip or a suture needle at the tip of the multi-joint micromanipulator 36 forming the approach means. Reference numeral 34a indicates a fine suturing tool having a suture needle for suturing a living tissue at the tip portion, 34b indicates a fine grasping forceps having a clip at the tip, and 34c indicates a microinjector. This micro injector 3
A biocompatible adhesive such as fibrin glue can be injected from 4c to hemostasis or to reinforce the sutured surface. These active substance endoscope 32 and ultrafine active treatment instrument 34
Can be integrally controlled by the control means outside the body cavity together with the extra-fine active treatment instrument 28 of the small-diameter multifunctional endoscope 12.

FIG. 2 shows an embodiment of the fine suturing tool 34a. In the figure, the fine suturing tool 34a of the micromanipulator system 16 will be described. The small-diameter multifunction endoscope 1
The same applies to the fine suturing device 28a, which is the second ultrafine active treatment device. As shown in FIG. 2, the fine suturing tool 34 a includes a suture needle 38 at the tip of the multi-joint micromanipulator 36.
Has been placed. The suture needle 38 has an arc-shaped needle portion 38a.
Is formed in a curved structure having a linear support portion 38b and the support portion 38b is connected to a micromotor 40 which is a drive mechanism built in the multi-joint micromanipulator 30. The connecting portion between the support portion 38b and the micromotor 40 is located at the center of the arc of the needle portion 38a, and when the micromotor 40 is driven by a signal from outside the body, the needle portion 38a is moved from the tip to the living tissue. It can be inserted smoothly. Further, the suture thread 35 is guided from outside the body through the inside of the multi-joint micromanipulator 30, and the tip portion thereof is hooked on the tip side of the needle portion 38a.

When the living tissues M and m of an organ are sutured by the control system 10, they are carried out as follows. First, as shown in FIG. 1, a small-diameter multifunction endoscope 12 is inserted into an organ, a trocar 14 is inserted through an opening formed in a required portion of the abdominal wall, and a micromanipulator system 16 is inserted through the trocar 14. . Then, while operating the hardness varying means 20 contained in the active bending portion 18 of the small-diameter multifunctional endoscope 12 through the control means outside the body cavity, the distal end portion is brought close to the sutured portion from the inside of the organ, and further the micro The tips of the active stereoscopic endoscope 32 and the ultrafine active treatment instrument 34 of the manipulator system 16 are brought close to the sutured site from the outside of the organ.

The suturing of the living tissues M and m is performed by the observation means 22 of the small-diameter multifunctional endoscope 12 and the micromanipulator 1.
While observing the sutured site through the active stereoscopic endoscope 32 of 6, the procedure is performed from both inside and outside of the organ.

As shown in FIG. 2A, when performing this suturing, the suture needle 38 is positioned close to the suturing site by the multi-joint micromanipulator 36, and the needle portion 38 is formed.
a is placed on the opposite side of the living tissues M and m. Thereafter, the micromotor 40 is driven to rotate the suturing needle 38 in the direction of the tip of the needle portion 38a, and the living tissue M, m to be sutured is inserted as shown in FIG. 2B. 18 suture needles
The needle 38a is rotated by 0 °, and the tip of the needle 38a is again moved to the living tissue M,
The rotation is stopped when it projects from m. FIG. 2C shows a state in which the rotation of the suture needle 38 is stopped in this way. Then, the suture thread 35 attached to the suture needle 38
Is inserted into the living tissue M, m in an arc shape along the passage of the needle portion 38a. The suture thread 35 protruding from the living tissues M and m is grasped by the fine grasping forceps 34b, and the suture needle 38 is reversed to return to the original position. In this way, the suture thread 35 is inserted into the living tissue M, m in an arc shape.

Such a suturing operation is performed by the above small-diameter multifunction endoscope 12 from the side opposite to the living tissues M and m, that is, from the inside of the organ. In FIG. 1, the small-diameter endoscope 12 performs varus suture of an organ. It is preferable that the operations of the small-diameter multifunctional endoscope 12 and the micromanipulator system 16 are integrally controlled by a control unit (not shown).

According to this operation system 10, the small-diameter multi-function treatment instrument 12 has the active bending portion 18 by the hardness varying means 20.
Freely bending and flexing each ultrafine active treatment instrument 28 by its articulated micromanipulator 30.
In addition, the micromanipulator system 16 inserted into the body cavity through the trocar 14 has an active stereoscopic endoscope 32.
Further, the ultrafine active treatment instrument 34 can be freely curved to simultaneously approach the sutured portion from the inside and outside of the body cavity organ in any direction, and the high resolution and high brightness observation means 22 and the active stereoscopic endoscope can be used. With 32, it is possible to perform a suture operation safely, reliably and efficiently from the inside and the outside of a required site of an organ while always observing the suture with an appropriate and clear image.

