JP3587571B2 - Medical suture device - Google Patents

Description

[0001]
[Industrial applications]
The present invention relates to a medical suturing device used for suturing tissue with a suture in a surgical operation, for example.
[0002]
[Prior art]
2. Description of the Related Art Conventionally, as a medical suturing device for sewing a living tissue or the like with a suture, there is a suturing device disclosed in U.S. Pat. No. 3,657,056, for example. This suture device uses an ultrasonic wave to easily create a knot (thread clasp) of the yarn, and connects the yarn with the yarn by ultrasonic waves or an end portion of the yarn passed through a fastener. Is deformed by an ultrasonic wave to form a head shape, thereby connecting the fastener and the thread.
[0003]
In addition, as such a suturing device, a suturing clip disclosed in U.S. Pat. No. 5,171,251, U.S. Pat. No. 5,306,280, Japanese Patent Application Laid-Open No. 6-7361 and the like are also available. is there. In this suture clip, a suture is placed inside a clip made of a polymer material having two feet, and in this state, heat is applied to the clip to soften the clip. And then removing the heat and compressive force to tether the suture and clip.
[0004]
[Problems to be solved by the invention]
However, when the sutures are connected to each other by the ultrasonic suturing device disclosed in U.S. Pat. No. 3,657,056, a sufficient joining strength cannot be obtained because the joining area between the sutures is small. In addition, since ultrasonic waves are applied while applying tension to the yarn, it is necessary to set the size of the ultrasonic waves, the emission time, the tension of the yarn, and the like within an allowable range so that the yarn is not cut by the tension and the ultrasonic energy. Therefore, the suturing operation and the suturing strength are restricted by the suture itself. Further, the operation of shaping the end of the suture into a head shape is not easy.
[0005]
In contrast, the aforementioned suture clips do not have such disadvantages. However, since heat is applied to the clip to soften the entire clip, the time required from heating to softening, cooling, and curing requires about 10 seconds. Therefore, quick suturing cannot be performed. Further, since the clip and the thread must be held for 10 seconds, a considerable burden is imposed on the operator and the patient, and the efficiency of the suturing operation is low. Especially when many parts are clipped, the operation is very difficult. In addition, since the clip is made of a polymer, the hinge portion of the clip is elastically deformed by an external force, and as a result, both legs of the clip may be opened and the suture may come off.
[0006]
The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a medical suturing device capable of obtaining a sufficient suturing strength by a simple suturing operation.
[0007]
Means and action for solving the problem
In order to solve the above-mentioned problem, a medical suture device of the present invention includes a suture connected and fixed, a suture fixing member having at least one accommodating portion capable of accommodating a part of the suture, and a surgical site. A sheath that can be inserted into the sheath and that can set the thread stop member in a detachable manner, and that the thread stop member disposed in the sheath and set in the sheath is deformed to allow the thread stop member to be inserted into the housing portion. Thread fastening means for tightening and fixing the suture accommodated in the armature.
[0008]
According to the above configuration, in a state where the suture is drawn into the accommodation portion of the suture fixing member, the suture can be deformed by the suture fixing means to tighten and fix the suture. In other words, the thread fastening means can deform the thread fastening member such that the suture is fastened by the thread fastening member and coupled to the thread fastening member.
In particular, when the thread fastening means deforms the thread fastening member by ultrasonic vibration energy, the suturing operation can be performed more quickly.
[0009]
【Example】
Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 shows a medical suturing device 1 according to an embodiment of the present invention. As shown in FIG. 1B, the suturing device 1 of the present embodiment includes a tubular sheath 5 that can be inserted into the body and a hollow ultrasonic probe 6 that is inserted into the sheath 5 so as to be able to advance and retreat. The suturing device main body is configured. The ultrasonic probe 6 is connected to an ultrasonic transducer (not shown) and an ultrasonic drive circuit. An opening 10 is formed at the distal end of the sheath 5, and the suture body 20 can be set in the distal end of the sheath 5 through the opening 10.
