JP7320523B2 - Bi-directional medical suture system - Google Patents

Description

TECHNICAL FIELD The present invention relates to a bidirectional medical suturing system having a suturing mechanism capable of suturing an object bidirectionally from the proximal side to the distal side and vice versa from the distal side to the proximal side.

Trans-Sphenoidal Surgery (TSS) is often performed to remove tumors in the pituitary gland. TSS is generally performed by the following procedures. First, the operator advances along the patient's nasal septum while detaching the nasal mucosa, opens the sphenoid bone and opens the dura mater to reach the pituitary gland. Next, the pituitary tumor is removed, and finally the dura is sutured to reconstruct the sphenoid bone and nasal mucosa. As a device for suturing the dura mater, a suturing device has been proposed in which a suture thread is passed bi-directionally from the distal side to the proximal side and from the proximal side to the distal side of the dura mater (for example, Patent Document 1 ~7). With such a bidirectional suturing device, it is desired to pass the suture thread through an appropriate position of the sutured object such as the dura mater. For example, Patent Literatures 1 and 2 disclose a suturing device equipped with an endoscope. According to the suturing device, a suturing operation can be performed while viewing an image obtained by the endoscope. On the other hand, as an endoscope, there is known one in which a plurality of objective lenses are arranged in a direction perpendicular to the perspective direction (eg, Patent Documents 8 to 10).

Japanese Patent Publication No. 2011-509121 WO2009/089101 Japanese Patent Publication No. 2014-528768 WO2013/024466 JP 2011-72790 A Japanese Patent Publication No. 2012-515636 WO2010/085793 Japanese Patent Application Laid-Open No. 2014-230788 JP 2013-253797 A Japanese Patent Publication No. 11-503844

When suturing a dura mater or the like using a bidirectional suturing device, it is desirable to more accurately grasp the shape of the suturing target such as the dura mater and pass the suture thread through an appropriate portion of the suturing target. For example, in the suturing devices disclosed in Patent Documents 1 and 2, the suture target can only be grasped two-dimensionally. When an endoscope in which a plurality of objective lenses are arranged at the end is used, it is possible to grasp a three-dimensional image. However, when a plurality of objective lenses are arranged in a direction perpendicular to the perspective direction, the size in the direction perpendicular to the perspective direction, that is, the radial direction becomes large, so this is not a preferable mode for a bidirectional suturing device. do not have.

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned circumstances, and its object is to make it possible to three-dimensionally grasp an object to be sutured and to form a treatment portion for suturing with a compact size in the radial direction. To provide a medical two-way suturing system capable of

The two-way medical suture system of the present invention, which can solve the above problems, comprises a shaft extending in the near and far direction and a first needle movable in the near and far direction and having a distal end facing the distal side. a member, a second needle member that is movable in a far-near direction and that is disposed distally relative to the first needle member and has a tip facing proximally; a first objective lens and a second objective lens; A bi-directional medical suturing system having an objective lens group, wherein the first objective lens is disposed proximal to and extends distally from the distalmost end of the movable section of the tip of the first needle member. characterized in that the second objective lens is positioned distally of the proximal-most end of the movable section at the tip of the second needle member and faces proximally.

According to the two-way medical suturing system of the present invention, an object to be sutured can be image-recognized by the first objective lens and the second objective lens, and the object to be sutured is sandwiched between the first objective lens and the second objective lens. By installing the , it is possible to grasp the position of the object to be sewn in the perspective direction from the degree of defocusing of the image by the first objective lens and the second objective lens, so that the object to be sewn can be grasped three-dimensionally. becomes possible. In addition, since the first objective lens and the second objective lens are arranged side by side in the perspective direction, stitching is performed more than when the first objective lens and the second objective lens are arranged side by side in the direction perpendicular to the perspective direction. The radial size of the treatment section can be made compact.

The first objective lens is arranged proximal to the most proximal end of the movable section of the tip of the first needle member, and the second objective lens is the most distal end of the movable section of the tip of the second needle member. It may be located distal to the . Also, the first objective lens and the second objective lens may be arranged such that at least a portion thereof overlaps with each other when viewed from the perspective direction of the shaft.

An illuminator may be provided in the bi-directional medical suturing system. Thereby, a clearer image can be obtained through the first objective lens and/or the second objective lens. The illuminator can, for example, be arranged proximal to the first objective lens and/or distal to the second objective lens. Further, an illuminator is arranged distal to the first objective lens and proximal to the second objective lens, and the emitted light from the illuminator does not directly enter the first objective lens or the second objective lens. It may be shielded as shown.

It is preferable that the optical axis of the first objective lens and the optical axis of the second objective lens are parallel in the perspective direction. The first objective lens may be movable in the near and far directions with respect to the shaft. The numerical aperture of the first objective lens is preferably greater than the numerical aperture of the second objective lens.

A two-way medical suturing system includes a storage unit holding information for specifying a first puncture position on an object to be sutured; It may further comprise a controller for controlling the first needle member to move from the positional side to the distal side. The bidirectional medical suturing system also includes a storage unit that holds information for specifying a second puncture position on the object to be sutured; It may further comprise a controller for controlling the second needle member to move from the distal side to the proximal side.

The bi-directional medical suturing system further comprises a display device for displaying the image obtained through the first objective lens or the image obtained through the second objective lens, the display device displaying the first needle position or the second needle position. A sign may be displayed at a position corresponding to . The bi-directional medical suturing system may also generate three-dimensional image data of the suture object based on the image obtained through the first objective lens and the image obtained through the second objective lens.

The bi-directional medical suturing system may have a mechanism for moving the shaft in a direction different from the near-far direction.

The bidirectional medical suturing system is a positioning marker that indicates a specific position in two-dimensional coordinates perpendicular to the perspective direction, and at least one of an image captured by the first objective lens and an image captured by the second objective lens. may have a positioning marker displayed on the .

According to the two-way medical suturing system of the present invention, an object to be sutured can be image-recognized by the first objective lens and the second objective lens, and the object to be sutured is sandwiched between the first objective lens and the second objective lens. By installing the , it is possible to grasp the position of the object to be sewn in the perspective direction from the degree of defocusing of the image by the first objective lens and the second objective lens, so that the object to be sewn can be grasped three-dimensionally. becomes possible. In addition, since the first objective lens and the second objective lens are arranged side by side in the perspective direction, stitching is performed more than when the first objective lens and the second objective lens are arranged side by side in the direction perpendicular to the perspective direction. The radial size of the treatment section can be made compact.

