JP5943748B2 - Medical suture tool - Google Patents

Description

  TECHNICAL FIELD The present invention relates to a medical suturing device used when a suture for holding a visceral wall of an organ such as a stomach or a bladder from the outside of the body to the body surface such as an abdominal wall is introduced into the internal organ or pulled out from the internal organ. .

  Conventionally, enteral nutritional administration that supplies liquid foods, nutrients, etc. using a fistula catheter to people who have the ability to ingest food by mouth due to aging or illness (hereinafter referred to as patients) has been Has been done. For example, in the case of using percutaneous endoscopic gastrostomy (PEG), a through-hole (for example, a fistula such as a gastrostoma) penetrating the patient's abdominal wall and visceral wall (gastric wall) is created. Then, a fistula catheter is attached to the through hole, and liquid food or the like is supplied to the patient through the fistula catheter.

  When constructing a through hole, in order to easily form the through hole, the visceral wall and the abdominal wall which are easy to move are usually sutured and fixed percutaneously using sutures. Various types of medical suturing tools have been proposed that are used for securing the visceral wall and the abdominal wall together.

  As such, “inside the case body, it is housed in the inside of the puncture needle 30 for feeding and the sending mechanism for sequentially sending the sutures inserted from the proximal end of the puncture needle 20 for inserting the suture in the distal direction. A medical device is disclosed that houses a protruding mechanism that causes the annular member of the stylet to protrude from the distal end of the suture grasping puncture needle 30 (see, for example, Patent Documents 1 and 2). This medical instrument is designed so that ligation in a living body can be carried out efficiently and safely by only one operator or two operators and an assistant.

JP 2009-213763 A (for example, FIG. 5 and FIG. 6) JP 2009-213764 A (for example, FIG. 5 and FIG. 6)

  In a medical instrument as described in Patent Documents 1 and 2, a stylus is used to form an annular member in an annular shape after puncturing a suture insertion puncture needle and a suture grasping puncture needle from the abdominal wall into the stomach. Operation to push the let, operation to turn the operation roller to insert the suture into the stomach, and operation to push the release button to grasp the suture with the annular member are required, and the operability is low. It was.

  In a medical instrument as described in Patent Documents 1 and 2, when the internal organ wall and the abdominal wall are fixed at a plurality of locations, the operator must insert a suture into the medical instrument each time. There was a lot of trouble for the surgeon. For this reason, reduction of the work burden at the time of inserting a suture into a medical instrument has been desired.

  The present invention has been made to solve the above-described problems, and provides a medical suturing tool in which the burden on the operator is reduced.

The medical suturing instrument according to the present invention is housed in the suturing needle introduction needle, the grasping instrument introducing needle provided substantially parallel to the suturing thread introducing needle at a predetermined distance, and the grasping instrument introducing needle. A suture gripper that has a gripping portion on the distal end side that extends in the direction of the suture thread introduction needle when it comes out from the gripper needle introduction needle and is slidably inserted into the gripper needle introduction needle A tool, a gripper feed-back mechanism that moves the suture gripper in the axial direction, a suture feed mechanism that feeds the suture to the distal end side of the suture introduction needle, and an operation unit that receives an operation from the operator When the operation unit is operated, the gripping tool feed-back mechanism transmits an operation force applied to the operation unit to the suture gripping tool, and the gripping part of the suture gripping tool Projecting from the tip of the gripper introduction needle, and the gripper guides the gripper When protruding from the tip of the needle to a predetermined position, the transmission of the operating force to the suture grasping tool is released and the suture grasping tool is not displaced, and the suture feed mechanism is at least one of the grasping portions. After the portion protrudes from the distal end of the gripper introduction needle, the operating force is transmitted to the suture to cause the suture to protrude from the distal end of the suture introduction needle, and then to the suture. The transmission of the operating force is released, and the suture is allowed to advance and retract .

  According to the medical suturing tool of the present invention, the suture grasping tool can be introduced into the internal organs and the suture thread can be introduced into the internal organs in conjunction with the input operation to the operation unit. The burden can be reduced.

It is a figure explaining the medical suture tool which concerns on embodiment. It is a principal part schematic sectional drawing of the holding | gripping tool return mechanism vicinity of the medical suturing tool which concerns on embodiment. It is a principal part schematic sectional drawing of the suture-feeding mechanism vicinity of the medical suture tool which concerns on embodiment. It is a figure explaining the holding body provided in the suture thread feeding mechanism which concerns on embodiment. It is a figure explaining the structure of the base end side of the suture feed mechanism of the medical suture tool which concerns on embodiment. It is a figure explaining the structure of the front end side of the suture feed mechanism of the medical suture tool which concerns on embodiment. It is a schematic sectional drawing explaining operation | movement of the medical suturing tool which concerns on embodiment, and is a figure which shows the initial state of a medical suturing tool. It is a schematic sectional drawing explaining operation | movement of the medical suturing tool which concerns on embodiment, and is a figure which shows the delivery operation | movement of a suture grasping tool and a suture. It is a schematic sectional drawing explaining operation | movement of the medical suturing tool which concerns on embodiment, and is a figure which shows return operation | movement of a suture grasping tool. It is a figure explaining a mode that a visceral wall and an abdominal wall are fixed using the medical suturing tool which concerns on embodiment.

  DESCRIPTION OF EMBODIMENTS Hereinafter, embodiments of a medical suturing device according to the present invention will be described with reference to the drawings. In addition, this invention is not limited by the form of drawing shown below.

Embodiment.
[Configuration of medical suturing device]
1A and 1B are diagrams illustrating a medical suturing tool (hereinafter referred to as a suturing tool 100) according to an embodiment. FIG. 1A is a schematic cross-sectional view of the suturing tool 100, and FIG. 3 is a perspective view of the thread gripping tool 10. FIG. The suture instrument 100 is used to introduce a suture thread that holds and holds the visceral wall of an organ such as the stomach or bladder from the outside of the body to the abdominal wall side in order to facilitate fistula insertion for inserting a fistula catheter. It is what In addition, in the following drawings including FIG. 1, the relationship of the size of each component may be different from the actual one.

  The suturing tool 100 is housed inside the grasping tool introducing needle 2, the suturing thread introducing needle 3 provided substantially parallel to the grasping tool introducing needle 2 at a predetermined distance, and the grasping tool introducing needle 2. The suture grasping tool 10, the grasping tool feed-back mechanism 20 that feeds back the suture grasping tool 10 in the axial direction, and the suture feed mechanism 30 that sends the suture 1 inserted into the suture introduction needle 3. The operation unit 40 operated by the surgeon and the support column 50 that integrally supports them are provided.

  In the following description, the distal end side refers to the side inserted into the patient in use, that is, the needle tip direction of the grasping tool introduction needle 2 and the suture introduction needle 3 (the lower side in the drawing in FIG. 1). Shall. Further, the proximal end side means a side (upper side of the drawing in FIG. 1) operated by the operator in the usage state. Further, the forward direction may be referred to as the forward direction and the proximal direction may be referred to as the backward direction. In FIG. 1, the suture thread 1 fed from the distal end (needle tip) of the suture thread introduction needle 3 by the suture tool 100 is also conceptually illustrated.

(Suture 1)
Although the suture thread 1 does not constitute the suture tool 100, it functions as an organ fixing tool and will be briefly described. The suture thread 1 is made of a material (for example, nylon thread or the like) having a flexibility that can be bent along a living tissue when inserted into a living body and a tensile strength that can lift an organ. Configure. The suture 1 is cut when it is attached to or removed from the patient. For this reason, it is preferable that the suture thread 1 is composed of a material and a diameter dimension that can be cut with a tool provided at a medical site such as scissors. Furthermore, it is preferable that the suture thread 1 has a length required for a plurality of fixing procedures. The surgeon punctures the patient with the suture tool 100 in a state where the suture thread 1 is inserted up to the tip of the suture thread introduction needle 3.

(Suture grasping tool 10)
The suture grasping tool 10 includes a thin rod-shaped shaft portion 11 that can move in the front-rear direction within the lumen of the grasping device introduction needle 2, and a grasping portion 12 provided at the tip of the shaft portion 11. The proximal end of the shaft portion 11 is connected to the gripping tool feed back mechanism 20. The grip portion 12 is made of a flexible material, and when inserted into the gripping tool introduction needle 2, the gripping portion 12 is deformed substantially linearly and accommodated in the lumen of the gripping tool introduction needle 2. However, as shown in FIG. 1B, in a state where the needle is introduced from the tip of the grasping tool introduction needle 2 (a state where no external force is applied), it is restored to an annular shape.