[0010]
That is, as shown in FIG. 1A, the suture body 20 includes a resin thread stop member 4 having a U-shaped cross section, a suture 2 connected and fixed to the thread stop member 4, And a suture needle 3 provided at the tip of the suture 2. The suture body 20 is detachably set on the sheath 5 by fitting and fixing the suture fixing member 4 into the distal end of the sheath 5 through the opening of the sheath 5. In this case, the opening 10 of the sheath 5 is formed by cutting out the upper surface on the distal end side of the sheath 5, and when the thread probe 4 set on the sheath 5 is pushed forward by the ultrasonic probe 6, the thread is clamped. The distal end of the sheath 5 is formed with a large cutout so that the member 4 can protrude from the distal end side of the opening 10.
[0011]
The suture 2 used in this embodiment is preferably formed of a bioabsorbable resin, but may be non-absorbable. In addition, the suture 2 can use a monofilament (single line) and a multifilament (double line). In this case, the monofilament preferably has a two-layer structure of a core made of a material having a high tensile strength and a clad made of a material having a good welding property. The multifilament is preferably formed by knitting a yarn or twisting a yarn. In this manner, when the suture 2 is tightened in the suture member 4 and the two are joined (described later), the suture member 4 bites into the stitches or twists of the suture 2 and the joining strength is increased. And the suture 2 hardly slips off from the thread stopper 4. In this case, the multifilament may be formed by combining different materials.
[0012]
The suture needle 3 provided at the distal end of the suture thread 2 is appropriately selected depending on the suture site, such as a linear one, a curved one, or a straight one with a curved end. To use.
[0013]
Next, a case where the living tissue is sutured using the suturing device 1 having the above configuration will be described with reference to FIG.
First, the suture body 20 is set on the sheath 5. In this operation, the ultrasonic probe 6 in the sheath 5 is slightly retracted toward the hand side to form a space in the distal end portion of the sheath 5 in which the thread stopper 4 can be accommodated, and the thread stopper 4 is opened in this space. This is done by setting through.
[0014]
Next, the sheath 5 on which the suture body 20 is set is inserted into a body cavity via a trocar (not shown). Then, the suture needle 3 is pierced into the living tissue 30 to be sutured while holding the suture needle 3 with a needle holder (not shown) inserted into the body cavity by another route, and the suture 2 coming out of the living tissue 30 is sewn. Is drawn into the U-shaped groove 4a of the thread stopper 4 (the state shown in FIG. 2A).
[0015]
In this state, as shown in FIG. 2B, the suture 2 is pulled using the forceps 32, and the ultrasonic probe 6 is advanced in the sheath 5 while the tissues are joined by the pulling force. The distal end of the sheath 5 is pressed against the suture site of the tissue 30 in a state where the sheath 5 is pressed against the suture fixing member 4. Then, in this state, the ultrasonic waves from the ultrasonic probe 6 are transmitted to the thread stopper 4. Thereby, the inside of the thread stopper member 4 is heated and softened by the ultrasonic waves from the ultrasonic probe 6, and is easily deformed by the pressing force of the ultrasonic probe 6 to tighten the suture 2. At this time, the ultrasonic probe 6 pushes the suture member 4 toward the tissue 30 while pulling the suture 2 together with the deformation of the suture member 4, and pulls the sheath 5 back toward the hand side (the state shown in FIG. 2C). Then, the thread stopper 4 comes out of the distal end of the opening 10 (sheath 5) and presses against the suture portion of the tissue 30, and the suture strength to the tissue 30 increases.
[0016]
Thereafter, the suture 2 and the thread stopper 4 are left in the body in this state. At this time, the excess suture 2 is cut off with scissors forceps and collected together with the suture needle 3. This completes the suturing of the tissue.
[0017]
As described above, according to the medical suturing device 1 of the present embodiment, the suture thread 2 can be easily drawn into the thread fastening member 4 by the U-shaped groove 4a formed in the thread fastening member 4, In a state where the suture thread 2 is drawn into the U-shaped groove 4a, the suture thread member 4 can be deformed by ultrasonic waves to tighten the suture thread 2, so that the suture thread can be securely, easily and quickly formed. Can be.
[0018]
In addition, since the suture 2 is tightened by ultrasonically deforming the suture member 4 to join the sutures 2 together, the sutures 2 may be joined together and sutured, or the suture 2 and the suture clamp 4 may be crimped by heat. The suturing strength is higher than in the case where Therefore, the suturing state is not loosened by the subsequent external force, and the joined state between the suture fixing member 4 and the suture 2 is not released.