FIG. 2 shows an example of a side view of a suturing instrument provided in a bidirectional medical suturing system; An example of a cross-sectional view of a treatment section on the distal side of the suture instrument is shown. FIG. 3 is a cross-sectional view showing a state in which a needle member pierces an object to be sutured in the treatment portion of the suture device shown in FIG. 2 ; FIG. 10B shows another example of a cross-sectional view of the treatment section on the distal side of the suture instrument, and shows a configuration example of the treatment section provided with a member for fixing the sutured object. FIG. 5 is a cross-sectional view showing a state in which an object to be sutured is sandwiched between fixing members in the treatment portion of the suture instrument shown in FIG. 4 ; Another example of a cross-sectional view of the treatment section on the distal side of the suturing instrument, showing the treatment section provided with a regulating member, in a state where the regulating member is positioned so as not to interfere with the movement of the needle member. A configuration example is shown. FIG. 7 shows a cross-sectional view of the treatment portion of the suture device shown in FIG. 6 in a state where the restricting member is positioned to hinder the movement of the needle member; An example of a cross-sectional view of the treatment section on the distal side of the suturer is shown, and an example of the configuration of the treatment section in which a spacer member is provided below the regulating member. FIG. 11 shows an example of a cross-sectional view of a treatment section on the distal side of the suturing device, and shows an example of the configuration of the treatment section provided with a sutured object fixing member and a regulating member. 1 shows an example of a block configuration diagram of a bi-directional medical suturing system. FIG.

The present invention relates to a two-way medical suturing system having a two-way suturing mechanism capable of passing a suturing object such as a biological membrane in both directions, from one side to the other side and from the other side to the other side. It is. The two-way suture system for medical use of the present invention includes a first needle member that feeds a thread from the proximal side to the distal side, a second needle member that feeds the thread from the distal side to the proximal side, and a first needle member side. a first objective lens provided on the needle member and facing the distal side; and a second objective lens provided on the side of the second needle member and facing the proximal side. According to the two-way medical suturing system of the present invention, the first objective lens and the second objective lens can perform image recognition of the object to be sutured, and also grasp whether or not the position of the object to be sutured in the perspective direction is appropriate. Therefore, it is possible to appropriately set the needle positions of the object to be sutured by the first needle member and the second needle member.

The bidirectional medical suturing system of the present invention will be specifically described below based on the following embodiments, but the present invention is not limited by the following embodiments, and can conform to the gist of the above and later descriptions. Of course, it is possible to make appropriate changes within the scope and implement them, and all of them are included in the technical scope of the present invention. In each drawing, for the sake of convenience, hatching, member symbols, etc. may be omitted, but in such cases, the specification and other drawings shall be referred to. In addition, the dimensions of various members in the drawings may differ from the actual dimensions, since priority is given to helping to understand the features of the present invention.

FIG. 1 shows an example of a side view of a suture device provided in a two-way medical suture system, and FIGS. 2 and 3 show examples of cross-sectional views of a treatment section provided on the distal side of the suture device. rice field. FIG. 2 shows the state before the needle member is pierced into the suture object, and FIG. 3 shows the state after the needle member has been pierced into the suture object. In this specification, the "medical bidirectional suturing system" may be simply referred to as the "suturing system."

The suturing system has a suturing instrument 11 with a suturing mechanism with a first needle member 16 and a second needle member 17 . The suturing device 11 has a shaft 12 extending in the near-and-far direction, and the distal portion of the shaft 12 is provided with a treatment section 13 for suturing an object to be sutured such as a biological membrane. The treatment section 13 includes a first needle member 16 and a second needle member 17, and by operating these members, an object to be sutured can be sutured.

A handle portion 15 is preferably provided on the proximal side of the shaft 12 . The handle portion 15 may simply hold or fix the shaft 12 during treatment, or may be provided with an operation portion for operating the treatment portion 13 . The operation of the treatment section 13 may be performed by the operator holding the handle section 15 and operating it, or by remote control while the operator watches a monitor or the like from a place away from the handle section 15. . In the latter case, the suturing system preferably has an operating section separate from the suturing device, and the operating section is provided with, for example, an input section for operating the first needle member and the second needle member. Alternatively, the treatment section 13 may be operated mechanically according to a predetermined protocol without intervention of the operator.

In the present invention, the perspective direction is determined based on the extending direction of the shaft 12 . The proximal side of the shaft 12 refers to the direction toward the handle portion 15 side, and the distal side refers to the direction opposite to the proximal side, that is, the direction toward the object to be treated. 1-3, the left side of the drawing is the distal side and the right side of the drawing is the proximal side. Also, the direction from one of the proximal side and the distal side to the other is referred to as the far-near direction.

The size of the suturing device 11 in the far-near direction may be set based on the distance from the hand of the operator to the object to be sutured. In TSS (transsphenoidal sinus pituitary tumorectomy), the distance from the pituitary gland to the nostril may be used as a reference, and for example, 20 cm or more and 50 cm or less is preferable.

Each part of the suture device 11 is preferably made of biocompatible material. Examples of such materials include metal materials such as stainless steel and resin materials. In particular, the portion to be inserted into the body is preferably made of a biocompatible material or provided with a biocompatible coating layer.

As shown in FIGS. 2 and 3, the first needle member 16 has a distal end facing distally and is movable in the far-near direction. The second needle member 17 is arranged on the distal side of the first needle member 16, has a distal end facing the proximal side, and is movable in the far-near direction. As shown in FIG. 3, the object to be sutured 31 is placed between the tip of the first needle member 16 and the tip of the second needle member 17, and the first needle member 16 is threaded and moved distally. , the first needle member 16 pierces the sutured object 31, and the thread can be passed through the sutured object 31 from the proximal side to the distal side. Also, by threading the second needle member 17 and moving it to the proximal side, the thread can be similarly passed through the suture object 31 from the distal side to the proximal side. At this time, the thread passed through the suturing object 31 from the proximal side by the first needle member 16 and sent to the distal side moves toward the second needle member 17 , and is moved from the distal side by the second needle member 17 . The thread passed through the object 31 to be sutured and sent to the proximal side moves toward the first needle member 16 . As a result, the thread can be moved in the far-near direction, and the suture object 31 can be sutured. For suturing, for example, a first needle member 16 is used to pass a thread from the proximal side to the distal side through one side portion of an incision such as a biological membrane sandwiching the incision line, and the second needle member 17 is passed through the other side portion. This can be done by passing the thread from the distal side to the proximal side.

Shaft 12 preferably has a lumen, and first needle member 16 and second needle member 17 are preferably disposed within the lumen of shaft 12 . The shaft 12 is also preferably provided with a notch 14 in which the suture object 31 is placed during the procedure. The notch 14 may be provided at least partly between the tip of the first needle member 16 and the tip of the second needle member 17 . Specifically, the notch 14 is formed so that the distal end of the first needle member 16 of the shaft 12 is positioned with the first needle member 16 positioned most proximally and the second needle member 17 positioned most distally. It may be provided on at least a portion of the more distal side and proximal side than the tip of the second needle member 17 . The notch 14 may be formed to extend proximally from the tip of the first needle member 16 and/or distally from the tip of the second needle member 17 .