  In the use state, as shown in FIGS. 8E and 8F described later, the suture thread 1 is inserted into the grip portion 12. For this reason, when restoring so that the suture thread 1 delivered from the distal end of the suture thread introduction needle 3 is more reliably inserted into the inside of the grip portion 12 delivered from the distal end of the grasper introduction needle 2. The extending direction and size of the grip portion 12 are set. For example, if the grip portion 12 is formed in such a size that the center of the grip portion 12 is positioned on the extension line of the suture thread introduction needle 3, the suture thread 1 delivered from the suture thread introduction needle 3 can be gripped more reliably. It is inserted into the part 12.

In the present embodiment, the shape of the gripping part 12 in plan view is a substantially circular ring shape, but the gripping part 12 in a state of being fed from the tip of the gripper introduction needle 2 (a state in which no external force is applied). The planar shape is not limited to a substantially circular ring shape. For example, the gripping portion 12 is formed so as to have an arcuate shape when viewed from the side in a state where the gripper is introduced from the tip of the gripper introduction needle 2, and the gripping portion 12 is formed at a predetermined angle with the tip of the shaft portion 11. It can be fixed with. The curved shape of the grip portion 12 in this case is, for example, a shape in which the apex portion of the curved portion protrudes in the forward direction (tip direction) in a state where the grip portion 12 is viewed from the side. Good. If the grip portion 12 is formed in such a shape, the suture thread 1 can be more reliably positioned inside the grip portion 12.
Moreover, the holding part 12 is not limited to such an endless shape without an end part. For example, the grip portion 12 is configured by a thin line extending in a bifurcated manner from the distal end of the shaft portion 11 and formed with a bent portion at each distal end portion, and is gripped when being fed from the distal end of the gripper introduction needle 2 The portion 12 extends toward the suture introduction needle 3 side. In this case, the size of the gripping portion 12 and the tip of the gripper introduction needle 2 are inserted so that the suture thread 1 fed from the tip of the suture thread introduction needle 3 is inserted between the two thin lines divided into two branches. Adjust the direction when it is sent out from the.

  Further, in the annular gripping portion 12 of the present embodiment, the portion facing the connecting portion with the shaft portion 11 may be substantially V-shaped or substantially U-shaped. By doing in this way, since the width | variety of the part (substantially V-shaped, substantially U-shaped part) which hold | grips the suture thread 1 of the holding part 12 can be narrowed, the suture thread 1 can be pinched | interposed into the said part. Thus, the suture thread 1 fed out from the tip of the suture thread introduction needle 3 can be gripped more reliably.

  The holding part 12 should just be comprised with the member which can deform | transform, for example, a stainless steel wire (high tensile stainless steel for springs), a piano wire (a piano wire with nickel plating or chrome plating), or a superelastic alloy Wires (alloys of titanium and nickel, alloys of copper and zinc (or alloys including beryllium, silicon, tin, aluminum, gallium, etc.), alloys of nickel and aluminum, etc.) can be used.

  The shaft portion 11 can be configured using a metal (for example, stainless steel), a synthetic resin (for example, a polyolefin such as polypropylene or polyethylene, or a fluororesin such as PTFE or ETFE). The shaft portion 11 can be configured using a stylet or the like. When the grip portion 12 is made of a relatively rigid material, the shaft portion 11 and the grip portion 12 may be made of the same material. In this case, the shaft portion 11 and the grip portion 12 may be configured integrally or may be configured separately.

(Gripping tool introduction needle 2)
The grasping tool introduction needle 2 has a lumen penetrating in the front-rear direction, and accommodates the suture grasping tool 10 in the lumen so as to be movable in the front-rear direction. The proximal end portion of the grasping tool introducing needle 2 is attached to a needle holding portion 51 that constitutes a part of the support column 50 so that the opening of the proximal end portion is opened to the grasping tool feed-back mechanism 20 side. Yes. The gripper introduction needle 2 is attached to the needle holder 51 so that the axis of the gripper introduction needle 2 coincides with the axis of the gripper feed-back mechanism 20. By doing so, the gripping tool feed-back mechanism 20 can feed back the suture gripping tool 10 linearly. The gripper introduction needle 2 may be formed of a metal such as stainless steel.

  The grasping tool introduction needle 2 has a blade surface for puncturing the skin at the tip. The blade surface may be formed by cutting the gripping tool introduction needle 2 at a surface that obliquely intersects the axis of the gripping tool introduction needle 2. The distal end opening of the grasping tool introducing needle 2 is configured so that the grasping portion 12 of the suture grasping tool 10 fed out from the distal end opening of the grasping tool introducing needle 2 extends more reliably in the direction of the suture introducing needle 3. Therefore, it is preferable that the opening is made toward the suture thread introduction needle 3.

  The shape of the grasping tool introduction needle 2 is not particularly limited as long as it can puncture the skin and insert the suture grasping tool 10. For example, as the grasping tool introduction needle 2, one having an outer diameter of about 21 to 17 G (preferably 20 to 18 G) and a length of about 70 to 120 mm (preferably 80 to 100 mm) may be used. Further, it is preferable to form a chamfered portion at the tip of the grasping tool introduction needle 2 so that the grasped suture thread 1 is not broken.

(Suture introduction needle 3)
The suture thread introduction needle 3 has a lumen penetrating in the front-rear direction, and the suture thread 1 is inserted into the lumen so as to be movable in the front-rear direction. The proximal end portion of the suture thread introducing needle 3 is attached to a needle holding portion 51 that constitutes a part of the strut so that the opening of the proximal end portion is opened to the suture feed mechanism 30 side. The suture introduction needle 3 is attached to the needle holding portion 51 such that the axis coincides with the axis of the suture feed mechanism 30. By doing so, the suture feed mechanism 30 can feed the suture 1 linearly. The suture thread introduction needle 3 may be formed of a metal such as stainless steel.

  The suture introduction needle 3 has a blade surface for puncturing the skin at the tip. The blade surface may be formed by cutting the suture introduction needle 3 at a surface that obliquely intersects the axis of the suture introduction needle 3. The direction of the distal end opening of the suture thread introduction needle 3 is not particularly limited, but may be in the direction of the grasping tool introduction needle 2.

  The suture thread introduction needle 3 is not particularly limited in shape as long as it can puncture the skin and insert the suture thread 1. For example, as the suture thread introducing needle 3, one having an outer diameter of about 21 to 17 G (preferably 20 to 18 G) and a length of about 70 to 120 mm (preferably 80 to 100 mm) may be used.

(Grip tool feed back mechanism 20)
The gripping tool feed back mechanism 20 feeds the suture gripping tool 10 to the distal end side and pulls back the sent suture gripping tool 10 to the proximal end side. The gripping tool holder 21, the first elastic member 22, and the like. Is provided. In the present embodiment, when the operation unit 40 is operated by the operator, the gripping tool feed-back mechanism 20 operates by receiving the operation force.

FIG. 2 is a schematic cross-sectional view of the main part in the vicinity of the gripping tool feed-back mechanism of the medical suturing tool according to the embodiment. 2A, 2 </ b> B, and 2 </ b> C, an example of an operation state of the gripping tool feed-back mechanism 20 is shown together with the operation unit 40.
The grasping tool holder 21 connects the connecting piece 211 for connecting and fixing the suture grasping tool 10, the base end wall 212 arranged to face the connecting piece 211 in the axial direction, and the connecting piece 211 and the base end wall 212. And a peripheral wall 213 extending in the axial direction. A space surrounded by the connecting piece 211, the base end wall 212, and the peripheral wall 213 is referred to as an accommodation space 214, and the first elastic member 22 is accommodated in the accommodation space 214. In the present embodiment, the gripper holder 21 is provided with a protrusion 215 that protrudes toward the suture feed mechanism 30.

  The connecting piece 211 is a member that fixes the proximal end portion of the shaft portion 11 of the suture grasping tool 10, and constitutes a wall on the distal end side of the accommodation space 214 in the present embodiment. In the present embodiment, the connecting piece 211 is formed separately from the base end wall 212 and the peripheral wall 213 and is fixed to the peripheral wall 213. A through passage extending in the axial direction is formed in the connecting piece 211 of the present embodiment, and an engaging portion 211a having an inner diameter narrowing stepwise toward the distal end is formed in the through passage, and a suture thread By engaging the engaging portion 13 having a large diameter formed at the base end portion of the shaft portion 11 of the gripping tool 10 with the locking portion 211a, the connecting piece 211 and the suture gripping tool 10 are connected and fixed. . The fixing manner of the suture grasping tool 10 is not particularly limited. For example, the shaft portion 11 and the connecting piece 211 may be fixed using an adhesive or the like, or the notch provided in the connecting piece 211 is used. You may fix so that the axial part 11 may be fitted in. In addition, a portion for fixing the suture grasping tool 10 (the connecting piece 211) may be formed integrally with the base end wall 212 and the peripheral wall 213.