Further, since the suture thread 35 is inserted into the living tissue M, m in an arc shape, the force of the suture thread 35 acting on the living tissue M, m is dispersed. Therefore, the living tissue M, m is not locally subjected to a strong force, and the possibility that the living tissue M, m is broken by the suture thread 35 becomes extremely small. Since the living tissues M and m are sewn from both the front and back sides, the strength of the sewn portion is large, and reliable suturing can be performed, and only the suture thread 35 having an appropriate length is consumed by the suturing operation. And is more economical than using a stapler. As a drive mechanism for driving the suturing needle 38, an appropriate mechanism shown in FIG. 3 or 4 can be adopted instead of the above-mentioned micromotor 40.

The drive mechanism shown in FIG. 3 includes a wire 42 and a pulley 43 instead of the micromotor 40 shown in FIG. By changing the pulling direction of the wire 42, this drive mechanism can rotate the suturing needle 38 in any direction and at any angle. The structure is simplified and can be made simpler. FIG. 4 shows a driving mechanism according to still another embodiment as used in the fine suturing tool 28a of the small-diameter multifunction endoscope 12.

As shown in FIG. 4, the drive mechanism of this embodiment includes a shape memory alloy (SMA) 46 attached to the proximal end of an arcuate suture needle 44, and these suture needle 44 and shape memory alloy are provided. 46 is accommodated in a curved guide tube 48. The guide tube 48 may form a part of the micromanipulator 30 (FIG. 1) of the fine suturing tool 28a. The suturing with the fine suturing tool 28a is performed as follows.

First, as shown in FIG. 4A, the guide tube 4
The micromanipulator 30 (FIG. 1) is operated with the arcuate suture needle 44 accommodated in the needle 8, and the distal end portion thereof is guided to the suture site. Here, the shape memory alloy 46 is energized,
The Joule heat generated by this energization causes shape memory alloy 46.
To stretch. The suture needle 44 attached to the tip of the shape memory alloy 46 is inserted into the living tissue M, m, and as the shape memory alloy 46 extends, the living tissue M, m is removed as shown in FIG. Penetrate. As a result, the suture thread 35 attached near the tip of the suture needle 44 is inserted into the living tissues M, m together with the suture needle 44 in an arc shape. The tip of the suture thread 35 is grasped by the fine grasping forceps 28b. Then, when the energization of the shape memory alloy 46 is stopped, the shape memory alloy 46 is cooled and contracts to the original length, and the suture needle 35 connected to the shape memory alloy 46 also comes out of the living tissues M, m. , Return to the original position. As a result, the suture thread 35 is inserted into the living tissue M, m in an arc shape.

[0025]

As is apparent from the above, according to the surgical system of the present invention, the first treatment tool having at least a suture needle is provided.
And the second treatment tool, respectively, inside and outside the organ in the body cavity
From the side and close to the sutured part, inside and outside the organ in the body cavity
The suture can be sewn from, and safe and reliable suture can be economically performed without the risk of the suture portion being torn after the operation.

[Brief description of drawings]

FIG. 1 is an explanatory diagram of a surgery system according to an embodiment of the present invention.

2 is an explanatory view of a sutured state with a suture needle of the surgical system of FIG. 1. FIG.

FIG. 3 is an explanatory view showing another embodiment of the drive mechanism of the suture needle.

FIG. 4 is an explanatory diagram of still another embodiment.

[Explanation of symbols]

10 ... Surgery system, 12 ... Small diameter multifunctional endoscope, 16 ...
Micromanipulator system, 18 ... Active bending part,
20 ... Hardness varying means, 28, 34 ... Ultra-fine active treatment instrument, 3
0, 36 ... Articulated micromanipulator, 35 ... Suture thread, 38, 44 ... Suture needle, 40 ... Micromotor, 42
... wire, 43 ... pulley, 46 ... shape memory alloy.

Claims (2)

(57) [Claims] 1. A sutured part for inserting into a body cavity and organs in the body cavity
First approach hand that can be approached from inside the organ
The step and the suture by the first approach means
Closed and sewn into the living tissue from the inside of the body cavity organ.
First procedure having at least a suture needle capable of inserting a compound thread
Instrument and the suture needle of the first treatment instrument are used as living tissue of the organ.
The first drive mechanism that inserts inside the body, and
The second suture can be approached from outside the organ
And the second approach
From the outside of the body cavity organ
Fewer suture needles can be used to insert sutures into living tissue.
A second treatment tool that is provided at least and sewing of the second treatment tool
Second driving machine for inserting the needle into the living tissue of the organ
And a control for controlling the first and second approach means.
A surgical system having a control means . 2. The suture needle has an arcuate shape, and the drive mechanism rotates the suture needle about the center of the arc to pierce the suture needle into the living tissue of an organ in an arcuate shape so that a suture thread is formed. The surgical system according to claim 1, wherein the surgical system is inserted.