Preferably, the shaft 12 is provided with an insertion passage through which the first needle member 16 passes and/or an insertion passage through which the second needle member 17 passes. By providing these insertion paths, it becomes easier to stably move the first needle member 16 and the second needle member 17 in the distance direction.

The first needle member 16 is preferably movable to a position closer to the proximal side than the tip of the second needle member 17 while the second needle member 17 is positioned on the most distal side. It is preferred not to reach further distal than the tip of 17 . That is, the most distal end of the movable section of the tip of the first needle member 16 is located on the proximal side of the tip of the second needle member 17 when the second needle member 17 is positioned on the most distal side. preferably. The tip of the second needle member 17 is preferably movable to a position distal to the tip of the first needle member 16 while the first needle member 16 is positioned most proximally. It is preferred not to reach proximally beyond the tip of the needle member 16 . That is, the most proximal end of the movable section of the distal end of the second needle member 17 is positioned further distally than the distal end of the first needle member 16 when the first needle member 16 is positioned most proximally. is preferred. This makes it easier to move the thread between the first needle member 16 and the second needle member 17 when the thread is passed over the first needle member 16 or the second needle member 17 and moved in the distance direction.

It is preferable that the first needle member 16 and the second needle member 17 are arranged so that at least a part thereof overlaps each other when viewed from the perspective direction of the shaft 12, and the axial center of the first needle member 16 and the second needle member It is more preferable that the center of the axis of 17 coincides. That the first needle member 16 and the second needle member 17 overlap each other when viewed from the distal side means that the first needle member 16 and the second needle member 17 are substantially on the same straight line in the distance direction. means In this case, it is preferable that at least the tip portion of the first needle member 16 and the tip portion of the second needle member 17 overlap each other when viewed from the distal side. By arranging the first needle member 16 and the second needle member 17 in this manner, the thread moved to the distal side by the first needle member 16 is easily arranged near the tip of the second needle member 17, thereby The thread moved proximally by the needle member 17 is more likely to be arranged near the tip of the first needle member 16 . Therefore, the thread can be easily moved between the first needle member 16 and the second needle member 17 . If it is difficult to pierce the object to be sutured with the one of the first needle member 16 and the second needle member 17 with which the thread is passed, the needle member without the thread is used to puncture the object to be sutured. By opening, it is also possible to easily suture the object to be sutured.

The thread is not particularly limited as long as it is a suture thread for medical use, and may be a single thread or a braided thread. The diameter of the thread can be appropriately selected as long as it is a diameter commonly used for sutures. The thread material may be a degradable material. The length of the thread is desirably long enough not to interfere with surgery, preferably 20 cm or more and 200 cm or less. For example, in TSS, a length that allows the suture to travel back and forth from outside the body to the dura plus a length sufficient for a physician to knot the suture outside the patient's body is preferred, and is preferred in TSS. The thread length is 40 cm or more and 150 cm or less.

The first and second needle members 16 and 17 are preferably made of a material that is biocompatible and strong enough to pierce an object to be sutured, such as a biological membrane. The first and second needle members 16 and 17 are preferably made of, for example, a metal material such as stainless steel or a resin material, and more preferably made of stainless steel from the viewpoint of safety and ease of processing.

The first and second needle members 16, 17 may be solid or hollow. It is preferable that the first and second needle members 16 and 17 are solid from the viewpoint of ease of manufacture and high strength.

The outer diameters of the first and second needle members 16 and 17 are not particularly limited as long as they are diameters used for general suture needles, but are preferably 0.05 mm or more and 1.5 mm or less, for example. When the first and second needle members 16 and 17 are hollow, the thickness thereof is preferably 0.01 mm or more and 0.5 mm or less, for example.

The lengths of the first and second needle members 16 and 17 can be appropriately set within the range of 1.5 mm or more and 40 cm or less, which is the distance from the nasal cavity to the pituitary gland, for example for TSS.

The first needle member 16 and the second needle member 17 are preferably directly or indirectly connected to the handle portion 15 . As a result, the movement of the first needle member 16 and the second needle member 17 in the far-near direction can be performed from the proximal side of the suturer. When first needle member 16 or second needle member 17 is indirectly connected to handle portion 15, first needle member 16 or second needle member 17 is connected to handle portion 15 via one or more connecting members. It is good if there is

The distal end portions of the first and second needle members 16 and 17 are preferably formed so that the cross-sectional area decreases toward the distal end, thereby allowing the first and second needle members 16 and 17 to be sutured. Makes it easier to prick.

The first and second needle members 16, 17 are preferably bifurcated into at least a first end and a second end. The first and second needle members 16, 17 may have three or more ends at their distal ends. As a result, when the first needle member 16 is moved distally or the second needle member 17 is moved proximally, the thread is passed through the bifurcated portion of the first needle member 16 or the second needle member 17. be able to. The branched portion of each needle member preferably has a groove shape with a predetermined angle with respect to the moving direction of the needle member, that is, the perspective direction, and is arranged perpendicular to the perspective direction, for example. When the thread is hooked on such a branched portion, the thread can be moved together with the movement of the first needle member 16 and the second needle member 17 in the distance direction, making it easier to pass the thread through the object to be sutured. The tip position of each branched end may be the same or different with respect to the perspective direction.

The overall shape of the first and second needle members 16, 17 may be linear, curved, or a combination thereof. The first and second needle members 16, 17 may have folds. In the drawing, the second needle member 17 is provided with a bent portion. By providing the second needle member 17 with a bent portion, the distal end of the second needle member 17 faces the proximal side, and the base end side of the second needle member 17 also faces the proximal side. Thus, the second needle member 17 can be connected to the handle portion 15 . In addition, a cutout portion 14 in the shaft 12 is provided so that the connection portion connecting the portion extending in the distance direction on the distal end side of the second needle member 17 and the portion extending in the distance direction on the base end side of the second needle member 17 can move in the direction of distance. A groove 20 for the connecting portion to pass through is formed on the distal side. Although not shown in the drawings, the second needle member 17 is not provided with a bent portion, but is provided with a connecting member extending in the distal and near directions at the distal end of the second needle member 17, and this connecting member The second needle member 17 may be connected to the handle portion 15 via.

Although not shown in the drawings, the shaft 12 may be fitted with a protective lid that covers the notch 14 . As a result, the distal ends of the first needle member 16 and the second needle member 17 can be prevented from being exposed from the notch portion 14 when the shaft 12 is moved inside the body before and after suturing. It is preferable that the protective lid is attached so as to be movable in the near and far directions. Moreover, it is preferable that opening and closing of the protective lid can be operated by the handle portion 15 on the hand side. As a result, the protective lid can be moved to expose the notch 14 during suturing, and the notch 14 can be covered with the protective lid during non-suturing.