  The first elastic member 22 is an elastic member having an elastic force that can expand and contract in the front-rear direction. In the present embodiment, an example in which the first elastic member 22 is configured by a coil-shaped push spring is shown, but other springs (coil spring, air spring, etc.), rubber, or the like may be used. The first elastic member 22 is accommodated in the accommodating space 214 of the gripper holder 21 in a state compressed in the front-rear direction. Further, the first elastic member 22 accommodated in the accommodation space 214 has room for further compression, and the first elastic member 22 is compressed when a force is applied in the front-rear direction.

  As shown in FIG. 2A, the operation unit 40 is inserted between the proximal end portion of the first elastic member 22 and the proximal end wall 212 of the gripping tool holder 21. Since the first elastic member 22 is housed in the housing space 214 of the gripper holder 21 in a compressed state in the front-rear direction, a force is applied to press the operation portion 40 toward the base end wall 212 side. ing.

  FIG. 2B shows a state in which the operation unit 40 is pushed toward the distal end side. As shown in FIG. 2 (b), the operating portion 40 is moved to the distal end side by a force exceeding the frictional force between the grip portion 12 accommodated in the gripper introduction needle 2 and the lumen of the gripper introduction needle 2. When it is pushed, the force applied to the operation unit 40 is transmitted to the gripping tool holder 21 via the first elastic member 22, and the gripping tool holder 21 moves toward the distal end side.

  FIG. 2C shows a state where the operation unit 40 is further pushed toward the distal end side in a state where the gripper holder 21 is moved to the most distal end side. As shown in FIG. 2 (c), the tip of the gripping tool holder 21 abuts on the first protrusion 57 provided on the support column 50, so that the movement of the gripping tool holder 21 toward the tip side is restricted. In this state, when the operation unit 40 is pushed toward the distal end side with a force capable of compressing the first elastic member 22, the force applied to the operation unit 40 compresses the first elastic member 22 and the gripping tool holder 21. The operation unit 40 moves toward the tip side while the position is fixed.

  The gripper holder 21 is moved to the proximal end side by the reverse procedure (FIGS. 2C, 2B, and 2A) shown in FIGS. 2A, 2B, and 2C. It is also possible to do. The movement of the gripping tool holder 21 toward the base end side is restricted by the base end wall 212 of the gripping tool holder 21 coming into contact with a part of the suture thread feeding mechanism 30 (a base end wall 323 described later). In addition, the structure for restricting the movement of the gripping tool holder 21 in the front-rear direction such as the base end wall 323 and the first protrusion 57 is an example, and other structures may be adopted as long as the same function can be exhibited. Can do.

  The grasping tool holder 21 may fix the suture grasping tool 10 and accommodate the first elastic member 22 therein, and may be configured to be movable in the front-rear direction, and its outer shape is particularly limited. It is not a thing. For example, the gripping tool holder 21 may be constituted by a hollow columnar member (cylindrical member), a hollow prism member (square tube member), or the like, and a slit or a cut is formed in a part of the wall of the gripping tool holder 21. The accommodation space 214 may be configured to communicate with the outside. In the example of FIG. 2, the peripheral wall 213 is not provided in a part of the grasping tool holder 21 on the suture feed mechanism 30 side, and the accommodation space 214 is opened toward the suture feed mechanism 30 side.

(Suture feed mechanism 30)
In FIG. 1, a suture feed mechanism 30 is a mechanism that feeds the suture 1 inserted into the suture introduction needle 3 so as to be movable in the front-rear direction from the distal end of the suture introduction needle 3. The suture thread feeding mechanism 30 includes a holding body 31, a holding body holder 32 that accommodates the holding body 31, a first pipe 33, a second pipe 34, a third pipe 35, and a second elastic member 36. . In the present embodiment, when the operation unit 40 is operated by the operator, the suture feed mechanism 30 operates by receiving the operation force.

  FIG. 3 is a schematic cross-sectional view of the main part in the vicinity of the suture feed mechanism of the medical suturing device according to the embodiment. 3A, 3 </ b> B, and 3 </ b> C, an example of the operation state of the suture feed mechanism 30 is shown together with the operation unit 40.

  The holding body 31 has a through passage 311 penetrating in the front-rear direction, and is a member that holds a member to be held (the suture thread 1, the first pipe 33, and the second pipe 34) inserted into the through passage 311. is there. The holding body 31 is movable in the front-rear direction, and selectively holds one of the suture thread 1, the first pipe 33, and the second pipe 34 according to the position.

  FIG. 4 is a view for explaining a holding body provided in the suture thread feeding mechanism according to the embodiment. Note that the horizontal direction in FIG. 4 coincides with the front-rear direction of the suturing tool 100. The holding body 31 of the present embodiment is made of an elastic body such as natural rubber or synthetic rubber, for example, and as shown in FIG. 4A, a through passage 311 penetrating in the front-rear direction is formed inside. ing. The holding body 31 tightens the held member inserted into the through passage 311 using its own elastic force, and friction between the surface of the through passage 311 and the held member inserted into the through passage 311. The held member is held by force.

  The through passage 311 is provided so as to penetrate the holding body 31 in the axial direction. The penetration path 311 can be formed by a cut line, a slit, a pore, or the like. In any case, the inner diameter of the penetration path 311 is that the suture thread 1 inserted into the penetration path 311 is the same as the penetration path 311. Dimensions are in contact with the inner surface.

  As shown in FIG. 4B, when only the suture thread 1 is inserted into the through path 311, the inner surface of the through path 311 is in close contact with the suture thread 1 to tighten the suture thread 1, and friction between both The suture thread 1 is held by the holding body 31 by force. When the holding body 31 moves in the front-rear direction in this state, the suture thread 1 also moves as the holding body 31 moves.

  Further, as shown in FIG. 4C, hollow members (corresponding to the first pipe 33 and the second pipe 34 in the present embodiment, simply referred to as the hollow member 200 in this embodiment) are provided in the through passage 311. When inserted, the inner surface of the through passage 311 is in close contact with the surface of the hollow member 200 to tighten the hollow member 200, and the hollow member 200 is held by the holding body 31 by the frictional force of both. When the holding body 31 moves in the front-rear direction in this state, the hollow member 200 also moves as the holding body 31 moves. On the other hand, since the suture thread 1 inserted into the hollow member 200 is not in close contact with the inner surface of the through-pass 311, the suture thread 1 is released from the holding body 31 and is in a state of being freely advanced and retracted (free state).

  As described above, the holding body 31 of the present embodiment holds the suture 1 when the suture 1 is directly inserted into the through passage 311, and the hollow member 200 is inserted into the through passage 311. When the suture thread 1 is inserted, the holding of the suture thread 1 can be released.

  In the present embodiment, an example in which the holding body 31 is configured by an elastic body such as natural rubber or synthetic rubber has been described. However, instead of such an elastic body, the holding body 31 is relatively soft, such as copper. The coil 1 may be formed of a coiled metal ring that is made of a simple metal and that can tighten the outer periphery of the suture thread 1. Even with such a metal ring, the suture 1 can be held and released selectively.

The description of FIG. 3 is continued.
The holding body holder 32 is a member that accommodates the holding body 31 and transmits an operating force applied to the operation unit 40 as a moving force of the holding body 31. The holding body holder 32 is also received at a position on the distal end side of the holding body holder 32, comes into contact with the operation section 40 that moves toward the distal end side, receives a force from the operation section 40, and a proximal end wall 323. And a peripheral wall 324 extending from the proximal end wall 323 toward the distal end side. The base end wall 323 is formed with a holding body accommodating portion 322 in which the holding body 31 is accommodated. A space surrounded by the peripheral wall 324 and the base end wall 323 is referred to as a spring member accommodating portion 325, and the second elastic member 36 is inserted into the spring member accommodating portion 325. No wall is provided on the distal end side of the spring member accommodating portion 325, and the spring member accommodating portion 325 opens toward the distal end side.

