JP4790549B2 - 縫合具 - Google Patents
縫合具 Download PDFInfo
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- JP4790549B2 JP4790549B2 JP2006249321A JP2006249321A JP4790549B2 JP 4790549 B2 JP4790549 B2 JP 4790549B2 JP 2006249321 A JP2006249321 A JP 2006249321A JP 2006249321 A JP2006249321 A JP 2006249321A JP 4790549 B2 JP4790549 B2 JP 4790549B2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00876—Material properties magnetic
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0417—T-fasteners
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0454—Means for attaching and blocking the suture in the suture anchor the anchor being crimped or clamped on the suture
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
- A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B2017/06052—Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Endoscopes (AREA)
Description
この発明は、このような事情に鑑みてなされたもので、組織の偏りを防止し、穿孔の周囲の組織同士を密着できるようにすることを主な目的とする。
この縫合具は、縫合糸が閉ループ状になるので、穿孔を挟んだ両側の組織を近づけることができる。さらに、1組のアンカー(上記第一の連結部材および上記第二の連結部材)が互いに引き合うように着磁されているので、穿孔を縫合する過程においてアンカー同士が近接して密着する。
また、前記ストッパは、前記第一の端部及び前記第二の端部が前記ストッパから離れる方向へ移動する力が前記縫合糸にかけられたときに前記切片によって前記縫合糸を締め付けてもよい。
図1に本実施形態に使用される内視鏡及び縫合器を示す。内視鏡1(軟性内視鏡)は、術者が操作をする内視鏡操作部2を有する。内視鏡操作部2は、ユニバーサルケーブル3で制御装置に接続されており、各種のスイッチ4や、アングルノブ5が設けられている。内視鏡操作部2の先端は、可撓性で長尺の内視鏡挿入部6が延設されている。内視鏡挿入部6の先端には、体内の映像を取得する観察装置7及び照明装置8と、チャンネル9の先端開口などが設けられている。観察装置7には、CCD(Charge Coupled Device)を有する撮像装置や、光ファイバーなどが用いられる。照明装置8は、光源の光を導く光ファイバーを有する。チャンネル9は、内視鏡挿入部6を通って内視鏡操作部2の側部2aに開口する。側部2aの開口には、蓋10が装着されている。蓋10には、挿入孔が形成されており、この挿入孔から縫合器11などの処置具や、チャンネル9内に挿入される。
図5に示すように、マウスピース40を装着した患者41の口(生体内の自然の開口、肛門、鼻、耳なども含む)から内視鏡挿入部6を挿入する。アングルノブ5で内視鏡挿入部6の先端を湾曲させる。内視鏡挿入部6のチャンネル9に高周波切除具である針状ナイフを通して、胃43の壁部の組織を切開して穿孔を形成する。図6に示すように、内視鏡挿入部6は、胃43に形成した穿孔52を通って腹腔53に導かれる。チャンネル9に鉗子54を通し、鉗子54で腹腔53の処置を行う。処置が終了したら、内視鏡挿入部6は、胃43内に引き戻される。
この把持片64で縫合具16の縫合糸25の結び目31を把持した後に、外シース61を前進させて外シース61の先端をストッパ26に押し当てる。図11に示すように、外シース61がさらに前進すると、ストッパ26が胃43の壁部に向かって押し込まれる。ストッパ26は、この方向に移動可能に構成されているので、壁部に向かってストッパ26が移動する。一対の把持片64の位置は変わらないので、ストッパ26は、縫合糸25に対して相対的に前進する。その結果、ストッパ26とアンカー27との間の距離が縮まって縫合糸25が絞られる。これによって、図12及び図13に示すように、穿孔52の周囲の組織が引き寄せられて、縫合糸25によって穿孔52が縫合される。
磁力で密着するアンカー27を介して縫合糸25が閉ループ状になるので、穿孔52を挟んだ両側の組織の内側と外側とのそれぞれを近づけることができる。したがって、外科的に縫合する場合と同様に、確実に縫合できる。アンカー27の密着の仕方によって縫合糸25のループの径を調整することができる。ループの径を大きくしたいときには、アンカー27同士を平行に密着させれば良い。縫合糸25のループの径を小さくしたいときには、アンカー27同士を直線状に密着させれば良い。
図15に示すようなアンカー70は、縫合糸25の第一、第二の端部のそれぞれに取り付けられ、長手方向に垂直に2分割された連結部材である。2分割された一方の部分70AがS極になり、他方の部分70BがN極になる。磁力によって密着可能な領域が大きいので、アンカー同士が密着し易くなる。
図16に示すようなアンカー71は、縫合糸25の第一、第二の端部のそれぞれに取り付けられ、長手方向に平行に2分割された連結部材である。2分割された一方の部分71AがS極になり、他方の部分71BがN極になる。
図17に示すように、1つ目のアンカー72は、縫合糸25の第一の端部に取り付けられ、磁石から製造された第一の連結部材である。2つ目のアンカー73は、縫合糸25の第二の端部に取り付けられ、強磁性体から製造された第二の連結部材である。強磁性体としては、例えば、純鉄や、パーマロイなどが用いられる。アンカー73は、アンカー72の磁力によってアンカー72に密着し、これらアンカー72,73を介して縫合糸25の両端部が連結される。一方のアンカー72のみが磁石でも、前記と同様の効果が得られる。
これらアンカー27,70,71,72,73は、断面が円形や楕円形でも良いし、断面が四角形などの多角形でも良い。