The suturing system has an objective lens group including a first objective lens 18 and a second objective lens 19 . The first objective lens 18 is disposed proximal to the distal end of the movable section at the tip of the first needle member 16 and faces distally, and the second objective lens 19 is the second It is located distal to the most proximal end of the movable section of the tip of needle member 17 and faces proximally. The suturing system is preferably provided with an imaging device for converting an image obtained through the lens into an electrical signal for the first objective lens 18 and the second objective lens 19 . The object 31 to be sutured can be image-recognized by the first objective lens 18 and the second objective lens 19, and the puncture position of the object 31 to be sutured by the first needle member 16 and the second needle member 17 can be appropriately set. can. In addition, by installing the first objective lens 18 and the second objective lens 19 with the stitching target 31 interposed therebetween, the degree of defocusing of the image by the first objective lens 18 and the second objective lens 19, in other words, the out-of-focus blur Depending on the situation, it is possible to grasp whether the position of the object 31 to be sutured in the near-far direction is appropriate. Furthermore, since the first objective lens 18 and the second objective lens 19 are arranged side by side in the distance direction, the size of the treatment section 13 can be reduced. It is possible to grasp the object 31 to be sutured three-dimensionally while arranging the object 19 . It is preferable that the first objective lens 18 and the second objective lens 19 are arranged so that at least a part thereof overlaps each other when viewed from the perspective direction of the shaft 12 . If the first objective lens 18 and the second objective lens 19 are arranged in this manner, the size of the treatment section 13 with respect to the radial direction of the shaft 12 can be made compact.

The direction in which the first objective lens 18 faces the distal side, that is, the direction in which the optical axis of the first objective lens 18 extends from the first objective lens 18 to the suture object 31 side from the first objective lens 18 is , preferably within ±30°, more preferably within ±20°, and even more preferably within ±10° relative to the distal direction. The direction in which the second objective lens 19 faces the proximal side, that is, the direction in which the optical axis of the second objective lens 19 extends from the second objective lens 19 to the suturing object 31 side from the second objective lens 19 is , preferably within ±30°, more preferably within ±20°, and even more preferably within ±10° with respect to the proximal direction. If the first objective lens 18 and the second objective lens 19 are installed in this way, when the suturing target 31 is arranged at a position where the suturing target 31 can be punctured by the first needle member 16 and the second needle member 17, The image recognition of the object 31 can be favorably facilitated by the first objective lens 18 and the second objective lens 19 . The optical axis of the first objective lens 18 and the optical axis of the second objective lens 19 are parallel to the perspective direction of the shaft 12 because it is easier to grasp the position of the object to be sewn 31 in the perspective direction more accurately. is preferred. In particular, it is preferable that the lens surfaces of the first objective lens 18 and the second objective lens 19 are arranged perpendicular to the straight line extending in the perspective direction. Furthermore, it is preferable to arrange the first objective lens 18 and the second objective lens 19 on the same straight line extending in the distance direction.

The first objective lens 18 is arranged at or proximal to the proximal end of the cutout 14, and the second objective lens 19 is arranged at or distal to the distal end of the cutout 14. is preferred. In this case, the suturing object 31 is arranged in the notch 14, so that the suturing object 31 can be reliably contained in the image by the first objective lens 18 and the second objective lens 19. FIG.

Although not shown in the drawings, the first objective lens 18 may be arranged proximal to the most proximal end of the movable section at the distal end of the first needle member 16, and the second objective lens 19 may , the distal end of the movable section of the tip of the second needle member 17 may be arranged on the distal side. By arranging the first objective lens 18 and the second objective lens 19 in this manner, it becomes easier to include the tip of the first needle member 16 or the tip of the second needle member 17 together with the object 31 to be sutured in the image. It becomes easier to more accurately set the puncture positions of the object 31 to be sutured by the first needle member 16 and the second needle member 17 .

The first objective lens 18 may be provided on the shaft 12 as long as it is arranged on the proximal side of the distal end of the movable section at the tip of the first needle member 16, and any member other than the shaft 12 may be provided. may be provided in The second objective lens 19 may be provided on the shaft 12 as long as it is disposed on the distal side of the most proximal end of the movable section at the distal end of the second needle member 17, and may be provided on any member other than the shaft 12. may be provided. When the first objective lens 18 or the second objective lens 19 is provided on the shaft 12, the first objective lens 18 or the second objective lens 19 may be arranged inside the shaft 12 or outside the shaft 12. good. The drawing shows a configuration example in which the first objective lens 18 and the second objective lens 19 are provided in the shaft 12 . On the other hand, although not shown in the drawings, when the first objective lens 18 or the second objective lens 19 is provided on a member other than the shaft 12, for example, the suturing system includes an endoscope, The lens provided on the mirror may be the first objective lens 18 or the second objective lens 19 . In this case, it is particularly convenient to construct the first objective lens 18 from an endoscope lens. On the other hand, the second objective lens 19 is preferably provided on the shaft 12, so that the treatment section 13 can be formed compactly.

The first objective lens 18 and/or the second objective lens 19 may be fixed with respect to the shaft 12 or may be movably provided. For example, the first objective lens 18 and/or the second objective lens 19 may be movable relative to the shaft 12 , in particular the first objective lens 18 may be movable relative to the shaft 12 . There may be. In this case, a lens drive mechanism can be arranged on the shaft 12 in order to make the first objective lens 18 and/or the second objective lens 19 arranged on the shaft 12 movable. By moving the first objective lens 18 and/or the second objective lens 19 in the distance direction, the focal position of the lens can be adjusted. When the first objective lens 18 is composed of an endoscope lens, the first objective lens 18 is formed so as to be movable relative to the shaft 12 in the distance direction. The first objective lens 18 and/or the second objective lens 19 may be rotatable about a direction perpendicular to the shaft 12 . By rotationally moving the first objective lens 18 and/or the second objective lens 19, a wider area can be observed.

The numerical aperture of the first objective lens 18 is preferably greater than that of the second objective lens 19 . The numerical aperture is one of the indexes that express the resolving power of a lens, and the larger the numerical aperture, the more brightness can be captured. When suturing the object 31 to be sutured, the first step is to pass the thread from the proximal side to the distal side of the object 31 to be sutured by the first needle member 16, so that the numerical aperture of the first objective lens 18 is set to the second. If the numerical aperture is larger than the numerical aperture of the objective lens 19 , the puncture position of the first needle member 16 can be determined more accurately based on the image acquired through the first objective lens 18 .

Although not shown in the drawings, the suturing system may be provided with an illuminator. This allows the first objective lens 18 and/or the second objective lens 19 to acquire a clearer image. The illuminator is provided to illuminate the suture object 31, and is preferably arranged, for example, at least one of proximal to the first objective lens 18 and distal to the second objective lens 19. More preferably, they are arranged on the proximal side of the lens 18 and on the distal side of the second objective lens 19 . By providing the illuminator at such a position, a wide range of the suturing object 31 can be illuminated.