  The second elastic member 36 is a member having an elastic force that can be expanded and contracted in the front-rear direction, and is composed of, for example, a spring (coil spring, air spring, etc.) or rubber. In the present embodiment, an example is shown in which the second elastic member 36 is configured by a coil-shaped pressing spring. The second elastic member 36 is disposed between the inside of the spring member accommodating portion 325 of the holder holder 32 and the proximal end surface of the needle holding portion 51 of the support 50 in a state compressed in the front-rear direction. The second elastic member 36 has room for further compression, and the second elastic member 36 is compressed when a force is applied in the axial direction. When a coiled spring is used as the second elastic member 36 as in the present embodiment, the coiled second elastic member 36 is installed so as to wrap around the outer periphery of the second pipe 34 and the third pipe 35. It is good to do. By doing in this way, the axial center of the 2nd pipe 34, the 3rd pipe 35, and the 2nd elastic member 36 is substantially corresponded, and even when the 2nd elastic member 36 is compressed, it is hard to produce a bending and a bending.

  The first pipe 33 (first hollow member), the second pipe 34 (second hollow member), and the third pipe 35 are cylindrical members having lumens made of a metal such as stainless steel, and are sutures. The feeding direction of 1 and the axial direction are arranged to coincide with each other. In the present embodiment, a part of the second pipe 34 is inserted into the lumen of the third pipe 35 so as to be movable in the front-rear direction, and a part of the first pipe 33 is inserted into the lumen of the second pipe 34. In this configuration, the first pipe 33, the second pipe 34, and the third pipe 35 are arranged substantially coaxially. The suture thread 1 is inserted into the lumens of the first pipe 33, the second pipe 34, and the third pipe 35 so as to be slidable in the front-rear direction, and these pipes function as a guide for sending the suture thread 1. .

  The first pipe 33 is fixed to a column base end wall 52 constituting a part of the base end side of the column 50, and the third pipe 35 is fixed to a needle holding part 51 constituting a part of the tip side of the column 50. Has been. On the other hand, the 2nd pipe 34 is provided in the front end side rather than the 1st pipe 33, and is comprised so that a movement in the front-back direction is possible.

FIG. 5 is a view for explaining the configuration of the proximal end side of the suture feed mechanism of the medical suturing tool according to the embodiment, and is an enlarged view showing the vicinity of the holding body 31 in FIG. .
As shown in FIG. 5, the support base end wall 52 is formed with a holding hole 54 penetrating in the axial direction, and the base end portion of the first pipe 33 is fixed to the inner peripheral surface of the holding hole 54. Yes. The suture thread 1 is inserted into the opening at the proximal end of the first pipe 33.

  As described above, the holding body 31 and the second pipe 34 are configured to be movable in the front-rear direction, and FIG. 5 shows a state in which both are moving most proximally. In this state, the substantially central portion of the first pipe 33 is inserted into the through passage 311 of the holding body 31, and the tip portion of the first pipe 33 is inserted into the lumen of the second pipe 34. The suture thread 1 inserted into the first pipe 33 is not in contact with the holding body 31 and is in a free state where it is not held by the holding body 31.

FIG. 6 is a view for explaining the configuration of the distal end side of the suture feed mechanism of the medical suturing device according to the embodiment.
As shown in FIG. 6, a region of a predetermined length at the distal end portion of the second pipe 34 is inserted into the third pipe 35, and the enlarged diameter portion 341 projecting radially outward is formed at the distal end portion of the second pipe 34. Is formed.
A tip side movement restricting portion 351 that protrudes inward in the radial direction is formed inside the tip side of the third pipe 35. The distal end side movement restricting portion 351 is in contact with the enlarged diameter portion 341 of the second pipe 34 and restricts the movement of the second pipe 34 toward the distal end side. Further, a proximal side movement restricting portion 352 that protrudes radially inward is formed on the inner side of the third pipe 35 on the proximal side. The proximal end side movement restricting portion 352 is in contact with the enlarged diameter portion 341 of the second pipe 34 and restricts the movement of the second pipe 34 toward the proximal end side.

  The specific configuration for restricting the movement of the second pipe 34 in the front-rear direction is not limited to the distal end side movement restricting portion 351 and the proximal end side movement restricting portion 352, and any specific example that can realize the same function. A general configuration can be adopted. For example, the inner surface shape of the third pipe 35 may be a tapered shape whose diameter is reduced in a direction in which movement is desired to be restricted.

In addition, the third pipe 35 is provided as in the present embodiment, and the suture 1 is prevented from being bent by passing the suture 1 through the lumen. However, the third pipe 35 is provided. It is also possible to adopt a configuration without this. That is, the suture thread 1 may be exposed on the proximal end side with respect to the second pipe 34. In the case where the third pipe 35 is not provided, a member that exhibits the same function as that of the distal end side movement restricting portion 351 and the proximal end side movement restricting portion 352 can be provided in the support column 50, for example.
Further, the proximal end portion of the suture thread introduction needle 3 may be configured to function as the third pipe 35.

The operation of the suture feed mechanism 30 will be described with reference to FIG.
FIG. 3A shows a state in which the holding body 31, the holding body holder 32, and the second pipe 34 are located on the most proximal side. This state is the initial state of the suture thread feeding mechanism 30. In the initial state, the first pipe 33 is inserted into the through passage 311 of the holding body 31, and the suture thread 1 in the first pipe 33 is not held by the holding body 31 and is in a free state. . Further, the second elastic member 36 is held between the inside of the spring member accommodating portion 325 and the proximal end surface of the needle holding portion 51 in a state compressed in the front-rear direction. On the other hand, a force is applied to press against the support base end wall 52 side.

  As shown in FIG. 3B, when the operation unit 40 is pushed toward the distal end side and comes into contact with the contact portion 321 of the holder holder 32, the force applied to the operation unit 40 is transmitted to the holder holder 32. The holder holder 32 moves toward the tip side. With the movement of the holder holder 32, the holder 31 also moves toward the distal end side. When the holder 31 moves by a predetermined distance, the first pipe 33 comes out of the through passage 311 of the holder 31. If it does so, it will be in the state by which only the suture thread 111 was inserted in the penetration path 311 of the holding body 31, and the suture thread 1 will be hold | maintained by the holding body 31, and will move toward a front end side with the holding body 31.

  Further, the second pipe 34 moves toward the distal end side together with the holding body 31 so that the base end side thereof is in contact with the distal end surface of the holding body 31 and is pushed by the holding body 31. Then, when the enlarged diameter portion 341 of the second pipe 34 comes into contact with the distal end side movement restricting portion 351 of the third pipe 35, the second pipe 34 stops moving toward the distal end side. In this state, when the operation portion 40 is pushed toward the distal end side with a force capable of compressing the second elastic member 36, the force applied to the operation portion 40 is second elastic as shown in FIG. The member 36 is compressed, and the base end portion of the second pipe 34 enters the through passage 311 of the holding body 31 while the position of the second pipe 34 is fixed. If it does so, the suture 1 will be in the state inserted in the penetration path 311 of the holding body 31 via the 2nd pipe 34, will not be hold | maintained by the holding body 31, but will be in a free state.

  As described above, the holding body 31 according to the present embodiment tightens and holds any one of the first pipe 33, the second pipe 34, and the suture thread 1 inserted into the through passage 311. When the holding body 31 is holding the suture 1, the suture 1 is moved with the movement of the holding body 31, and when the holding body 31 is releasing the holding of the suture 1, The suture feed mechanism 30 does not act on the movement of the suture 1.

The lengths in the axial direction of the first pipe 33, the second pipe 34, and the third pipe 35 are determined in consideration of the length of the suture thread 1 and the length of the support 50 that are desired to be sent out in a single procedure, The length is not particularly limited.
Moreover, the 1st pipe 33, the 2nd pipe 34, and the 3rd pipe 35 should just be able to exhibit the function mentioned above, for example, may be comprised in square tube shape besides cylindrical shape, and it may be in a part of cylinder wall. You may comprise so that a slit and a cut | interruption may be formed and the inside of a hollow part and the exterior can be connected.

(Operation unit 40)
The operation unit 40 is a member that is operated by an operator when the abdominal wall and the visceral wall are fixed using the suture tool 100. In the present embodiment, the operation unit 40 transmits the force applied by the operator to the gripping tool feed-back mechanism 20 and the suture feed mechanism 30, respectively, and in conjunction with the operation force applied to the operation unit 40, The gripping tool feed back mechanism 20 and the suture thread feed mechanism 30 operate. As shown in FIGS. 1 and 2, a part of the operation unit 40 transmits a manipulation force to the grasping tool feed-back mechanism 20 to send the suture grasping tool 10 to the distal end side. It is sandwiched between the end side and the inner wall on the base end side of the gripping tool holder 21. As shown in FIGS. 1 and 3, a part of the operation portion 40 is a contact portion of the holder holder 32 for transmitting the operation force to the suture feed mechanism 30 and feeding the suture 1 to the distal end side. 321 is configured to be able to come into contact with 321.