この実施形態では、第1の実施形態と同じ内視鏡1及び縫合器11を使用する。第1の実施形態と重複する説明は省略する。
図18に示すように、縫合具80は、縫合糸25の第一の端部にリング81が設けられている。リング81は、孔を有する第一連結部材である。縫合糸25の第二の端部には、第二連結部材であるタグ82が設けられている。タグ82の太さは、リング81の内側に挿入可能な大きさである。タグ82の長さは、リング81の外径よりも大きい。リング81及びタグ82は、針14の内部に収容可能である。このため、リング81及びタグ82は、可撓性を有する材料から製造され、折り曲げた形態で針14に収容される。なお、リング81及びタグ82は、針14の内径以下の大きさに製造しても良い。
図5に示すように、内視鏡1が胃43に導かれる。図6に示すように、内視鏡挿入部6は、穿孔52を通って腹腔53に進入する。内視鏡挿入部6に通した鉗子54で腹腔53において処置が行われる。穿孔52を縫合するときには、縫合器11が使用される。図19に示すように、縫合器11の針14が穿孔52の周囲の組織を胃43の内側から腹腔53に向けて貫通したら、プッシャ20を前進させて針14からリング81を押し出す。リング81が押し出されたら、針14を引き戻して組織から引き抜く。さらに、穿孔52を挟んで略対称な位置に、リング81を留置するときと同じ向き、すなわち、胃43の内側から腹腔53に向けて針14を貫通させる。プッシャ20をさらに前進させる。針14からタグ82が腹腔53側に押し出される。タグ82が押し出されたら、針14が壁部から引き抜かれる。
鉗子54を穿孔52から胃43内に引き戻した後に、縫合具80が締め付けられる。締め付け方法は、第1の実施形態と同じである。縫合糸25のループが形成されて穿孔52が塞がれる。
この実施形態によれば、縫合糸25の端部のそれぞれにリング81とタグ82を1つずつ設けたので、リング81とタグ82を係合させることで縫合糸25のループを形成でき、確実に穿孔を縫合できる。
縫合糸25の先端部の形態は、磁石や、リング、タグ、フックに限定されない。縫合糸25の両端部を束ねた後に、クリップや高周波鉗子などの処置具で両端部を係合させ、その後に縫合糸25を締め付けても良い。縫合糸25の両端部を接着剤で接着してから縫合糸25を締め付けても良い。
第1の実施形態のアンカー27を処置具で掴んで強制的に密着させ、その後に縫合糸25を締め付けても良い。
図24に示すように、内視鏡挿入部6が2つのチャンネル9を有する場合に、それぞれのチャンネル9に縫合器11を1本ずつ通しても良い。この場合に、縫合具16のアンカー27は、各縫合器11の針14のそれぞれに1つずつ収容される。他のタイプのアンカーについても同様である。
25 縫合糸
27,70,71,72,73 アンカー(第一の連結部材、第二の連結部材)
43 胃(管腔器官)
52 穿孔
81 リング
82 タグ
86 フック
Claims (3)
- 管腔器官に形成された穿孔を縫合する縫合具であって、
前記穿孔の周囲の組織を、前記管腔器官の管壁の厚さ方向における第一の表面側から、前記第一の表面と反対の第二の表面側へ貫通する縫合糸と、
前記縫合糸の第一の端部に設けられ、前記第二の表面側に配置される第一の連結部材と、
前記縫合糸の第二の端部に設けられ、前記第二の表面側に配置され前記第一の連結部材に連結可能な第二の連結部材と、
前記第一の表面側に配置され、前記縫合糸を保持し、前記第一の連結部材と第二の連結部材とに対する距離を短くするように前記縫合糸に沿って相対移動可能なストッパと、
を有し、
前記第一の連結部材は、少なくとも一部が着磁されており、前記第二の連結部材は、前記第一の連結部材の磁力によって前記第一の連結部材に密着する部材を有する縫合具。 - 請求項1に記載の縫合具であって、
前記ストッパは、前記縫合糸を通す貫通孔が中央に形成された細長の板状で、長手方向の両端部は前記中央側へ折り返され、前記縫合糸を挟み込む切片が前記両端部に形成されている縫合具。 - 請求項2に記載の縫合具であって、
前記ストッパは、前記第一の端部及び前記第二の端部が前記ストッパから離れる方向へ移動する力が前記縫合糸にかけられたときに前記切片によって前記縫合糸を締め付ける縫合具。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/238,006 | 2005-09-28 | ||
US11/238,006 US8702753B2 (en) | 2005-09-28 | 2005-09-28 | Method for suturing perforation and suture instrument |
Publications (2)
Publication Number | Publication Date |
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JP2007090062A JP2007090062A (ja) | 2007-04-12 |
JP4790549B2 true JP4790549B2 (ja) | 2011-10-12 |
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Application Number | Title | Priority Date | Filing Date |
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JP2006249321A Expired - Fee Related JP4790549B2 (ja) | 2005-09-28 | 2006-09-14 | 縫合具 |
Country Status (4)
Country | Link |
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US (1) | US8702753B2 (ja) |
EP (1) | EP1769749B1 (ja) |
JP (1) | JP4790549B2 (ja) |
DE (1) | DE602006010153D1 (ja) |
Families Citing this family (135)
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US8652172B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Flexible anchors for tissue fixation |
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