The illuminator may be positioned distal to the first objective lens 18 and proximal to the second objective lens 19 . By providing the illuminator at such a position, the object to be sewn 31 can be illuminated more brightly, and the object to be sewn 31 can be less likely to be shadowed. In this case, the illuminator is located distal to the first objective lens 18 and proximal to the second objective lens 19, and is located distal and proximal to the position where the sutured object 31 is arranged. and more preferably on the proximal side and the distal side of the position where the suture object 31 is arranged.

The illuminator may be provided at the same position as the first objective lens 18 or at the same position as the second objective lens 19 in the perspective direction. Even if the illuminator is provided at such a position, it is possible to prevent the sewing object 31 from being shadowed. In this case, the illuminator may be placed on at least one of the distal side and the proximal side of the position where the suture target 31 is placed, and the illuminator may be placed on the proximal side and the proximal side of the position where the suture target 31 is placed. More preferably, they are each arranged distally.

The illuminator is preferably shielded so that its output light does not directly enter the first objective lens 18 or the second objective lens 19 . Specifically, when the illuminator is arranged on the proximal side of the position where the suturing target 31 is arranged, the light emitted from the illuminator is shielded so as not to enter the first objective lens 18 directly. When the illuminator is arranged on the distal side of the position where the suture object 31 is arranged, the light emitted from the illuminator is shielded so as not to enter the second objective lens 19 directly. preferably. This makes it difficult for halation to occur in the image obtained by the first objective lens 18 or the second objective lens 19 .

The illuminator may be provided on the shaft 12 or may be provided on any member other than the shaft 12 . If the shaft 12 is provided with an illuminator, the illuminator may be positioned within the lumen of the shaft 12 or may be positioned outside the shaft 12 . If the illuminator is provided on any member other than the shaft 12, for example, the suturing system includes an endoscope, and the illuminator provided in the endoscope is positioned proximally of the first objective lens 18 or It may be used as an illuminator provided on the distal side or as an illuminator provided on the proximal or distal side of the second objective lens 19 .

As a light source for the illuminator, for example, an LED, a xenon lamp, an organic EL, a laser beam, or the like can be used.

The suturing device is preferably provided with a fixing member for fixing a biological membrane or the like, which is an object to be sutured. FIGS. 4 and 5 show configuration examples of the treatment portion of the suturing device provided with the fixing member 21. FIG. The fixing member 21 is formed to be movable in the far-near direction, and by moving in the far-near direction, the object to be sutured 31 can be clamped and fixed. This facilitates puncturing by the first needle member 16 and the second needle member 17 .

The fixing member 21 is preferably disposed within the shaft 12 and adjacent to the notch 14 in the perspective direction. In this case, the length of the notch 14 in the perspective direction can be changed by moving the fixing member 21 in the perspective direction.

FIG. 4 shows the treatment section 13 before holding the suture object 31 therebetween, and FIG. 5 shows the treatment section 13 with the suture object 31 held therebetween. FIGS. 4 and 5 show a configuration example of the treatment section 13 capable of sandwiching the suture target 31 when the fixing member 21 is moved distally. With the first needle member 16 positioned most proximally and the second needle member 17 positioned most distally, the proximal end is distal to the tip of the first needle member 16 and the second needle. It is preferably located proximal to the tip of member 17 . In this case, the fixed member 21 can be provided with the first objective lens 18 , and the fixed member 21 can also be provided with an illuminator for the first objective lens 18 .

Although not shown in the drawings, the fixing member 21 may be capable of sandwiching the suture object 31 when moved proximally. In this case, the proximal end of the fixing member 21 is positioned further than the tip of the first needle member 16 with the first needle member 16 positioned most proximally and the second needle member 17 positioned most distally. It is preferable that the second needle member 17 be positioned distally and proximally relative to the tip of the second needle member 17 . In this case, the fixed member 21 can be provided with the second objective lens 19 , and the fixed member 21 can also be provided with an illuminator for the second objective lens 19 .

It is preferable that the fixing member 21 has a first insertion passage 22 extending in the distance direction, and the first needle member 16 and/or the second needle member 17 are inserted through the first insertion passage 22 . The first insertion passage 22 is provided so as to pass through the fixing member 21 in the far-near direction. By providing the first insertion passage 22 in the fixing member 21 in this manner, the fixing member 21 can fix the periphery of the point where the object to be sutured 31 is punctured by the first needle member 16 or the second needle member 17. Pricking by the first needle member 16 and the second needle member 17 is facilitated. In addition, the trajectories of the first needle member 16 and the second needle member 17 moving in the distance direction are stabilized.

The fixing member 21 is preferably directly or indirectly connected to the handle portion 15 . Thereby, the movement of the fixing member 21 in the far-near direction can be performed from the proximal side of the suture instrument. When the fixing member 21 is indirectly connected to the handle portion 15, the fixing member 21 may be connected to the handle portion 15 via one or more connecting members.

The suture device has the first needle member 16 positioned most proximally and the second needle member 17 positioned most distally, and the needle member 16 is positioned distally of the first needle member 16 and/or the second needle member 17 is positioned distally. It is preferable that the restricting member be provided at a position closer to the proximal side than the needle member 17 . FIGS. 6 and 7 show configuration examples in which a restricting member 24 is provided for the treatment portion 13 shown in FIGS. 2 and 3. FIG. By providing the regulating member 24, when the thread is fed from the proximal side of the sutured object 31 by the first needle member 16 or when the thread is fed from the distal side of the sutured object 31 by the second needle member 17, Movement of the thread can be restricted so that the thread does not slip out of the suturer. 6 and 7, a first restricting member 24A and a second restricting member 24B are provided as the restricting member 24, and at least a portion of the second restricting member 24B is located on the distal side of the first restricting member 24A. It is designed to The restricting member 24 is preferably arranged within the shaft 12 .

The restricting member 24 is movably formed between a position where movement of the first needle member 16 and/or the second needle member 17 is obstructed and a position where it is not obstructed. Specifically, the restricting member 24 has a holding portion 25, and the holding portion 25 moves between a position that interferes with the movement of the first needle member 16 and/or the second needle member 17 and a position that does not interfere with it. formed to move. The position that interferes with the movement of the first needle member 16 refers to the locus of the first needle member 16 when the first needle member 16 is moved in the distance direction, where the first needle member 16 is the most proximal. In the state located on the side, it means an arbitrary position on the distal side from the tip of the first needle member 16 . The position that hinders the movement of the second needle member 17 is the locus of the second needle member 17 when the second needle member 17 is moved in the distance direction, and the position where the second needle member 17 is the most distal. In the state of being located on the side, it means an arbitrary position on the proximal side from the tip of the second needle member 17 .