  The constituent material of the operation unit 40 is not particularly limited, and a synthetic resin material similar to that of the support column 50 may be used, or a material different from that of the support column 50 may be used. Moreover, it is preferable that the shape of the part that receives an operation from the operator in the operation unit 40 is appropriately designed in consideration of the ease of operation by the operator's finger or hand, and the shape is not particularly limited.

(Support 50)
The strut 50 is a member for holding the gripping tool introduction needle 2 and the suture thread introduction needle 3 and unitizing the gripping tool feed back mechanism 20, the suture thread feed mechanism 30, and the operation unit 40. As shown in FIG. 1, the strut 50 includes a needle holding portion 51 provided on the distal end side, a strut proximal end wall 52 provided on the proximal end side so as to face the needle holding portion 51 in the axial direction, A guide portion 53 that extends in the front-rear direction and connects the needle holding portion 51 and the support base end wall 52 is provided.

  The needle holder 51 supports the grasping tool introduction needle 2 and the suture introduction needle 3 substantially in parallel with a predetermined distance therebetween. The needle holding portion 51 is formed with a passage penetrating in the front-rear direction, and the grasper introduction needle 2 and the suture introduction needle 3 are attached to the passage, respectively. The distance between the grasper introduction needle 2 and the suture introduction needle 3 is preferably set to a length (for example, about 10 to 30 mm) at which the suture 1 fixes the patient's abdominal wall and visceral wall. . If the distance between the grasping tool introduction needle 2 and the suture introduction needle 3 is within this range, the abdominal wall and visceral wall of the patient can be sufficiently fixed by the suture 1.

  In the present embodiment, substantially rectangular parallelepiped supports 55 and 56 made of, for example, a synthetic resin material are attached to the proximal end sides of the gripper introduction needle 2 and the suture introduction needle 3, respectively. The holding tool introduction needle 2 and the suture introduction needle 3 are supported by the needle holder 51 via the supports 55 and 56. In the example of FIG. 1, the supports 55 and 56 protrude from the surface on the distal end side of the needle holding part 51, but the supports 55 and 56 do not have to protrude from the needle holding part 51. The configuration for holding the grasping tool introduction needle 2 and the suture thread introduction needle 3 substantially in parallel at a predetermined distance is not limited to the needle holding portion 51 and the supports 55 and 56 illustrated in FIG.

Further, the gripper introduction needle 2 and the suture thread introduction needle 3 may be configured to be detachable from the needle holding portion 51. By doing so, it is possible to exchange the grasping tool introduction needle 2 and the suture introduction needle 3.
Further, the distance between the grasper introduction needle 2 and the suture introduction needle 3 may be adjustable. By doing in this way, it becomes possible to arrange | position the holding tool introduction needle 2 and the suture thread introduction needle 3 at a position according to the patient's physique and the like.
Moreover, you may comprise so that adjustment of the protrusion length from the needle holding part 51 of the needle | hook 2 for holding tool introduction and the needle 3 for suture introduction | transduction is possible. By doing so, the relative positions between the needle tips of the grasping tool introduction needle 2 and the suture thread introduction needle 3 and the suture thread 1 and the grasping portion 12 fed from these needles are adjusted. be able to.
Further, the proximal end portions of the grasping tool introducing needle 2 and the suture thread introducing needle 3 may protrude more proximally than the needle holding portion 51. In this way, the portion protruding to the proximal end side of the needle functions as a guide when the members inserted therein (the suture grasping tool 10 and the suture 1) move, and these members move smoothly. Can be made.

  Although not shown, a flat plate member through which the grasping tool introduction needle 2 and the suture thread introduction needle 3 are slidably inserted may be provided on the distal end side of the needle holding portion 51. By providing such a flat plate member, the bending of the grasping tool introducing needle 2 and the suture thread introducing needle 3 is suppressed, and the distance between the grasping tool introducing needle 2 and the suture thread introducing needle 3 is greatly increased. It is possible to prevent the change.

  In this embodiment, the support base end wall 52 is provided on the base end side of the gripper holder 21 and the holder holder 32, and restricts the movement of these members to the base end side. The support base end wall 52 is formed with a holding hole 54 to which the first pipe 33 of the suture feed mechanism 30 is fixed. In the example of FIG. 1, the base end surface of the column base end wall 52 and the base end surface of the first pipe 33 are formed to coincide with each other, but the base end portion of the first pipe 33 is formed from the column base end wall 52. May be projected to the proximal end side, and the work load when inserting the suture thread 1 into the first pipe 33 can be reduced. In addition, another configuration for facilitating insertion of the suture thread 1 into the first pipe 33 can be employed. For example, a region of a predetermined length on the proximal end side of the first pipe 33 may be formed in a funnel shape that increases in diameter toward the proximal end side, whereby the suture 1 is inserted into the first pipe 33. Can reduce the burden of work. Further, instead of making the base end side portion of the first pipe 33 into a funnel shape, a similar funnel-shaped member is provided on the base end side further than the base end portion of the first hollow member, or the holding hole 54 is provided. A similar funnel shape may be used.

  The guide portion 53 connects the needle holding portion 51 and the column base end wall 52 and also has a function of guiding the movement of the gripping tool holder 21 and the holding body holder 32 in the front-rear direction in the present embodiment. . A groove (not shown) in which a part of the gripper holder 21 and the holder holder 32 is slidably fitted is formed in the guide portion 53, and the gripper holder 21 and the holder holder 32 are formed along the groove. Moves back and forth. By doing in this way, the holding tool holder 21 and the holder holder 32 can be moved straight in the front-rear direction. Note that the groove formed in the guide portion 53 is preferably configured so as not to generate frictional resistance as much as possible when the gripper holder 21 and the holder holder 32 are moved.

A first protrusion 57 that restricts the movement of the gripper holder 21 toward the distal end side is provided on the distal end side of the guide portion 53. When the gripper holder 21 moves to the distal end side and the distal end thereof contacts the first protrusion 57, the gripper holder 21 cannot move further to the distal end side.
Further, a second protrusion 58 that restricts the movement of the holder holder 32 toward the distal end side is provided on the distal end side of the guide portion 53. In this embodiment, as shown in FIG. 8 (f) described later, the protrusion 215 of the gripper holder 21 moved to the distal end abuts on the second protrusion 58, and further, the holder 215 Although the tip of 32 is in contact, the protrusion 215 may not be provided, and the movement of the holder holder 32 may be restricted only by the second protrusion 58.
In addition, the specific structure of the 1st projection part 57 and the 2nd projection part 58 is not limited to these, As long as the movement to the front end side of the holding | gripping tool holder 21 and the holding body holder 32 can be controlled in a predetermined position, it is. Any thing can be adopted.

  Further, on the distal end side of the needle holding portion 51, a hook portion 59 that protrudes in a hook shape toward the radially outer side is provided. The buttocks 59 are configured so that the operator can attach or hold the hand when the patient introduces the grasping tool introduction needle 2 and the suture introduction needle 3 into the patient. It is provided to assist.

  Although the constituent material of the support | pillar 50 is not specifically limited, For example, synthetic resins, such as polyolefin, such as a polypropylene and polyethylene, a polyvinyl chloride, and a polycarbonate, can be utilized.

[Operation of medical suturing tool]
The operation and action of the suturing tool 100 when the patient's abdominal wall and visceral wall are fixed will be described.
7 to 9 are schematic cross-sectional views for explaining the operation of the suturing tool 100 according to the embodiment. FIG. 7 is an initial state of the suturing tool 100, and FIG. 8 is a delivery of the suture grasping tool 10 and the suture 1. Operation, FIG. 9 shows the return operation of the suture grasping tool 10. Moreover, FIG. 10 is a figure explaining a mode that a visceral wall and an abdominal wall are fixed using the suturing tool 100 which concerns on embodiment. Hereinafter, a description will be given with reference to FIGS.

(1) Puncture the suture tool 100 into the patient First, the operator inserts an endoscope into the internal organs (for example, the stomach) from the mouth or nose of the patient. Thereafter, the operator sufficiently supplies a gas (for example, carbon dioxide) into the internal organs to expand the internal organs. Then, the visceral wall 102 is brought into close contact with the abdominal wall 101. Then, the skin 103 including the portion to be punctured with the grasper introduction needle 2 and the suture introduction needle 3 is disinfected. Then, the position of the viscera is confirmed by the light emitted from the endoscope, and local anesthesia is performed on this site.