[0019]
Further, since the ultrasonic probe 6 deforms the thread fixing member 4 in a state where the ultrasonic probe 6 and the thread fixing member 4 are held in the sheath 5, the sewing operation can be performed easily and reliably.
[0020]
Further, in the medical suturing device 1 of the present embodiment, since the joining force of the tissue joining made by the suture thread 2 can be held in a state where the suture fixing member 4 is pressed against the suture tissue 30, that is, the thread Since the thread fastening can be performed while the stopper member 4 is pressed against the suture tissue 30, the thread fastening strength is high, and thus the sewing operation can be reliably performed with high sewing strength.
[0021]
FIG. 3 shows a modification of the thread stopper 4. That is, the thread stopper 4a shown in FIG. 3A has a V-shape, the thread stopper 4b shown in FIG. 3B has an S-shape, and is shown in FIG. 3C. The thread stopper 4c has a W shape, the thread stopper 4d shown in FIG. 3D has a Z shape, and the thread stopper 4e shown in FIG. 3E has an X shape. The thread stopper 4f shown in FIG. 3 (f) has an H shape. In any case, one or a plurality of grooves 35 through which the suture 2 can be easily pulled in are provided.
[0022]
According to such a configuration, the suture 2 having the tissue sewn can be drawn into one of the grooves 35 according to the tissue / procedure to be sutured. That is, the groove 35 into which the suture 2 is to be drawn can be selected. Thus, if the suture thread 2 can be drawn into the convenient groove 35, the suture can be smoothly advanced.
[0023]
The thread stopper 4g shown in FIG. 3 (g) is formed in a trumpet shape. In such a configuration, the suture 2 having the tissue sewn is inserted into the thread stopper 4g through the wide opening 38 together with the suturing needle 3 and pulled out from the narrow opening 39.
[0024]
Since the wrapper-shaped thread stopper 4g allows the suture 2 to be completely inserted therein, the suture 2 is deformed by the suture 2 when the suture 2 is tightened. Never get out of the way. Therefore, the suture 2 can be easily tightened. In addition, since the wide opening 38 is provided, the suture 2 can be easily passed through the thread stopper 4g.
[0025]
Further, the thread fastening member 40 shown in FIG. 4A has a plurality of holes 40a, 40b, and 40c having different diameters through which the suture 2 can be inserted, and different sizes in which the sewn suture 2 can be locked. It has a plurality of grooves 35a, 35b, 35c. That is, the holes 40a, 40b, 40c to be inserted and the grooves 35a, 35b, 35c to be locked can be selected according to the thickness of the suture thread 2.
[0026]
In this configuration, the knot 41 is formed in a state where the suture 2 is inserted into any one of the holes 40 a, 40 b, and 40 c of the suture fixing member 40, and the suture 2 is fixed to the suture fixing member 40. Then, in this fixed state, the suture 2 having the tissue sewn is locked in any of the grooves 35a, 35b, 35c to perform temporary fixing. After that, the suture fixing member 40 is deformed by ultrasonic waves, and the suture fixing member 40 and the suture 2 are joined.
[0027]
That is, according to this configuration, the suture 2 is temporarily fixed by locking the suture 2 in the grooves 35a, 35b, and 35c, and thus the suture 2 is pulled into the grooves 35a, 35b, and 35c by the forceps. Even when the forceps are separated from the suture 2 later, when the suture 2 is tightened by deforming the suture fixing member 40, the suture 2 may come off from the grooves 35 a, 35 b, 35 c, or the suturing state of the suture 2 may be loose. There is nothing.
[0028]
4B is composed of two rods 45a and 45b, and these two rods 45a and 45b are rotatably connected to each other by a hinge 46. In this configuration, after the tissue is sewn with the suture 2, the bars 45a and 45b are closed in a state where the sewn suture 2 is disposed between the two bars 45a and 45b. In this state, the suture thread 45 is deformed by ultrasonic waves, and the suture 2 is tightened and fixed.
[0029]
4C includes a first member 51 to which the suture 2 is connected and fixed, and an engagement hole 54 that can engage with a projection 53 formed on the first member 51. And a second member 52 having the following. In this configuration, after the tissue is sewn with the suture 2, the projection 53 is engaged with the engagement hole 54 in a state where the sewn suture 2 is disposed between the two members 51 and 52. When the members 51 and 52 are united, the suture 2 is tightened and fixed. Of course, if the suture fixing member 50 is deformed by ultrasonic waves in this state, the suture strength is improved.
