JP7349553B2 - Endoscope needle holder - Google Patents

Description

The present invention relates to an endoscopic needle holder and an endoscopic suturing method.

BACKGROUND ART Needle holders for laparoscopy or endoscopy that grip suturing needles for suturing living tissue have been known (for example, see Patent Documents 1 to 4).

US Patent No. 5,951,587 US Patent No. 6,063,096 US Design Patent No. 773044 US Patent No. 5,196,023

To suture tissue under an endoscope, a needle holder that grips the suture needle is operated to pass the needle tip of the suture needle through the tissue and protrude from the tissue, and then the needle holder that grips the needle tip The entire suture needle must be withdrawn from the tissue by the action of the instrument. That is, when suturing tissue using a single needle holder, it is necessary to change the grasping position of the suture needle held by the needle holder.

A technique using two needle holders has been proposed as a method for simplifying the procedure by eliminating the need to change the grasping position. However, the movement of each needle holder inserted into the body via an endoscope is limited to forward and backward movement in the longitudinal direction and rotation around the longitudinal axis, and each needle holder cannot be moved laterally. In order to smoothly transfer the suture needle from one needle holder to the other with such limited movement, one needle holder must stably hold the suture needle in an appropriate posture. is important. However, when the needle holders of Patent Documents 1 to 4 are used, the position and posture of the suture needle held by the needle holder are not stable, and the suture needle is transferred from one needle holder to the other needle holder. It is not easy to receive and receive.

The present invention has been made in view of the above-mentioned circumstances, and provides an endoscopic needle holder and an endoscopic suturing method that can smoothly transfer a suture needle to another needle holder. The purpose is to

In order to achieve the above object, the present invention provides the following means.
One aspect of the present invention includes a long flexible tube having flexibility, a first gripping member and a second gripping member that are connected to a distal end of the flexible tube and can be mutually opened and closed, The first gripping member and the second gripping member each have a first inner surface and a second inner surface that face each other in a closed state in which the first gripping member and the second gripping member are closed, and the first inner surface is It has a pair of receiving parts parallel to each other and a groove formed between the pair of receiving parts, and the pair of receiving parts and the groove are arranged in a direction along the longitudinal axis of the flexible tube in the closed state. and the second inner surface has a protrusion that faces the groove and extends in the direction along the longitudinal axis in the closed state, and the top surface of at least a portion of the protrusion is oriented with respect to the longitudinal axis. the inclined surface has a distal end portion facing toward the proximal side of the groove, and a proximal end portion facing toward the distal end side of the groove; , a needle holder for an endoscope, in which a suture needle is held between the distal end portion and the proximal end portion.

According to this aspect, when the first gripping member and the second gripping member close each other, the suture needle is gripped between the pair of receiving portions and the protruding portion. When the suture needle is a curved needle with directionality, there is a pair of receiving parts that support the radially outer surface of the suture needle, and a part that is located between the pair of receiving parts in the circumferential direction of the suture needle and that supports the radially inner surface of the suture needle. The protrusion supporting the side surface allows the suturing needle to be held in a posture along a plane perpendicular or substantially perpendicular to the longitudinal axis of the flexible tube.

Further, the distal end portion and the proximal end portion of the top surface of the protrusion are inclined in opposite directions. Therefore, the suture needle gripped by the pair of receivers and the protrusion can be positioned in the direction along the longitudinal axis at a position where the distal and proximal parts of the protrusion simultaneously contact the suture needle. .
In this way, the posture and position of the suture needle gripped by the first gripping member and the second gripping member are stabilized, so that the suture needle gripped by the endoscopic needle holder of this aspect can be easily moved It can be transferred smoothly to the container.

In the above aspect, the tip of at least one of the first inner surface and the second inner surface has an uneven surface having a plurality of convex portions or a plurality of concave portions, and the pair of receiving portions, the groove and the protrusion are , may be provided closer to the proximal end than the uneven surface.
The convex portions or concave portions of the uneven surface function as a non-slip against the surface of the suture needle. By providing such an uneven surface at the distal end of at least one inner surface, the suture needle can be firmly gripped even at the distal end of the gripping member. In particular, the tip of the gripping member can firmly grip a thin needle tip that is difficult to grip with the pair of receiving parts and the protrusion.

In the above aspect, a tip portion of the first inner surface may have the uneven surface, and the pair of receiving portions may be offset from the uneven surface to a side opposite to the second inner surface.
According to this configuration, the suture needle placed on the pair of receivers remains stably on the pair of receivers due to the step difference between the pair of receivers and the uneven surface. Therefore, it is possible to prevent the suture needle from slipping out of the pair of receiving portions toward the uneven surface side against the operator's intention.