  Subsequently, the operator prepares the suturing tool 100 in the initial state shown in FIG. Here, the initial state of the suturing tool 100 is that the grasping tool holder 21 is located on the most proximal side in the grasping tool feed-back mechanism 20, and the grasping portion 12 of the suture grasping tool 10 is a grasping tool introduction needle. It is the state accommodated in 2 lumen | bore. In the suture feed mechanism 30, the holder holder 32 is positioned on the most proximal side, and the first pipe 33 is inserted into the through passage 311 of the holder 31. The suture 1 is in a state of being accommodated in the lumen of the suture introduction needle 3 so as not to protrude from the tip of the suture introduction needle 3.

The operator punctures the abdominal wall 101 of the patient with the grasping tool introduction needle 2 and the suture thread introduction needle 3 of the suturing tool 100 in the initial state, and the grasping tool introduction needle 2 and the visceral wall 102 into the internal organs. The suture thread introduction needle 3 is protruded (FIG. 10A).
The surgeon who has confirmed this state with the endoscope pushes the operation unit 40 toward the distal end side.

(2) Delivery of suture grasping tool 10 and suture 1 (2-1) Start of delivery of suture grasping tool 10 As shown in FIG. When applied, the operating force is transmitted to the gripping tool holder 21 via the first elastic member 22, and the gripping tool holder 21 moves to the distal end side. Along with this, the suture grasping tool 10 attached to the grasping tool holder 21 also moves to the distal end side, and a part of the grasping portion 12 is exposed from the distal end of the grasping tool introduction needle 2.

  On the other hand, in the suture feed mechanism 30, in the state shown in FIG. 8A, the operation unit 40 does not contact the holder holder 32, and the operation force applied to the operation unit 40 is transmitted to the holder holder 32. It is a state that is not done. For this reason, each part which comprises the suture feed mechanism 30 does not operate | move, and the suture 1 also does not move.

(2-2) End of sending out the suture grasping tool 10 (restoration of the grasping portion 12)
As shown in FIG. 8 (b), when a surgeon further applies a force toward the distal end side to the operation unit 40, the grasping tool holder 21 and the suture grasping tool 10 are further moved to the distal end side to introduce the grasping tool. The grip portion 12 protrudes from the tip of the needle 2. The gripping part 12 sent out from the tip of the gripper introduction needle 2 is in a state where no external force is applied, and is restored to an annular shape. Then, the distal end of the grasping tool holder 21 comes into contact with the first protrusion 57, and the grasping tool holder 21 and the suture grasping tool 10 are not moved further to the distal end side, and the sending of the suture grasping tool 10 is finished.

  On the other hand, in the suture feed mechanism 30, the operation unit 40 comes into contact with the contact part 321 of the holder holder 32 as shown in FIG. Then, the operating force from the operation unit 40 is transmitted to the holder holder 32.

  The timing at which the suture feeding mechanism 30 starts to receive the operation force from the operation unit 40 is preferably after at least a part of the grasping portion 12 of the suture grasping tool 10 is exposed from the needle tip of the grasping tool introduction needle 2. Further, it is more preferable that the gripping portion 12 is restored to an annular shape. By doing so, the suture thread 1 fed out from the suture thread introduction needle 3 can be reliably inserted into the grip portion 12. However, the purpose is to insert the suture thread 1 into the grip portion 12, and the timing at which the suture feed mechanism 30 starts to receive the operation force from the operation portion 40 is not strictly defined. In this embodiment, the timing at which the suture feed mechanism 30 starts to receive the operation force from the operation unit 40 can be adjusted by the position of the contact portion 321.

(2-3) Start of Operation of Suture Feeding Mechanism 30 As shown in FIG. 8 (c), when a surgeon further applies a force toward the distal end side to the operation unit 40, the grasping tool holder 21 becomes the first protrusion. Since the movement toward the distal end side is restricted by 57, the force applied to the operation portion 40 becomes a force that compresses the first elastic member 22, and the first elastic member 22 contracts in the front-rear direction, and the first elasticity The operation unit 40 provided on the proximal end side of the member 22 also moves toward the distal end side. Since the position of the gripping tool holder 21 does not change, the suture gripping tool 10 fixed to the gripping tool holder 21 is also not displaced. In this way, by using the force applied to the operation unit 40 as a force that compresses the first elastic member 22, the transmission of the operation force to the suture grasping tool 10 is released, and the suture grasping tool 10 is not displaced. I am doing so.

  On the other hand, in the suture feed mechanism 30, the abutting portion 321 of the holder holder 32 that abuts the operating portion 40 receives a force from the operating portion 40, and the holder holder 32 moves toward the distal end side. As the holder holder 32 moves, the holder 31 attached to the holder holder 32 also moves to the tip side. At the initial stage when the holding body 31 starts moving toward the distal end side, the first pipe 33 is inserted into the through passage 311 of the holding body 31 and the suture 1 is free. Further, as the holder holder 32 moves toward the distal end side, the second elastic member 36 is also compressed in the front-rear direction. Further, when the holder holder 32 moves toward the distal end side, the surface on the distal end side of the holder 31 comes into contact with the proximal end surface of the second pipe 34, and the holder 31 pushes the second pipe 34. Therefore, the second pipe 34 is pushed by the holding body 31 and moves toward the tip side.

(2-4) Holding of the suture thread 1 by the holding body 31 As shown in FIG. 8D, when a surgeon further applies a force toward the distal end side to the operation unit 40, as in FIG. 8C. The first elastic member 22 is compressed in the front-rear direction and the operation unit 40 also advances toward the distal end side, but the grasping tool holder 21 and the suture grasping tool 10 do not move.

  On the other hand, in the suture feed mechanism 30, the abutting portion 321 of the holder holder 32 that abuts the operating portion 40 receives a force from the operating portion 40, and the holder holder 32 and the holding body 31 further move toward the distal end side. The second pipe 34 is also moved toward the distal end side by being pushed by the surface on the distal end side of the holding body 31.

  Then, the first pipe 33 comes out from the through passage 311 of the holding body 31. FIG. 8D shows a state in which the first pipe 33 has been removed from a partial region on the distal end side of the through-pass 311 of the holding body 31. When the first pipe 33 is removed from the through passage 311 of the holding body 31, the holding body 31 tightens and holds the suture 1.

(2-5) Delivery of suture thread 1 As shown in FIG. 8 (e), when a surgeon further applies a force toward the distal end side to the operation unit 40, as in FIGS. 8 (c) and 8 (d). The first elastic member 22 is compressed in the front-rear direction and the operation unit 40 also advances toward the distal end side, but the grasping tool holder 21 and the suture grasping tool 10 do not move.

  On the other hand, in the suture feed mechanism 30, the holder holder 32 receives the force from the operation unit 40, and the holder holder 32 and the holder 31 further move toward the distal end side. Then, the suture 1 held by the holding body 31 also moves to the distal end side together with the holding body 31, and the suture 1 is sent out from the distal end of the suture introduction needle 3. The suture thread 1 sent out from the distal end of the suture thread introduction needle 3 enters the grasping portion 12 of the suture grasping tool 10 arranged at the tip in the traveling direction.

Further, as the holder holder 32 moves toward the distal end side, the second elastic member 36 is compressed in the front-rear direction.
Further, as the holding body 31 moves toward the distal end side, the second pipe 34 is also pushed by the surface on the distal end side of the holding body 31 and moves toward the distal end side. The three pipes 35 come into contact with the tip side movement restricting portion 351. If it does so, the movement to the front end side of the 2nd pipe 34 will be controlled, and the 2nd pipe 34 will be in the state which does not move to the front end side any more.

(2-6) End of delivery of suture 1 As shown in FIG. 8 (f), when a surgeon further applies a force toward the distal end side to the operation unit 40, FIGS. 8 (c), 8 (d), ( Similarly to e), the first elastic member 22 is compressed in the front-rear direction and the operation unit 40 advances toward the distal end side, but the gripping tool holder 21 and the suture gripping tool 10 do not move.

  On the other hand, in the suture feed mechanism 30, the holder holder 32 receives the force from the operation unit 40, and the holder holder 32 and the holder 31 further move toward the distal end side. Here, in the movement of the previous stage, the second pipe 34 was also moved to the tip side by being pushed by the surface on the tip side of the holding body 31, but as described in FIG. 8 (e), the second pipe 34 is moved. Is a state in which movement toward the tip side is restricted. For this reason, when the holding body 31 moves toward the distal end side, the proximal end portion of the second pipe 34 pierces the through passage 311 of the holding body 31, and the second pipe 34 is inserted into the through passage 311. Then, the second pipe 34 is interposed between the suture thread 1 and the holding body 31, and the suture thread 1 is released from being held by the holding body 31 and becomes free.