[0030]
The thread stopper 55 shown in FIG. 4D includes a rod-shaped member 55a. In this configuration, after the tissue is sewn with the suture thread 2, the suture thread 2 and the rod member 55a are welded by ultrasonic waves in a state where the sewn suture 2 is wound around the rod member 55a.
[0031]
5B is formed in a cylindrical shape, and has a small-diameter hole 61 through which the suture thread 2 passes. FIG. 5A shows the suture body 20 having the thread stopper 60. In this configuration, the knot 63 is formed in a state where the suture 2 is inserted into the small-diameter hole 61 of the suture fixing member 60, and the suture 2 is fixed to the suture fixing member 60.
[0032]
FIG. 6 shows a state in which living tissue is sutured using the suture body 20 having the thread stopper 60 and the suture instrument main body shown in FIG.
That is, first, the thread stopper 60 is set in the distal end portion of the sheath 5 through the opening 10. Thereafter, the sheath 5 on which the thread stopper 60 is set is inserted into the body cavity via a trocar (not shown). Then, while holding the suture needle 3 with a needle holder (not shown), the suture needle 3 is pierced into the living tissue 30 to be sutured, and the suture 2 coming out of the living tissue 30 is inserted into the inner hole of the suture fixing member 60. It is retracted (the state of FIG. 6A).
[0033]
In this state, the suture 2 is pulled using the forceps 32, and the ultrasonic probe 6 is advanced in the sheath 5 and pressed against the suture fixing member 60 while joining the tissues by the pulling force. Then, the distal end of the sheath 5 is pressed against the suture site of the tissue 30. Then, in this state, the ultrasonic waves from the ultrasonic probe 6 are transmitted to the thread stopper 60. Thereby, the inside of the thread stopper member 60 is heated and softened by the ultrasonic waves from the ultrasonic probe 6, and easily deformed by the pressing force of the ultrasonic probe 6 to tighten the suture 2. At this time, when the suture 2 is pushed out to the tissue 30 side by the ultrasonic probe 6 while the suture 2 is being pulled together with the deformation of the suture fixing member 60 and the sheath 5 is pulled back to the hand side, the suture fixing member 60 is opened. 5), it comes out from the tip and comes into pressure contact with the suture portion of the tissue 30, and the suture strength to the tissue 30 increases (see FIG. 6B).
[0034]
Thereafter, the suture 2 and the thread stopper 60 are placed in the body in this state. At this time, the excess suture 2 is cut off with scissors forceps 69 (see FIG. 6B) and collected together with the suture needle 3. This completes the suturing of the tissue.
[0035]
Thereafter, when another tissue site is to be sutured, the suture 2 cut by the scissors forceps 69 is passed through the small-diameter hole 61 of the separately prepared thread stopper 60 (see FIG. 6C), and again. The knot 63 may be formed (see FIG. 6D).
[0036]
The suture fixing member 60 having such a configuration is economical because a single suture thread 2 can be repeatedly used for suturing at a plurality of positions only by preparing a plurality of the suture members. Further, since the suture fixing member 60 is formed in a cylindrical shape and the suture 2 can be completely inserted therein, the suture suture is required when the suture fixing member 60 is deformed to tighten the suture 2. 2 does not come off from the thread stopper 60.
[0037]
FIG. 7 shows a modification of the thread stopper 60. 7A has a plurality of holes 61a, 61b, 61c having different diameters through which the suture thread 2 can be inserted. In this configuration, after selecting a suture 2 having a thickness suitable for suturing, the suture 2 is passed through holes 61a, 61b, 61c having a diameter corresponding to the thickness of the selected suture 2. Thereafter, a knot 63 is created at the end of the suture 2. This is convenient because sutures 2 of various thicknesses can be used.
[0038]
The thread stop member 60b shown in FIG. 7B has a wide and tapered groove 70. In this configuration, after selecting a suture 2 having a thickness suitable for suturing, the suture 2 is fitted into the groove 70 to a depth corresponding to the thickness of the selected suture 2. Since the knot 63 does not need to be formed at the end of the suture thread 2, the suturing operation becomes easy.
[0039]
7C has a plurality of grooves 73a, 73b, 73c having different widths. This configuration is convenient because the grooves 73a, 73b, 73c to be fitted can be selected according to the thickness of the suture thread 2.