As the restricting member 24, a first restricting member 24A and a second restricting member 24B are preferably provided. It is movable, and the second restricting member 24B is movably formed between a position where the movement of the second needle member 17 is obstructed and a position where it is not obstructed. More preferably, both the first restricting member 24A and the second restricting member 24B are formed to be movable between a position that interferes with the movement of the first needle member 16 and the second needle member 17 and a position that does not interfere. be.

With the first needle member 16 positioned most proximally and the second needle member 17 positioned most distally, the holding part 25 is positioned distally of the first needle member 16 and of the second needle member. It is preferably located proximal to 17 . When the first restricting member 24A and the second restricting member 24B are provided as the restricting member 24, the holding portion 25 of the first restricting member 24A is positioned closer to the proximal side than the holding portion 25 of the second restricting member 24B. It is preferably provided. In this case, the object to be sewn 31 is preferably arranged between the holding portion 25 of the first restricting member 24A and the holding portion 25 of the second restricting member 24B. Preferably, the shaft 12 is provided on the proximal side of the notch 14 , and the holding portion 25 of the second restricting member 24</b>B is provided on the distal side of the notch 14 .

By moving in a direction different from the far-near direction, holding portion 25 can move between a position that interferes with the movement of first needle member 16 and/or second needle member 17 and a position that does not. preferable. The direction different from the perspective direction is preferably parallel movement in a direction different from the perspective direction. FIGS. 6 and 7 show configuration examples of the regulating member 24 in which the holding portion 25 moves in a direction perpendicular to the perspective direction as a mode in which the holding portion 25 moves parallel in a direction different from the perspective direction. In FIG. 6, the holding portion 25 is positioned so as not to interfere with the movement of the first needle member 16 and the second needle member 17. In FIG. in a position that interferes with By moving the holding portion 25 to a position that hinders the movement of the first needle member 16 and/or the second needle member 17, the thread to be delivered by the first needle member 16 or the second needle member 17 can be easily moved. You can keep it from falling out. On the other hand, when the holding portion 25 is at a position that does not hinder the movement of the first needle member 16 and/or the second needle member 17, by moving the first needle member 16 or the second needle member 17 in the distance direction, Yarn can be sent out. The holding part 25 may prevent the thread from falling off by directly contacting the thread, or may prevent the thread from falling off by moving to a position that hinders the thread from falling off.

The movement direction of the holding part 25 is preferably 45° or more and 90° or less with respect to the perspective direction, more preferably 60° or more and 90° or less, and still more preferably 75° or more and 90° or less. The holding part 25 is preferably movable in a direction perpendicular to the perspective direction, so that even if the holding part 25 comes into contact with the yarn when the holding part 25 is moved, the yarn is less likely to shift in the perspective direction. Become. In FIGS. 6 and 7, the restricting member 24 is formed in an L shape in cross section along the far-near direction, and the distal end of the portion extending perpendicular to the far-near direction is the holding portion 25 . It's becoming The holding part 25 is movable in a direction perpendicular to the perspective direction.

It is preferable that an insertion passage through which the holding portion 25 passes is provided inside the shaft 12 . The insertion path through which the holding portion 25 passes preferably extends along the moving direction of the holding portion 25 . By providing such an insertion path, it becomes easier to move the holding part 25 in parallel in a desired direction and accurately move it to a position where the movement of the first needle member 16 and/or the second needle member 17 is hindered. . It is preferable that the insertion path through which the holding part 25 passes is connected to the middle of the insertion path through which the first needle member 16 or the second needle member 17 passes. Further, the cutout portion 14 of the shaft 12 is provided on the distal side of the insertion path through which the holding portion 25 of the first restricting member 24A passes and the proximal side of the insertion path through which the holding portion 25 of the second restricting member 24B passes. is preferred.

The shape of the holding portion 25 is not particularly limited. In order to reduce the space in which the holding portion 25 moves within the shaft 12 and to easily prevent the thread from falling off due to the movement of the holding portion 25, the holding portion 25 has a rod-like or plate-like shape extending in a direction different from the perspective direction. and is movable in that direction.

The restricting member 24 is formed so as to be moved between a position that interferes with movement of the first needle member 16 and/or the second needle member 17 and a position that does not interfere with the operation from the proximal side of the suture instrument. It is preferable that From this point of view, it is preferable that the regulating member 24 has a supporting portion 26 extending in the far-near direction on the proximal side of the holding portion 25 . In this case, the movement of the support portion 26 is directly or indirectly controlled by manipulation from the proximal side of the suturing instrument to move the retainer portion 25 to the position of the movement of the first needle member 16 and/or the second needle member 17. It can be moved between an interfering position and a non-obstructing position.

The holding portion 25 and the support portion 26 of the regulating member 24 may be integrally constructed from one member, or may be constructed by combining a plurality of members. In FIGS. 6 and 7, the restricting member 24 is formed by bending the wire rod into an L shape, and the tip portion on the distal side of the bent L shape is used as a holding portion 25, and the portion on the proximal side is supported. 26.

The restricting member 24 is preferably formed such that the holding portion 25 and the supporting portion 26 are movable in a direction perpendicular to the distance direction. If the holding portion 25 and the support portion 26 are integrally movable in the direction perpendicular to the perspective direction, the holding portion 25 can be stably moved in the direction perpendicular to the perspective direction. In this case, the restricting member 24 is preferably formed so as to be movable in a direction perpendicular to the perspective direction as follows. That is, the vertical direction is defined as the direction perpendicular to the distance direction in which the holding part 25 can move, and the holding part 25 does not interfere with the movement of the first needle member 16 and/or the second needle member 17. A spacer member movable in the near-far direction is provided below the support portion 26 of the regulating member 24, and the spacer member is moved distally. Preferably, the retaining portion 25 and the supporting portion 26 move upward when the spacer member is moved, and the retaining portion 25 and the supporting portion 26 move downward when the spacer member is moved proximally.

FIG. 8 shows a configuration example in which a spacer member 27 movable in the far and near direction is provided below the support portion 26 of the regulating member 24 . As shown in FIG. 8, when the spacer member 27 is moved distally, the holding portion 25 and the support portion 26 of the first restricting member 24A move upward, and the holding portion of the second restricting member 24B moves upward. 25 and support 26 move upward. On the other hand, the state shown in FIG. 6 can be regarded as a state in which the spacer member 27 is moved proximally. , the support portion 26 moves downward, and the holding portion 25 and the support portion 26 of the second restricting member 24B move downward.

Spacer member 27 is preferably directly or indirectly connected to handle portion 15 . As a result, the spacer member 27 can be moved in the far-near direction by operating from the proximal side of the suture instrument, and the restricting member 24 can be moved to a position that hinders the movement of the first needle member 16 and/or the second needle member 17. and out of the way position. As the spacer member 27, it is preferable to use a rod-shaped or plate-shaped member extending in the distance direction. By using such a spacer member 27, it is possible to dispose the spacer member 27 even in a narrow space inside the shaft 12 and move it in the distance direction.