In the above aspect, at least the distal end portion of one side surface of the first gripping member and the second gripping member is a tapered surface inclined with respect to the longitudinal axis, and the tapered surface extends toward the distal end side. The widths of the first gripping member and the second gripping member may be inclined in a direction that gradually decreases.
When the needle tip of the suture needle protruding from the tissue is gripped by the first gripping member and the second gripping member, one side surface of the first gripping member and the second gripping member comes into contact with the tissue. At this time, the tissue may be pulled and raised by the suture needle. Since the side surfaces of the distal ends of the first gripping member and the second gripping member are tapered surfaces, it is possible to prevent the first gripping member and the second gripping member from coming into strong contact with the raised tissue.

The above aspect may include an opening regulating mechanism that prevents the first gripping member and the second gripping member from opening.
According to this configuration, the opening regulating mechanism prevents the first gripping member and the second gripping member from opening against the operator's intention. Therefore, the operator can take his hand off the endoscopic needle holder while maintaining the first and second gripping members that grip the suture needle in a closed state. This allows, for example, one operator to operate the endoscopic needle holder and other instruments.

Another aspect of the present invention is a suturing method in which a first needle holder and a second needle holder are inserted into the body via an endoscope, and tissues in the body are sutured under the endoscope. passing the suture needle through the tissue and protruding the needle tip of the suture needle from the tissue by the operation of the first needle holder that grips the suture needle; grasping the suture needle with two needle holders, pulling out the suture needle from the tissue by the operation of the second needle holder, and removing a portion of the suture needle pulled out from the tissue by the operation of the second needle holder. This is an endoscopic suturing method including placing the needle on the trajectory of the first needle holder.

According to this aspect, after the first needle holder grips the suture needle and passes the suture needle through the tissue, the second needle holder grips the needle tip of the suture needle and pulls the suture needle out of the tissue. Then, by the operation of the second needle holder, a portion of the suture needle is placed on the trajectory of the first needle holder. Movement of the first needle holder inserted into the body via the endoscope is limited to movement in a direction along the longitudinal axis of the first needle holder and rotation around the longitudinal axis. The suture needle can be smoothly transferred from the second needle holder to such a first needle holder.

In the above aspect, after the needle tip portion is gripped by the second needle holder, the first needle holder is separated from the suture needle and the first needle holder is retreated in the longitudinal direction; The method may further include gripping a portion of the suture needle disposed above with the first needle holder.
According to this configuration, when the suture needle is pulled out from the tissue by the operation of the second needle holder, and when a part of the suture needle is placed on the trajectory of the first needle holder by the operation of the second needle holder, , the first needle holder can be placed on standby at a position where it does not interfere with the suture needle. In this configuration, the method may further include moving the first needle holder forward after arranging a portion of the suture needle on the trajectory of the first needle holder.

In the above aspect, arranging a portion of the suture needle on the trajectory by the operation of the second needle holder rotates the second needle holder around the longitudinal axis of the second needle holder. May contain.
According to this configuration, when the suture needle is a curved needle, a portion of the suture needle held by the second needle holder is moved from the first needle holder by rotation about the longitudinal axis of the second needle holder. Can be placed in orbit.

In the above aspect, when the second needle holder is rotated after the suture needle is pulled out from the tissue, the suture needle held by the second needle holder is positioned at a position where it does not interfere with the tissue. The method may further include retracting the suture needle.
According to this configuration, when the second needle holder is rotated to place a portion of the suture needle on the orbit, it is possible to prevent the suture needle from interfering with the tissue.

In the above aspect, a pair of gripping members that are mutually openable and closable are provided at the tip of the second needle holder, and the needle tip protruding from the tissue is gripped by the tip of the pair of gripping members. , before positioning a portion of the suture needle on the trajectory of the first needle holder by the operation of the second needle holder, the gripping position of the suture needle is changed from the distal end of the pair of gripping members to the pair of gripping members. The gripping member may further include changing the proximal end of the gripping member.
When the above-mentioned uneven surface is provided on the inner surface of the distal end portions of the pair of gripping members, and the above-mentioned pair of receiving portions and protrusions are provided on the inner surface of the proximal end portions of the pair of gripping members, the fine needle tip portion is made uneven. The surface allows for a firm grip. Thereafter, the suturing needle can be held in a predetermined posture by the proximal ends of the pair of gripping members, and the suturing needle can be placed on the trajectory in a predetermined posture.
In the above embodiment, the tissue within the body may be a tissue of a hollow organ.