  In a state where the holding body 31 is moved to the distal end side until the second pipe 34 is inserted in the entire area in the front-rear direction of the through passage 311, the abutting portion 321 of the holding body holder 32 abuts on the protruding portion 215 and is held. Movement of the body holder 32 and the holding body 31 toward the distal end side is restricted.

  In this state, even if a force toward the distal end side is further applied to the operation unit 40 by the operator, the movement of the holding body holder 32 and the grasping tool holder 21 to the distal end side is restricted, and therefore the operation unit 40 is controlled. Does not move further to the tip side. Therefore, the operator can recognize that the delivery of the suture grasping tool 10 and the suture thread 1 has been finished when the operation unit 40 is pushed and no longer moves.

(3) Return of suture grasping tool 10 (3-1) Start of return of suture grasping tool 10 The operator stops pushing the operation unit 40 toward the distal end and pushes the operation unit 40 toward the distal end. Cancel the operation.
As shown in FIG. 9A, when the force toward the distal end side applied to the operation unit 40 by the operator is released, the compressed first elastic member 22 is restored (expanded). In addition, the operation unit 40 provided on the proximal end side of the first elastic member 22 is also pushed by the first elastic member 22 and moves to the proximal end side, and the operation unit 40 is connected to the proximal end portion of the first elastic member 22. And the inner surface of the base end wall 212 of the gripping tool holder 21.

  On the other hand, in the suture feed mechanism 30, the compressed second elastic member 36 is restored (expanded), and the holder holder 32 moves toward the proximal end side by the urging force of the second elastic member 36. As the holder holder 32 moves toward the proximal end, the holder 31 provided in the holder holder 32 and the second pipe 34 held by the holder 31 also move toward the proximal end. The enlarged diameter portion 341 of the second pipe 34 comes into contact with the proximal end side movement restricting portion 352 of the third pipe 35. Then, the movement of the second pipe 34 to the proximal end side is restricted, and the second pipe 34, the holding body 31 holding the second pipe 34, and the holding body holder 32 holding the holding body 31 are: Stop moving to the proximal side.

  Along with the movement of the second pipe 34 to the proximal end side, a part of the distal end side of the first pipe 33 is inserted into the lumen on the proximal end side of the second pipe 34. In at least a partial region of the holding body 31 in the front-rear direction, the second pipe 34 is held on the inner surface of the through passage 311, the first pipe 33 is inserted inside the second pipe 34, and the inside of the first pipe 33 In this state, the suture thread 1 is inserted. The first pipe 33 or the first pipe 33 and the second pipe 34 are interposed between the suture thread 1 and the holding body 31, and the suture thread 1 is not held by the holding body 31. 1 remains free.

(3-2) End of Returning Suture Holding Tool 10 The operator who has confirmed that the suture tool 100 is in the state shown in FIG. 9A is configured to pull the operation unit 40 back to the proximal end side. Apply force to 40.
As shown in FIG. 9B, when a surgeon applies a force toward the proximal end side to the operation unit 40, the operation force is transmitted to the grasping tool holder 21, and the grasping tool holder 21 moves to the proximal end side. To do. Along with this, the suture grasping tool 10 attached to the grasping tool holder 21 also moves to the proximal end side, and the grasping portion 12 of the suture grasping tool 10 remains in a state where the suture 1 is inserted therein. It is housed inside the grasping tool introduction needle 2. Since the suture thread 1 is in a free state, the suture thread 1 is gradually pulled out from the suture thread feeding mechanism 30 by being drawn to the grip portion 12.

  The grasping portion 12 of the suture grasping tool 10 housed inside the grasping tool introduction needle 2 is deformed substantially linearly, and the grasping portion 12 bends in the vicinity of the cutting edge in the grasping tool introduction needle 2. The suture thread 1 is gripped by the part. When the grasping portion 12 that grasps the suture thread 1 is accommodated in the grasping tool introduction needle 2, the feel at that time is transmitted to the surgeon via the operation section 40, so the surgeon grasps the suture thread 1. It can be determined that the tip of the introduction needle 2 is held.

  In this state, the operator removes the suture tool 100 from the patient. When the grasping tool introduction needle 2 and the suture thread introduction needle 3 are pulled out, the suture thread 1 held at one end by the cutting edge portion of the grasping tool introduction needle 2 is also pulled by the grasping tool introduction needle 2, and FIG. As shown in b), the suture thread 1 passes through the visceral wall and the abdominal wall in a substantially U-shape. Since the suture thread 1 is in a free state, the suture thread 1 is smoothly fed out from the suture thread feeding mechanism 30 as the grasper introduction needle 2 and the suture thread introduction needle 3 are removed.

  In a state where the grasping tool introduction needle 2 and the suture introduction needle 3 are pulled out of the body (FIG. 10B), the operator can use the needle tip of the suture introduction needle 3 or other cutting means (scissors or cutters). Etc.) and the both ends of the suture thread 1 drawn out of the body are ligated (FIG. 10C). By ligating the suture thread 1 in this manner, the visceral wall 102 and the abdominal wall 101 are fixed.

(4) Returning the Suture Tool 100 to the Initial State FIG. 9C shows a state in which the suture thread 1 is cut at the distal end side of the suture thread introduction needle 3 in the suture tool 100 pulled out to the outside of the body. Is shown.
In order to return the suturing tool 100 to the initial state shown in FIG. 9D, the operator pulls back the operation portion 40 of the suturing tool 100 in the state of FIG. 9C to the proximal end side. FIG. 9D is the same as FIG.

  When a surgeon applies a force toward the proximal end to the operation unit 40 of the suturing tool 100 shown in FIG. 9C, the grasping tool holder 21 is directed toward the proximal end by receiving the force from the operation unit 40. Move. The protrusion 215 of the gripping tool holder 21 moves toward the base end side while abutting and pushing against the abutting part 321 of the holder holder 32 arranged on the base end side relative to the gripping tool holder 21. . 9D, when the base end wall 323 of the holder holder 32 comes into contact with the support base end wall 52 of the support 50, and this base end wall 212 comes into contact with the base end wall 323, the gripping is performed. The tool holder 21 is not moved further to the base end side.

  On the other hand, in the suture feed mechanism 30, the abutting portion 321 and the proximal end wall 323 of the holder holder 32 abut against the protruding portion 215 and the proximal end wall 212 of the gripping tool holder 21, respectively, and receive force from them. The holder holder 32 moves toward the base end side. Then, as shown in FIG. 9D, when the base end wall 323 comes into contact with the support base end wall 52 of the support column 50, the movement of the support holder 32 to the base end side is restricted, and the support holder 32 is It will be in the state which does not move to the base end side any more.

  In the state shown in FIG. 9C, the holding body 31 is holding the second pipe 34, but the movement of the second pipe 34 toward the base end side is restricted by the third pipe 35. It is in a state where it cannot move further to the base end side. Therefore, when the holding body 31 moves to the proximal end side with the movement of the holding body holder 32, the second pipe 34 comes out from the inside of the through path 311 of the holding body 31, and the through path 311 as shown in FIG. The first pipe 33 is held inside.

  By such a procedure, the suturing tool 100 can be returned to the initial state shown in FIG. When the suture thread 1 protrudes more distally than the needle tip of the suture introduction needle 3, the excess suture thread 1 is introduced for suture introduction by pulling the suture thread 1 from the proximal end side of the support 50. What is necessary is just to fit in the lumen | bore of the needle 3. The suture tool 100 that has returned to the initial state is used for the second and subsequent stitches. When performing a plurality of fixing procedures using the suturing tool 100, the suturing tool 100 is punctured at a position separated by, for example, about 20 mm to 30 mm from the fixed position, and is similar to that shown in FIGS. Can be performed. If the length of the suture 1 introduced into the suture feed mechanism 30 is set to a length provided for a plurality of times of fixation, it is easy to use the suture tool 100 continuously. The trouble of inserting the suture thread feeding mechanism 30 can also be reduced.

  As described above, according to the suturing tool 100 of the present embodiment, the grasping tool feed-back mechanism 20 and the suture thread feeding mechanism 30 are interlocked, and the operator feeds the suture thread 1 into the internal organs with a simple operation. The sent suture can be pulled out from the internal organs. Therefore, it is possible to reduce the operation burden on the operator when fixing the abdominal wall and the visceral wall.