When the spacer member 27 is provided below the support portion 26 of the regulating member 24, it is preferable that the regulating member 24 receives a downward force when the spacer member 27 is moved proximally. This makes it easier for the restricting member 24 to move downward when the spacer member 27 is moved proximally. Therefore, it is preferable that the support portion 26 is in contact with an elastic member such as a spring or rubber. For example, a compression coil spring, a torsion spring, or a leaf spring may be installed on the upper side of the support section 26, or an extension coil spring may be installed on the lower side of the support section 26, or the support section 26 may be connected to the shaft 12 and rubber or the like on its lower side. A downward force can be applied to the support portion 26 by connecting it with an elastic string or elastic thread. As yet another example, a rubber or elastic string or elastic thread is wrapped around the cross section of the portion of the shaft 12 that includes the support portion 26 and the notch portion 14 as seen from the perspective direction. By providing it, a downward force can be applied to the support portion 26 . This makes it easier for the restricting member 24 to move downward when the spacer member 27 is moved proximally.

The suturing device may include both a fixing member for fixing the suturing object as described above and a restricting member for restricting movement of the thread so that the thread does not slip out of the suturing device. FIG. 9 shows a configuration example in which the restricting member 24 shown in FIGS. 6 and 7 is provided for the treatment portion 13 provided with the fixing member 21 shown in FIGS. 4 and 5 . Regarding the configuration example of FIG. 9, descriptions of parts overlapping with the above description will be omitted.

It is preferable that the fixing member 21 is provided with a second insertion path 23 extending in a direction different from the far-near direction, and at least a part of the holding portion 25 of the regulating member 24 is inserted through the second insertion path 23 . The second insertion path 23 is preferably connected to the middle of the first insertion path 22 through which the first needle member 16 or the second needle member 17 passes. In the treatment portion 13 shown in FIG. 9 , the holding portion 25 of the first restricting member 24A is inserted through the second insertion passage 23 . Note that the holding portion 25 of the second restricting member 24B may be inserted through the second insertion path 23. In this case, the object to be sutured 31 can be sandwiched when the fixing member 21 is moved proximally. can. By providing the second insertion passage 23 in the fixing member 21, the holding portion 25 of the regulating member 24 can be accurately moved in a direction different from the far-near direction. The second insertion path 23 is preferably formed so as to extend in a direction perpendicular to the perspective direction.

When at least a portion of the holding portion 25 of the regulating member 24 is inserted through the second insertion passage 23 of the fixing member 21, for example, as illustrated in FIG. A spacer member 27 was provided that was movable in the direction, and when the spacer member 27 was moved distally, the holding portion 25 and the support portion 26 moved upward, causing the spacer member 27 to move proximally. Sometimes, the retainer 25 and support 26 can be configured to move downward.

The suturing system preferably has a display for displaying the image obtained through the first objective lens 18 or the image obtained through the second objective lens 19 . The display device may display both the image obtained through the first objective lens 18 and the image obtained through the second objective lens 19 . The operator can perform the suturing operation on the suturing object 31 and determine the puncture position of the first needle member 16 or the second needle member 17 while viewing the image displayed on the display device.

The stitching system may generate three-dimensional image data of the stitching object 31 based on the image obtained through the first objective lens 18 and the image obtained through the second objective lens 19 . The operator can perform the suturing operation on the suturing object 31 and determine the puncture position of the first needle member 16 or the second needle member 17 while viewing the obtained three-dimensional image data.

The suturing system may have positioning markers that indicate specific locations in two-dimensional coordinates that are perpendicular to the perspective direction. A positioning marker is displayed on at least one of the image captured by the first objective lens 18 and the image captured by the second objective lens 19 . The positioning marker indicates a reference position in the surface direction of the suture object 31, and the operator can appropriately set the puncture position of the first needle member 16 or the second needle member 17 using the positioning marker as a guide. . The positioning marker may be, for example, a marker member attached to the suture device or a mark displayed on the image of the display device. In the former case, the marker member is provided at a position where it appears in the image captured by the first objective lens 18 or the second objective lens 19, and is preferably provided in the notch 14 of the shaft 12, for example.

As another method of using the positioning marker, the positioning marker can also be used as follows. That is, both the image captured by the first objective lens 18 and the image captured by the second objective lens 19 are displayed with positioning markers, and the image captured by the first objective lens 18 and the image captured by the second objective lens 19 are displayed. When the captured image is focused on the positioning marker, it can be determined that both the first objective lens 18 and the second objective lens 19 are observing the same two-dimensional plane perpendicular to the perspective direction. . Furthermore, by using the position of the positioning marker as the origin, the coordinate positions of the plane can be matched by the first objective lens 18 and the second objective lens 19, which is advantageous for generating three-dimensional image data of the suture object 31. Become.

The suturing system uses the first needle member 16 or the second needle member 16 by designating the position of the suturing object on a display that displays the image obtained through the first objective lens 18 or the image obtained through the second objective lens 19 . A needle position control section may be provided for controlling the needle position of the member 17 . The operator looks at the image obtained through the first objective lens 18 or the image obtained through the second objective lens 19, identifies the position to be punctured next, and displays the position on the display device or a separate designation device. You can enter information. The needle position control section to which the position information is input controls the first needle member 16 or the second needle member 17 to guide or needle the first needle member 16 or the second needle member 17 to the relevant position.

In the suturing system, the operator directly operates the handle portion 15 of the suturing device 11 based on the image information of the suturing object 31 acquired through the first objective lens 18 and/or the second objective lens 19 and the positional information in the near and far directions. The object to be sewn 31 may be sewn using the first objective lens 18 and/or the second objective lens 19, based on the image information of the object to be sewn 31 and position information in the perspective direction. The suturing of the object 31 may be performed automatically or semi-automatically. In the latter case, the suturing system includes a storage unit that holds information for specifying the puncture position on the suturing object 31, and controls the movement of the first needle member 16 and/or the second needle member 17 in the near and far directions. It is preferable to have a control unit that This will be described with reference to FIG. Regarding the puncture position of the needle member on the object to be sutured, the puncture position of the first needle member will be referred to as the "first puncture position", and the puncture position of the second needle member will be referred to as the "second puncture position".