According to the present invention, it is possible to easily transfer the suture needle to another needle holder.

1 is an overall configuration diagram of an endoscope needle holder according to an embodiment of the present invention. FIG. 2 is a side view of the distal end portion of the endoscopic needle holder shown in FIG. 1; 2B is an end view taken along the line II-II of the distal end of the endoscopic needle holder of FIG. 2A. FIG. FIG. 7 is an end view of a pair of receiving portions and a protrusion viewed from the distal end side with the suture needle being gripped. 3A is a partial vertical cross-sectional view of the pair of gripping members taken along the line III-III in FIG. 3A, and is a cross-sectional view of the pair of receiving portions and projections viewed from the left side with the suture needle gripped. FIG. 1 is an example of an endoscopic image illustrating a first step of an endoscopic suturing method according to an embodiment of the present invention. It is an example of the endoscopic image explaining the 2nd process of the endoscopic suturing method based on one embodiment of this invention. It is an example of the endoscopic image explaining the 2nd process of the endoscopic suturing method based on one embodiment of this invention. It is an example of the endoscopic image explaining the 3rd process of the endoscopic suturing method based on one embodiment of this invention. It is an example of the endoscopic image explaining the 3rd process of the endoscopic suturing method based on one embodiment of this invention. It is a figure explaining the usage method of the 1st gripping member and the 2nd gripping member which have a taper surface. FIG. 3 is a diagram illustrating an example of the configuration of an opening regulating mechanism provided in the operating section. It is a figure which shows the other example of a structure of the opening regulation mechanism provided in an operation part. FIG. 3 is a diagram showing an example of a fixture used in an endoscopic suturing method. It is a figure which shows the modification of the 2nd needle holder used in the endoscopic suturing method. 8A is a diagram showing a state in which the suture needle is being held by the second needle holder of FIG. 8A. FIG.

EMBODIMENT OF THE INVENTION Below, the endoscopic needle holder 1 and the endoscopic suturing method which concern on one Embodiment of this invention are demonstrated with reference to drawings.
As shown in FIGS. 4A to 4E, the endoscopic needle holder 1 according to the present embodiment is used for suturing tissue S in the body using a suture needle 22 and a suture thread 23 under an endoscope. Used for endoscopic suturing methods. The endoscope is a flexible endoscope that has a long and flexible insertion section, and has a treatment instrument channel that passes through the insertion section in the longitudinal direction. The endoscopic needle holder 1 is inserted into the body via the treatment instrument channel.

As shown in FIG. 1, the endoscopic needle holder 1 includes a long flexible tube 2 and a pair of grips connected to the distal end of the flexible tube 2 to grip a suture needle 22. It includes members 3 and 4, and an operating section 5 connected to the proximal end of the flexible tube 2 and operated by an operator.
In the following description, the up-down direction is a direction perpendicular to the longitudinal axis A of the flexible tube 2, and the left-right direction is a direction orthogonal to the longitudinal axis A and the up-down direction.

The flexible tube 2 includes, for example, a coil sheath, and has a rigidity capable of transmitting movement and force applied to the proximal end of the flexible tube 2 by an operator to the distal end of the flexible tube 2. The movement is, for example, a movement along the longitudinal axis A and a rotational movement around the longitudinal axis A. Therefore, in a state where the flexible tube 2 passes through the treatment instrument channel and the gripping members 3 and 4 protrude from the distal end surface of the endoscope, the operator holds the proximal end of the flexible tube 2 along the longitudinal axis A. By moving the pair of gripping members 3, 4 forward or backward in the direction, the pair of gripping members 3, 4 can be moved forward or backward, and by rotating the proximal end of the flexible tube 2 around the longitudinal axis A, the pair of gripping members 3, 4 can be moved forward or backward. It can be rotated around the longitudinal axis A.

The pair of gripping members 3 and 4 are arranged in the vertical direction, and the base end portions of the pair of gripping members 3 and 4 are connected to each other so as to be swingable about a swinging axis extending in the left-right direction. The pair of gripping members 3 and 4 can be opened and closed in the vertical direction.
In the drawings referred to, the pair of gripping members 3 and 4 are of a single-open type in which the first gripping member 3 on the lower side is fixed to the flexible tube 2 and the second gripping member 4 on the upper side swings. , it may be a double-opening type in which both the first gripping member 3 and the second gripping member 4 swing.