[Modification]
The present invention is not limited to the suturing tool 100 shown in the above embodiment, and various modifications can be made without departing from the technical idea of the present invention. Hereinafter, modifications of the suturing tool 100 according to the above embodiment will be exemplified.

(About the second elastic member 36)
The second elastic member 36 functions as a member that causes the action of pushing back the holder holder 32 to the proximal end side in the returning operation of the suture grasping tool 10 (see FIG. 9A and the like). Due to the repulsive force of the second elastic member 36, when the operation of the operation unit 40 is released, the holder holder 32 automatically returns to a predetermined position, so that the operator's work load is reduced. However, the second elastic member 36 may not be provided, and in that case, the operator can push the holding body holder 32 back to the proximal end side using the operation unit 40.

  In addition, a member having elasticity such as a spring or rubber that exhibits the same function as the second elastic member 36 may be provided in the gripping tool feed-back mechanism 20. Specifically, for example, an elastic member that is compressed by moving the gripper holder 21 toward the distal end side is provided between the distal end portion of the gripper holder 21 and the proximal end side of the needle holding unit 51. it can. By doing so, in the returning operation of the suture grasping tool 10, the grasping tool holder 21 is automatically returned to a predetermined position by the repulsive force of the elastic member, so that the burden on the operator can be reduced. .

(About the operation unit 40)
In the above-described embodiment, the operation unit 40 abuts on each of the members constituting the gripping tool feed-back mechanism 20 and the members constituting the suture thread feeding mechanism 30, so that the gripping tool feed-back mechanism 20 and the suture thread feeding mechanism are brought into contact with each other. The force to send out the suture grasping tool 10 and the suture 1 to 30 was directly transmitted. However, the operation force applied to the operation unit 40 may be transmitted to the suture thread feeding mechanism 30 via the gripping tool feed-back mechanism 20, and the same effect can be obtained. As described above, the present invention is not limited depending on whether the operation force applied to the operation unit 40 is transmitted directly or indirectly to the gripping tool feed-back mechanism 20 and the suture feed mechanism 30. .

  Further, it is not always necessary to provide a special member called the operation unit 40. For example, a part of the member constituting the gripping tool feed-back mechanism 20 is made to function as the operation unit, and the operation force received by the operation unit is sent to the suture thread. You may make it transmit to the mechanism 30. FIG.

  Moreover, in the said embodiment, by moving the operation part 40 to the front end side (front), the holding | gripping tool feed-back mechanism 20 and the suture feed mechanism 30 are the suture holding tool 10 and the suture 1 respectively on the front end side. It was the composition to send to. However, the direction of the operation applied to the operation unit 40 is not limited to the front end side (forward) direction, and the movement direction of the operation unit 40 can be determined by combining any structure that converts the movement direction of the operation unit 40 to another direction. Even if the sending direction of the suture grasping tool 10 and the suture thread 1 does not match, the suture grasping tool 10 and the suture thread 1 can be sent out to the distal end side.

  DESCRIPTION OF SYMBOLS 1 Suture thread, 2 grasping tool introduction needle, 3 suture introduction needle, 10 suture grasping tool, 11 shaft part, 12 grasping part, 13 engagement part, 20 grasping tool feed back mechanism, 21 grasping tool holder, 22 First spring member, 30 suture feed mechanism, 31 holder, 32 holder holder, 33 first pipe, 34 second pipe, 35 third pipe, 36 second spring member, 40 operation unit, 50 strut, 51 needle Holding part, 52 strut base end wall, 53 guide part, 54 holding hole, 55 support body, 56 support body, 57 first protrusion part, 58 second protrusion part, 59 buttock part, 100 suture instrument, 101 abdominal wall, 102 internal organs Wall, 103 Skin, 200 Hollow member, 211 Connection piece, 211a Locking part, 212 Base end wall, 213 Perimeter wall, 214 Housing space, 215 Protruding part, 311 Through passage, 321 Contact part, 322 Bearing member accommodating portion, 323 proximal wall 324 wall 325 spring member accommodating portion 341 enlarged diameter portion, 351 front end side movement restricting portion, 352 proximal side movement restricting portion.

Claims (4)

A suture introduction needle;
A grasping tool introduction needle provided substantially parallel to the suture introduction needle by a predetermined distance;
A gripping portion that can be stored in the grasping tool introduction needle and extends in the direction of the suture thread introduction needle when coming out of the grasping tool introduction needle, is slid into the grasping tool introduction needle. A suture gripper that is movably inserted;
A gripper feed-back mechanism for moving the suture gripper in the axial direction;
A suture feed mechanism for feeding a suture to the distal end side of the suture introduction needle;
An operation unit that receives operations from the surgeon,
When the operation unit receives an operation,
The gripper feed-back mechanism is
Transmitting the operating force applied to the operation portion to the suture grasping tool, and causing the grasping portion of the suture grasping tool to protrude from the tip of the needle for introducing the grasping tool;
When the gripping part protrudes from the tip of the gripper introduction needle to a predetermined position, the transmission of the operation force to the suture gripper is released and the suture gripper is not displaced,
The suture feed mechanism is
After at least a part of the gripping portion protrudes from the tip of the gripper introduction needle, the operating force is transmitted to the suture, and the suture protrudes from the tip of the suture introduction needle.
Thereafter, the transmission of the operating force to the suture is released, and the suture is allowed to advance and retract . After the suture is made to be freely advanced and retracted in the suture feed mechanism, when the operation to the operation unit is released or another operation is added to the operation unit,
The gripper feed-back mechanism is
The medical suturing tool according to claim 1, wherein the moving the suture gripper to return the grip portion to the inside of the gripper introduction needle. A suture introduction needle;
A grasping tool introduction needle provided substantially parallel to the suture introduction needle by a predetermined distance;
A gripping portion that can be stored in the grasping tool introduction needle and extends in the direction of the suture thread introduction needle when coming out of the grasping tool introduction needle, is slid into the grasping tool introduction needle. A suture gripper that is movably inserted;
A gripper feed-back mechanism for moving the suture gripper in the axial direction;
A suture feed mechanism for feeding a suture to the distal end side of the suture introduction needle;
An operation unit that receives operations from the surgeon,
The gripper feed-back mechanism is
A grasping tool holder having an accommodating space inside, and a proximal end portion of the suture grasping tool connected to the distal end side;
An elastic member housed in the housing space of the gripper holder in a compressed state in the moving direction of the suture gripper;
The operation portion is interposed between a base end portion of the elastic member and an inner wall of the accommodating space,
The suture feed mechanism is
A holding path for holding a member to be held that is formed in a through path that penetrates the suture thread in the delivery direction;
A holder holder that moves the holder in response to an operating force applied to the operating section;
A first hollow member having a lumen through which the suture thread can pass and having an outer shape that can be inserted into the through-passage of the holding body;
The first hollow member is provided so as to be movable in the axial direction on the distal end side, has a lumen through which the suture thread and the first hollow member can pass, and can be inserted into the through-passage of the holding body A second hollow member having an outer shape,
In the initial state in which the first hollow member is inserted into the through-passage of the holding body of the suture feed mechanism, the operation unit receives an operation.
In the gripping tool feed back mechanism,
The operating force applied to the operation unit is transmitted to the gripper holder through the elastic member, and the gripper holder moves to the tip side,
When the gripping part protrudes from the tip of the gripper introduction needle to a predetermined position, the movement of the gripper holder toward the tip side is restricted, and the elastic member is compressed and deformed by the operation force,
In the suture feed mechanism,
The holding body holder receives the operating force and moves the holding body toward the distal end side after the timing when at least a part of the gripping part protrudes from the tip of the grasping tool introduction needle, The medical suturing tool, wherein the first hollow member is removed from the through-passage of the holding body, and then the second hollow member enters the through-passage of the holding body . After the second hollow member is inserted into the through-passage of the holding body in the suture feed mechanism, the operation to the operation unit is released, or another operation is applied to the operation unit.
In the gripping tool feed back mechanism,
The gripping tool holder moves to the proximal end side so as to return the gripping part to the inside of the gripping tool introduction needle,
In the suture feed mechanism,
The holding body in a state where the second hollow member is inserted into the penetration path moves to the proximal end side, and the movement of the holding body moves the holding body into the proximal end side lumen of the second hollow member. is inserted the distal end side of the first hollow member, then, from the second hollow member moves said through passage is restricted to the base end side of claim 3, wherein said second hollow member comes out Medical suture tool.

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