Regarding the control of the movement of the first needle member 16 in the distance direction, it is preferable that the storage section and the control section are configured as follows. That is, the storage unit holds information for specifying the first puncture position on the sutured object 31, and the controller controls the position of the needle member 16 so that the tip of the first needle member 16 passes through the first punctured position on the sutured object 31. Preferably, the first needle member 16 is controlled to move from the proximal side to the distal side of the needle. The position of the first puncture is determined by the operator while viewing the image information displayed on the display device based on the image information obtained through the first objective lens 18 and/or the second objective lens 19. , may be input to the storage unit, or a calculation unit may be provided in the suturing system, and the calculation unit may determine the first puncture position and input it to the storage unit. The control unit moves the first needle member 16 from the proximal side to the first puncture position of the object 31 to be sutured based on the information of the first puncture position held in the storage unit, and punctures the object 31 to be sutured.

Regarding the control of the movement of the second needle member 17 in the distance direction, it is preferable that the storage section and the control section are configured as follows. That is, the storage unit holds information for specifying the second puncture position on the suture target 31, and the control unit controls the position of the second needle member 17 so that the tip of the second needle member 17 passes through the suture target 31 via the second puncture position. Preferably, the second needle member 17 is controlled to move from the distal side to the proximal side of the needle. The position of the second needle is determined by the operator while viewing the image information displayed on the display device based on the image information obtained through the first objective lens 18 and/or the second objective lens 19. , may be input to the storage unit, or a computing unit may be provided in the suturing system, and the computing unit may determine the second puncture position and input it to the storage unit. The control unit moves the second needle member 17 from the distal side to the second needle position on the sutured object 31 based on the second needle position information held in the storage unit, and pierces the sutured object 31 .

Preferably, the display device displays the marker at a position corresponding to the first pricking position or the second pricking position. When the suturing system generates three-dimensional image data of the object to be sutured, it is preferable to display the marker at a position corresponding to the first needle position or the second needle position in the three-dimensional image data. The indicator may be displayed by the operator inputting the first needle position or the second needle position, or the first needle position or the second needle position determined by the calculation unit is displayed. may be In either case, the first pricking position or the second pricking position can be confirmed on the display screen.

The suture instrument 11 preferably has a mechanism for moving the shaft 12 in a direction different from the near-far direction. For example, the shaft 12 is preferably formed so that the distal portion of the shaft 12 can move in a direction different from the distance direction with the proximal portion of the shaft 12 as a fulcrum. Moreover, it is preferable that the shaft 12 is formed so that it can be rotated about the distance direction of the shaft 12 as an axis. As a result, the tip of the first needle member 16 is moved to the first needle position or the tip of the second needle member 17 is moved to the second needle position based on the information on the first needle position or the second needle position held in the storage unit. It can be moved to the puncture position. In this case, the control unit moves the shaft 12 in a direction different from the far-near direction so that the tip of the first needle member 16 is moved to the position facing the first needle position or the tip of the second needle member 17 is moved to the second needle position. It is preferable to have the ability to control the movement of the shaft 12 so as to move it to a position opposite the . As a result, manpower saving or automation of the suturing operation can be achieved.

This application claims the benefit of priority based on Japanese Patent Application No. 2018-200351 filed on October 24, 2018. The entire contents of the specification of Japanese Patent Application No. 2018-200351 filed on October 24, 2018 are incorporated herein by reference.

11: Suturer 12: Shaft 13: Treatment Section 14: Notch 15: Handle 16: First Needle Member 17: Second Needle Member 18: First Objective Lens 19: Second Objective Lens 21: Fixing Member 22: First insertion path 23: Second insertion path 24: Regulating member 24A: First regulating member 24B: Second regulating member 25: Holding part 26: Supporting part 27: Spacer member 31: Object to be sewn

Claims (14)

a first needle member movable in a distal direction and having a tip facing distally for delivering a thread from the proximal side to the distal side ;
a second needle member that is movable in the distal and near directions, is arranged distally relative to the first needle member, has a distal end facing the proximal side, and feeds a thread from the distal side to the proximal side ;
an objective lens group including a first objective lens and a second objective lens ;
A shaft extending in a distal and proximal direction and having a lumen in which the first needle member and the second needle member are disposed, the shaft having a notch portion in which an object to be sutured is disposed. and a bi-directional medical suturing system comprising:
the first objective lens is arranged proximal to a distal end of the movable section of the tip of the first needle member and faces distally;
The bidirectional medical suturing system, wherein the second objective lens is arranged distally of the most proximal end of the movable section of the distal end of the second needle member and faces proximally. . the first objective lens is arranged proximal to the most proximal end of the movable section of the distal end of the first needle member;
The bidirectional medical suturing system according to claim 1, wherein the second objective lens is arranged distally of the distal end of the movable section of the tip of the second needle member. The two-way medical suturing system according to claim 1 or 2, wherein the first objective lens and the second objective lens are arranged so that at least a part thereof overlaps each other when viewed from the perspective direction of the shaft. The two-way medical suture according to any one of claims 1 to 3, wherein an illuminator is arranged on at least one of the proximal side of the first objective lens and the distal side of the second objective lens. system. An illuminator is disposed distal to the first objective lens and proximal to the second objective lens, and the illuminator emits light from the first objective lens or the second objective lens. 4. The two-way medical suturing system according to any one of claims 1 to 3, which is shielded so as not to directly enter the . The two-way medical suturing system according to any one of claims 1 to 5, wherein the optical axis of the first objective lens and the optical axis of the second objective lens are parallel in the perspective direction. The bidirectional medical suturing system according to any one of claims 1 to 6, wherein the first objective lens is movable in the near and far directions with respect to the shaft. The bidirectional medical suturing system according to any one of claims 1 to 7, wherein the numerical aperture of the first objective lens is greater than the numerical aperture of the second objective lens. a storage unit holding information for specifying the first puncture position on the object to be sutured;
1-, further comprising a control unit for controlling the first needle member such that the tip of the first needle member moves from the proximal side to the distal side of the object to be sutured via the first puncture position 9. The bi-directional medical suturing system according to any one of 8. a storage unit that holds information for specifying the second puncture position on the object to be sutured;
1-, further comprising a control unit for controlling the second needle member so that the tip of the second needle member moves from the distal side to the proximal side of the object to be sutured via the second needle position. 10. The medical bi-directional suturing system according to any one of 9. further comprising a display device for displaying an image obtained through the first objective lens or an image obtained through the second objective lens;
11. The bi-directional medical suturing system according to claim 9 or 10, wherein the display device displays a marker at a position corresponding to the first needle position or the second needle position. 11. The bidirectional medical suturing system according to claim 9, wherein three-dimensional image data of the suturing target is generated based on the image obtained through the first objective lens and the image obtained through the second objective lens. The bidirectional medical suturing system according to any one of claims 9 to 12, comprising a mechanism for moving the shaft in a direction different from the near-far direction. A positioning marker indicating a specific position of two-dimensional coordinates perpendicular to the perspective direction, the positioning marker being displayed on at least one of the image captured by the first objective lens and the image captured by the second objective lens. The bidirectional medical suturing system according to any one of claims 1 to 13, which has markers.

Images