The operating section 5 is connected to the second gripping member 4 by a long power transmission member such as a wire passing through the inside of the flexible tube 2 . The force applied by the operator to the operating section 5 is transmitted to the second gripping member 4 by the power transmission member , and the second gripping member 4s swings, thereby opening and closing the gripping members 3 and 4. For example, the operating section 5 includes a shaft 5a extending along the longitudinal axis A and a slider 5b slidable along the shaft 5a. The operator can close the gripping members 3, 4 by pulling the slider 5b toward the proximal end, and open the gripping members 3, 4 by pressing the slider 5b toward the distal end.

As shown in FIGS. 2A and 2B, the first gripping member 3 and the second gripping member 4 are arranged in the first gripping member 3 and the second gripping member 4 facing each other in the vertical direction in the closed state in which the first gripping member 3 and the second gripping member 4 are closed. Each has an inner surface 3a and a second inner surface 4a.
The first gripping member 3 and the second gripping member 4 grip the suture needle 22 by using uneven surfaces 6 and 7 at the distal end, and grip the suturing needle 22 by a pair of receiving parts 8 and a projection part 9 at the proximal end. The suturing needle 22 can be gripped in two ways.

Specifically, the tip of the first inner surface 3a has an uneven surface 6, and the tip of the second inner surface 4a has an uneven surface 7. The uneven surfaces 6 and 7 have a plurality of convex portions or a plurality of concave portions that function as a non-slip surface against the surface of the suture needle 22. For example, the uneven surfaces 6, 7 have a large number of convex portions 6a, 7a formed by cutting a flat surface, and each convex portion 6a, 7a is formed into a truncated quadrangular pyramid shape by, for example, diamond cutting. There is.

Further, the base end portion of the first inner surface 3a has a pair of receiving portions 8 and a groove 10, and the base end portion of the second inner surface 4a has a projection portion 9. The pair of receiving portions 8 and the grooves 10 are provided closer to the proximal end of the first gripping member 3 than the uneven surface 6, and the protruding portion 9 is provided closer to the proximal end of the second gripping member 4 than the uneven surface 7. .
The groove 10 is formed between the pair of receiving parts 8. The pair of receiving portions 8 and the grooves 10 extend in the direction along the longitudinal axis A, and are parallel to each other in the left-right direction of the first inner surface 3a.

The protrusion 9 faces the groove 10 and extends in the direction along the longitudinal axis A in the closed state. In the closed state, the vertical distance between the projection 9 and each receiving portion 8 is less than the diameter of the suture needle 22. Therefore, as shown in FIG. 3A, the suturing needle 22 can be held between the pair of receiving portions 8 and the protruding portions 9.
The suture needle 22 is a curved needle that curves in one direction, and the radially outer surface 22b of the suture needle 22 is supported by a pair of receiving portions 8 at two positions spaced apart from each other in the circumferential direction of the suture needle 22. The radially inner surface 22c of the suture needle 22 is supported by the protrusion 9 at a position between the two positions in the circumferential direction. By supporting the outer surface of the suture needle 22 at these three points, the posture of the suture needle 22 is fixed to a posture along a plane perpendicular or substantially perpendicular to the longitudinal axis A.

As shown in FIG. 3A, the protrusion 9 is formed in a protruding shape toward the first gripping member 3 when viewed from the front in a direction along the longitudinal axis A. Furthermore, the protrusion 9 has a top surface 9c that faces the first inner surface 3a and extends along the ridgeline of the protrusion 9. The top surface 9c is bent at an intermediate position in the longitudinal direction of the protrusion 9 when viewed from the side in a direction perpendicular to the longitudinal axis A and the opening/closing direction of the gripping members 3 and 4, and is opposite to the first inner surface 3a in the closed state. It extends in an arch shape that projects upward from the sides.

Specifically, as shown in FIG. 3B, at least a portion of the top surface 9c of the protrusion 9 has an inclined surface that is inclined with respect to the longitudinal axis A, and the inclined surface is located on the base end side of the groove 10. It has a distal end portion 9a facing toward the distal end of the groove 10, and a proximal end portion 9b facing toward the distal end of the groove 10. The distal end portion 9a and the proximal end portion 9b are inclined in opposite directions with respect to the longitudinal axis A. For example, the distance from the groove 10 to the distal portion 9a gradually increases from the distal end to the proximal end, and the distance from the groove 10 to the proximal portion 9b gradually decreases from the distal end to the proximal end. . As a result, the suture needle 22 is held between the distal end portion 9a, the proximal end portion 9b, and the pair of receiving portions 8. The grasped suture needle 22 is restricted from moving toward the distal end by the distal end portion 9a, and from moving toward the proximal end by the proximal end portion 9b. Therefore, the suturing needle 22 is positioned in the direction along the longitudinal axis A at a position where the distal end portion 9a and the proximal end portion 9b simultaneously contact the outer surface of the suturing needle 22. The cross-sectional shape of the suture needle 22 is preferably an oval shape having mutually parallel sides on the radially inner side and the radially outer side.