[0040]
The thread fastening member 60d in FIG. 7D has a projection 75 that projects in a hook shape. In this configuration, after selecting a suture 2 suitable for suturing, the suture 2 is tied to the projection 75.
[0041]
A projection 76 having a hole 77 is formed on the thread stopper 60e in FIG. In this configuration, after selecting the suture 2 suitable for suturing, the suture 2 is tied to the hole 77.
[0042]
In the embodiment described above, the suture and the suture member are joined by deforming the suture member and tightening the suture. However, the two are joined by adhesion, welding, pressure bonding, or the like. Needless to say, in the above embodiment, the thread fastening member is deformed by ultrasonic waves. However, the thread fastening member may be deformed by laser, heater, electromagnetic wave, electricity, vibration, chemical reaction, or the like. It goes without saying that you can do it.
[0043]
According to the above-described embodiments, various configurations described in the following sections can be obtained. 1. A suture fixing member having a suture connected and fixed therein and having at least one accommodating portion capable of accommodating a part of the suture, and a sheath insertable into a surgical site and capable of detachably setting the suture fixing member And a thread fastening means disposed in the sheath and configured to deform the thread fastening member set in the sheath to tighten and fix a suture housed in the accommodation portion of the thread fastening member. A medical suturing device, characterized in that:
[0044]
2. The medical suturing device according to claim 1, wherein the thread fastening means deforms the thread fastening member by ultrasonic vibration energy.
According to the configuration of the second aspect, the suture and the thread stopper can be quickly fixed. In this case, the ultrasonic vibration energy has a function of causing the inside of the thread stop member to generate heat and welding the contact surfaces of the thread stop members.
[0045]
3. The medical suture instrument according to claim 1, wherein the suture is detachably connected to and fixed to the thread stopper.
According to the configuration of the third aspect, the suture can be repeatedly used during the operation.
4. The medical suturing device according to claim 1, wherein the storage portion of the suture fixing member is capable of locking a suture.
[0046]
【The invention's effect】
As described above, according to the medical suturing device of the present invention, a sufficient suturing strength can be obtained by a simple suturing operation.
That is, the medical suture device of the present invention allows the suture to be easily drawn into the suture fixing member by the storage part formed in the suture fixing member, and the suture to be pulled in the state where the suture is drawn into the storage part. Since the suture can be tightened by deforming the member, it is possible to reliably, easily and quickly form a suture clasp.
[0047]
In addition, since the suture is tightened by deforming the suture member, the suture strength is lower than when the sutures are joined together and the suture is fastened, or when the suture and the suture member are crimped by heat. large. Therefore, the stitching state is not loosened by the subsequent external force, and the connected state between the suture fixing member and the suture is not released.
[0048]
Further, since the thread stopper can be deformed by the thread stopper while the thread stopper and the thread stopper are held in the sheath, the sewing operation can be performed easily and reliably.
[Brief description of the drawings]
1A is a configuration diagram of a suture body constituting a medical suturing device according to one embodiment of the present invention, FIG. 1B is a plan view showing a main part of the medical suturing device, and FIG. It is a sectional side view which shows the principal part of the suturing device.
FIG. 2 is a view showing a state where a suturing operation is performed using the medical suturing device of FIG. 1;
FIG. 3 is a view showing a modified example of the thread stopper member constituting the suture body.
FIG. 4 is a view showing a modified example of the thread stopper member constituting the suture body.
FIG. 5 is a view showing a modified example of the suture fixing member constituting the suture body.
FIG. 6 is a diagram showing a state where a suturing operation is performed using the suturing body of FIG. 5;
FIG. 7 is a view showing a modification of the thread stopper of FIG. 5;
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Medical suturing device, 2 ... Suture thread, 3 ... Suture needle, 4 ... Thread fastening member, 4a ... Accommodation groove (accommodating portion), 5 ... Sheath, 6 ... Ultrasonic probe (thread fastening means).

Claims (1)

A suture fixing member having a suture connected and fixed, and having at least one accommodating portion capable of accommodating a part of the suture;
A sheath that can be inserted into a surgical site and the thread stop member can be detachably set;
Threading means provided in the sheath, for tightening and fixing the suture contained in the accommodation portion of the threading member by deforming the threading member set in the sheath,
A medical suturing device comprising:

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