As shown in FIG. 2A, the pair of receiving parts 8 are offset downward with respect to the uneven surface 6, and a vertical step is formed between the pair of receiving parts 8 and the uneven surface 6. . As a result, the suture needle 22 placed on the pair of receivers 8 remains stably on the pair of receivers 8, and the suture needle 22 is moved from the pair of receivers 8 to the uneven surface 6 against the operator's intention. You can prevent it from slipping out.

Next, an endoscopic suturing method for suturing tissue S inside the body using the endoscopic needle holder 1 will be described with reference to FIGS. 4A to 4E.
The endoscopic suturing method according to the present embodiment uses one endoscope having two treatment instrument channels and two needle holders 1 and 21, and observes the tissue S using the endoscope. In this method, the tissue S is sutured while The tissue S is, for example, a tissue of a luminal organ such as the esophagus, stomach, small intestine, or large intestine. The first needle holder 21 is any needle holder generally used for suturing tissue S under an endoscope, and the second needle holder (endoscope needle holder) 1 is an arbitrary needle holder generally used for suturing tissue S under an endoscope. This is a mirror needle holder 1. The first needle holder 21 and the second needle holder 1 are inserted into the body via separate treatment instrument channels. The two treatment instrument channels do not necessarily need to be provided inside the endoscope; for example, one treatment instrument channel may be attached to the outside of the endoscope.

The endoscopic suturing method includes a first step of passing the suture needle 22 through the tissue S using the first needle holder 21 and protruding the needle tip 22a from the tissue S, and a second step using the second needle holder 1. It includes a second step of pulling out the suture needle 22 from the tissue S, and a third step of transferring the suture needle 22 from the second needle holder 1 to the first needle holder 21.

As shown in FIG. 4A, in the first step, the operator holds the suture needle 22 in the first needle holder by the pair of gripping members 21a and 21b of the first needle holder 21 that protrudes from the distal end surface of the endoscope. The suturing needle 22 is held in a position along a plane perpendicular or substantially perpendicular to the longitudinal axis of the device 21. Then, the operator inserts the needle tip 22a into the tissue S by rotating the first needle holder 21 around the longitudinal axis of the first needle holder 21, and inserts the needle tip 22a into the tissue S until the needle tip 22a protrudes from the tissue S. 1 Rotate the needle holder 21. In the first step, the second needle holder 1 is retreated to a position where it does not interfere with the needle tip 22a protruding from the tissue S.

Next, as shown in FIG. 4B, in the second step, the operator moves the second needle holder 1 forward and grips the needle tip 22a protruding from the tissue S with the pair of second needle holders 1. It is gripped by the tips of the members 3 and 4. Since the inner surfaces of the tips of each of the gripping members 3 and 4 are uneven surfaces 6 and 7, even when the thin needle tip 22a protrudes only a little from the tissue S, the tips of the pair of gripping members 3 and 4 The needle tip portion 22a can be firmly gripped.

Next, as shown in FIG. 4C, the operator releases the first needle holder 21 from the suture needle 22 and moves it backward. Then, the operator pulls out the entire suturing needle 22 from the tissue S by rotating the second needle holder 1 around the longitudinal axis A.
At this time, the bending portion of the endoscope may be bent in the direction in which the suture needle 22 is pulled out from the tissue S (leftward in the endoscopic images in the examples of FIGS. 4B and 4C), if necessary. By the bending motion of the curved portion, the pair of gripping members 3 and 4 and the suture needle 22 gripped by the pair of gripping members 3 and 4 are moved, and the suture needle 22 can be easily pulled out from the tissue S.

After pulling out the suture needle 22 from the tissue S and before performing the third step, when rotating the second needle holder 1 as necessary, the suture needle gripped by the second needle holder 1 The suture needle 22 may be retracted from the tissue S by moving the endoscope to a position where the suture needle 22 does not interfere with the tissue S. For example, the second needle holder 1 holding the suturing needle 22 may be moved to a position away from the suturing site of the tissue S by bending the bending portion of the endoscope. Thereby, it is possible to prevent the suturing needle 22 from interfering with the tissue S due to the rotational operation of the second needle holder 1 in the subsequent third step.
In addition, while pulling out the suture needle 22, the gripping position of the suture needle 22 gripped by the second needle holder 1 is changed from the needle tip 22a to a position closer to the proximal end than the needle tip 22a, if necessary. You may. At this time, the gripping position of the suture needle 22 in the second needle holder 1 is changed from between the uneven surfaces 6 and 7 at the distal end to between the pair of receiving parts 8 and the protrusion 9 at the proximal end.

Next, as shown in FIG. 4D, in the third step, the operator rotates the second needle holder 1 around the longitudinal axis A in the opposite direction to the rotation direction of the second needle holder 1 in the second step. By rotating the suture needle 22 , a portion of the suture needle 22 suitable for being gripped by the first needle holder 21 is placed on the trajectory B of the first needle holder 21 . The trajectory B is a path along which the first needle holder 21 advances and retreats, and coincides with or substantially coincides with an extension of the longitudinal axis of the treatment instrument channel into which the first needle holder 21 is inserted.

Here, as described above, before rotating the second needle holder 1, the operator changes the gripping position of the suture needle 22 from the distal end of the pair of gripping members 3, 4 to the gripping position of the pair of gripping members 3, 4. Change to the proximal end. That is, the state in which the suturing needle 22 is gripped by the uneven surfaces 6 and 7 is switched to the state in which the suturing needle 22 is gripped by the pair of receiving portions 8 and the protruding portions 9 (the distal end portion 9a and the proximal end portion 9b). Thereby, the suturing needle 22 is held in a posture along a plane perpendicular or substantially perpendicular to the longitudinal axis A by the pair of receiving parts 8 and the protruding part 9. Furthermore, since the top surface 9c of the protrusion 9 is arch-shaped in side view, the suture needle 22 is positioned in the direction along the longitudinal axis A with respect to the pair of gripping members 3 and 4, and This prevents rattling of the suture needle 22.

Next, as shown in FIG. 4E, the operator advances the first needle holder 21 toward a portion of the suture needle 22 disposed on the trajectory B, and uses the first needle holder 21 to move the suture needle 22 forward. grasp a part of At this time, since the two needle holders 1 and 21 protrude substantially parallel to each other from the distal end of the endoscope, the suture needle 22 gripped by the proximal ends of the pair of gripping members 3 and 4 is The first needle holder 21 is held in a posture along a plane perpendicular or substantially perpendicular to the longitudinal axis of the first needle holder 21 . Further, the suture needle 22 gripped by the proximal ends of the pair of gripping members 3 and 4, that is, the pair of receiving portions 8 and the protruding portions 9, is stably held at a fixed position without wobbling in the direction along the longitudinal axis A. be done. Therefore, the first needle holder 21 can easily hold the suture needle 22 in an appropriate posture.

Movement of the first needle holder 21 inserted into the body via the treatment instrument channel is limited to forward and backward movement along the longitudinal axis and rotation around the longitudinal axis. Similarly, the movement of the second needle holder 1 inserted into the body via another treatment instrument channel is limited to forward and backward movement along the longitudinal axis A and rotation around the longitudinal axis A. Therefore, when transferring the suture needle 22 from the second needle holder 1 to the first needle holder 21, the second needle holder 1 is only moved forward and backward relative to the first needle holder 21 and rotated. The position and posture of the suture needle 22 must be adjusted.

According to the present embodiment, the suture needle 22 is held in the first needle holder by the pair of receiving portions 8 and the protruding portions 9 provided at the proximal end portions of the pair of gripping members 3 and 4 of the second needle holder 1. It is stably held at a fixed position along a plane perpendicular or substantially perpendicular to the longitudinal axis of 21. Further, due to the rotation of the second needle holder 1, a portion of the suture needle 22 is placed on the orbit B of the first needle holder 21. Thereby, the suture needle 22 can be transferred smoothly from the second needle holder 1 to the first needle holder 21.

In this embodiment, as shown in FIG. 5, at least the tip of the right side surface of each gripping member 3, 4 may be a tapered surface 3b, 4b inclined with respect to the longitudinal axis A. The tapered surfaces 3b, 4b are inclined in a direction in which the width of the gripping members 3, 4 in the left-right direction gradually decreases toward the distal end side. The tapered surfaces 3b, 4b may be provided over the entire length of the gripping members 3, 4 in the longitudinal direction. In plan view seen from above or below, the tapered surfaces 3b, 4b may be flat surfaces or may be convex curved surfaces.
The left side surface of each gripping member 3, 4 is parallel or substantially parallel to the longitudinal axis A. Therefore, the gripping members 3 and 4 have an asymmetrical shape with respect to the longitudinal axis A when viewed from above or below.

In the state in which the needle tip 22a protrudes from the tissue S, the tissue S is pulled and bulges by the needle tip 22a. When moving the second needle holder 1 forward toward the needle tip 22a in order to grasp the needle tip 22a by the pair of gripping members 3 and 4, the tapered surfaces 3b and 4b on the right side of the gripping members 3 and 4 advances along the surface of the raised tissue S. Further, due to the force that the tapered surfaces 3b and 4b receive from the tissue S, the tip of the flexible tube 2 is bent to the left side, which is the side opposite to the tissue S. This allows the second needle holder 1 to grip the suture needle 22 that protrudes further to the left in the endoscopic image, and also prevents the gripping members 3 and 4 from coming into strong contact with the raised tissue S. can be prevented.

In the present embodiment, the endoscopic needle holder 1 may further include an opening restriction mechanism that prevents the pair of gripping members 3 and 4 from mutually opening.
In a surgery using an endoscope and two needle holders 1 and 21 as in this embodiment, one doctor operates the endoscope and two assistants operate the two needle holders 1 and 21. 1 and 21 are commonly operated. By providing the second needle holder 1 with the opening regulating mechanism, it becomes easy for one doctor to operate the endoscope and the second needle holder 1. That is, the doctor can take his hand off the operating section 5 of the needle holder 1 and operate the endoscope while the pair of grasping members 3 and 4 that grasp the suture needle 22 are maintained in a closed state by the opening regulating mechanism. can. Alternatively, one assistant can easily operate the two needle holders 1 and 21 at the same time. Thereby, the endoscopic suturing method of this embodiment can be performed by one doctor and one assistant.

FIGS. 6A and 6B show an example of the structure of the opening regulating mechanism. The opening regulating mechanism is provided in the operating section 5 and prevents the slider 5b from moving toward the tip side corresponding to the opening direction of the pair of gripping members 3 and 4 when the operator is not applying force to the slider 5b. .
The opening regulating mechanism in FIG. 6A includes a biasing member 11 that biases the slider 5b in a direction toward the proximal end corresponding to the closing direction of the pair of gripping members 3 and 4. The biasing member 11 is, for example, a compression spring that is disposed within the shaft 5a and is compressible in the direction along the longitudinal axis A. Reference numeral 13 denotes a power transmission member that connects the slider 5b and the second gripping member 4. The operator can open the pair of gripping members 3 and 4 by moving the slider 5b toward the distal end against the biasing force of the biasing member 11.

The opening regulating mechanism in FIG. 6B is a ratchet mechanism that limits the movement of the slider 5b only in the direction toward the proximal end corresponding to the closing direction of the pair of gripping members 3 and 4. This opening regulating mechanism includes a plurality of teeth 12a formed on the outer circumferential surface of the shaft 5a, a button 12b provided on the slider 5b, a movable member 12d fixed to the button 12b and having a claw 12c, and a movable member 12d having a claw 12c. and a biasing member 12e that biases the movable member 12d in the direction of fitting into the groove between the movable members 12d. The plurality of teeth 12a are arranged in the direction along the longitudinal axis A, and have a shape that allows the claw 12c to move toward the proximal end while locking the claw 12c from moving toward the distal end.

In a state where the button 12b is not pressed, the operator can close the pair of gripping members 3 and 4 by moving the slider 5b toward the proximal end. Further, by pressing the button 12b, the operator moves the movable member 12d in a direction in which the pawl 12c comes out from between the teeth 12a against the urging force of the urging member 12e, and moves the slider 5b in the longitudinal direction of the shaft 5a. It can be switched to a state where it can move freely in both directions.

A fitting may be used to attach the proximal end of the second needle holder 1 to the endoscope so that the doctor can easily operate both the endoscope and the second needle holder 1. good. For example, as shown in FIG. 7, a C-shaped hook may be used as the fixture 30. The C-shaped hook 30 is attached to the operating section 5 of the second needle holder 1, for example, to the tip of the shaft 5a.

In this embodiment, both the first inner surface 3a and the second inner surface 4a have the uneven surfaces 6, 7, but instead of this, only one of the first inner surface 3a and the second inner surface 4a has the uneven surface 6 or the uneven surface 6, 7. 7. Since at least one of the inner surfaces 3a and 4a has the uneven surface 6 or 7, the thin needle tip portion 22a can be firmly gripped.

In the endoscopic suturing method of this embodiment, a general-purpose needle holder is used as the first needle holder 21, but instead of this, an endoscopic needle holder 1 is used. Good too. That is, the above endoscopic suturing method may be performed using two endoscopic needle holders 1.

In the endoscopic suturing method of this embodiment, another needle holder may be used instead of the endoscopic needle holder 1 as the second needle holder. For example, as shown in FIG. 8A, a multi-legged forceps 40 having a plurality of legs may be used as the second needle holder. The multi-legged forceps 40 includes a long tubular sheath 40a and a plurality of legs 40b arranged within the sheath 40a, and the plurality of legs 40b can move forward and backward independently of each other with respect to the sheath 40a. It is. The distal end of each leg 40b is curved outward in the radial direction of the sheath 40a, and is elastically deformed into a linear shape within the sheath 40a. Therefore, by causing the distal ends of the plurality of legs 40b to protrude from the distal end surface of the sheath 40a, the distal ends of the plurality of legs 40b can be spread outward in the radial direction.

Therefore, as shown in FIG. 8B, the needle tip 22a protruding from the tissue S can be held between the legs 40b or between the legs 40b and the tip of the sheath 40a. In this embodiment, since the suturing needle 22 is gripped by moving the legs 40b back and forth, the positioning of the second needle holder 1 with respect to the needle tip 22a protruding from the tissue S becomes easy. Although the multi-legged forceps 40 is illustrated, the number of legs 40b does not necessarily have to be plural, and may be only one. Since the needle tip portion 22a can be held between only one leg 40b and the tip of the sheath 40a, even when the second needle holder has only one leg 40b, it can be held in the same way as the multi-legged forceps 40. , positioning of the second needle holder with respect to the needle tip portion 22a protruding from the tissue S becomes easy.

In this embodiment, a case has been described in which a curved needle with an oval cross-sectional shape is used as the suture needle 22, but a curved needle with other shapes such as a circular or oval cross-sectional shape may also be used for an endoscope. It can be used for the needle holder 1.

1 Endoscope needle holder, second needle holder 2 Flexible tube 3 First gripping member 3a First inner surface 3b, 4b Tapered surface 4 Second gripping member 4a Second inner surface 5 Operating portions 6, 7 Uneven surface 6a , 7a Convex part 8 Receiving part 9 Projection part 10 Groove 11 Biasing member, opening regulating mechanism 12a, 12b, 12c, 12d, 12e Opening regulating mechanism 13 Power transmission member 21 First needle holder 22 Suture needle 23 Suture thread 30 Multi Leg forceps, second needle holder A Longitudinal axis of flexible tube B Trajectory S Tissue

Claims (5)

a long flexible tube having flexibility;
comprising a first gripping member and a second gripping member connected to the tip of the flexible tube and mutually openable and closable;
The first gripping member and the second gripping member each have a first inner surface and a second inner surface that face each other when the first gripping member and the second gripping member are in a closed state,
The first inner surface has a pair of mutually parallel receiving parts and a groove extending between the pair of receiving parts,
The second inner surface has a projection at a position facing the groove, and is configured to grip a suture needle between the pair of receiving parts and the projection,
An uneven surface having a plurality of convex portions or a plurality of concave portions is formed on a tip end side of the first inner surface than the pair of receiving portions,
In the endoscopic needle holder, the pair of receiving portions are offset from the uneven surface to a side opposite to the second inner surface . The endoscopic needle holder according to claim 1, wherein the groove and the protrusion are provided closer to the proximal end than the uneven surface. At least the tip of one side of the first gripping member and the second gripping member is a tapered surface inclined with respect to the longitudinal axis of the flexible tube ,
The endoscope needle holder according to claim 1 , wherein the tapered surface is inclined in a direction in which the widths of the first gripping member and the second gripping member gradually become smaller toward the distal end side. The endoscope needle holder according to claim 1, further comprising an opening regulating mechanism that prevents the first gripping member and the second gripping member from opening. The pair of receiving portions and the groove each extend in a direction along the longitudinal axis of the flexible tube,
The top surface of at least a portion of the protrusion has an inclined surface that is inclined with respect to the longitudinal axis, and the inclined surface includes a distal end portion facing the proximal end of the groove and a distal end portion of the groove. a proximal portion facing toward the
The endoscopic needle holder according to claim 1, wherein a suture needle is held between the pair of receivers, the distal end portion, and the proximal end portion.

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