JPH01129843A - Suturing forceps - Google Patents

Abstract

PURPOSE:To simply hold a suture needle without moving the same before and behind or rotating and deforming the same, by mounting a groove for receiving the suture needle, which is provided to the opening and closing surface of one of a pair of opening and closing elements receiving the advance and retraction movement of an operating wire to open and close, and a press part for pressing the other suture needle. CONSTITUTION:A pair of opening and closing elements 6 receiving the advance and retraction movement of the operating wire 3 provided to the leading end part of a jacket tube 2 to open and close is provided and a groove 12 for receiving a suture needle 11 is provided to the opening and closing surface of one of the opening and closing elements 6 in a direction crossing the opening and closing direction of said elements 6 and a press part 14 for pressing the suture needle 11 received in the other opening and closing element 6 with the closing movement of the opening and closing elements 6 is provided to constitute a suturing forceps suitable for suturing. After the suture needle 11 is received in the groove 12, the opening and closing elements 6 are closed to press the suture needle 11 by the press part 14. By this simple operation, the suture needle 11 is fixed by the prescription due to the groove 12 and the pressing due to the press part 14 without being moved and deformed.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention relates to a suturing forceps for endoscopically introducing a gripped suture needle into a body cavity to suture a bleeding site to stop the bleeding.

[Conventional technology] In some cases, such as in the treatment of esophageal varices, it is not possible to stop bleeding with a laser. Therefore, in recent years, an endoscope and forceps have been used to suture the bleeding site.

Specifically, forceps are inserted into the channel of the endoscope in advance,
The forceps are used to grasp a surgical suture needle.

Then, while holding the suture needle, it is guided to the bleeding site within the body cavity using an endoscope, and then the entire forceps are rotated along the circumferential direction to suture the bleeding site.

As a forceps that can be inserted into an endoscope used for such suturing, there is a grasping forceps having a flange-shaped tip a as shown in FIG. Grasping forceps d were used in which rubber C was attached to the gripping surface.

[Problems to be Solved by the Invention] However, in the former gripping forceps, since the suture needle e is placed on the flange and gripped, the gripped suture needle e tends to shift, and during operation, the gripping forceps as shown in FIG. The problem is that the suture needle e moves back and forth as shown by the arrow. Also, the latter grasping forceps d
Because the suture needle e is held between the rubbers C and C, when an external force is applied to the gripped suture needle e, the rubbers C and C deform and rotate as shown by the arrow in Figure 13. Sometimes I put it away.

In addition, suturing instruments include
893, in which a suture needle with a thread attached is passed through the hole and then fixed with a clamping port, and US Patent No. 45,
There is a method, such as No. 97390, in which a suture needle is inserted between the slits of a double cylinder with slits on the end face, and then the cylinders are twisted in opposite directions to fix the needle, but in the former case, the operation of passing the hole through is troublesome. Moreover, in the latter case, there was a risk of accidentally bending the suture needle during fixation.

The present invention was made in view of these problems, and it is an object of the present invention to provide suture forceps that can easily hold the suture needle without moving it back and forth, without rotating it, and without deforming it. .

[Means and effects for solving the problems] This invention has the following features:
A pair of opening/closing elements 6 are provided which open and close in response to the forward and backward movement of the operating wire 3 provided at the tip of the mantle tube 2, and a suture needle 11 is attached to one opening/closing surface of the opening/closing element 6 in a direction crossing the opening/closing direction. A suture forceps suitable for suturing is constructed by providing a groove 12 for accommodating the suture needle 11 and a pressing portion 14 for pressing the accommodated suture needle 11 on the other side of the opening/closing element 6 as the opening/closing element 6 closes. do. After the suture needle 11 is accommodated in the groove 12,
With the simple operation of closing the opening/closing element 6 and pressing the suture needle 11 with the suppressing part 14, the suturing needle 11 is fixed without moving or deforming by being regulated by the groove 12 and pressed by the pressing part 14. do.

[Example] The present invention will be described below based on a first example shown in FIGS. 1 to 7. FIG. 2 shows the entire suturing forceps, in which 1 shows an operating wire 3 inside a small-diameter sheath 2 (corresponding to a mantle tube) made of a flexible metal coil.
4 is a tip forceps portion provided at the tip of the insertion portion 1, and 5 is an operation portion provided on the proximal side of the insertion portion 1.

As shown in FIG. 1, the tip forceps section 4 has a pair of openable and closable opening/closing members 6, which are approximately like an egg divided vertically into two, and a sheath 2.
The holding member 7 is provided at the tip of the holding member 7. The pivot side of the opening/closing member 6 is connected to the tip of the operating wire 3 via an extendable pantograph-type link mechanism 8, and by moving the operating wire 3 forward and backward,
The opening/closing member 6 can be opened and closed using the pivot shaft 6a as a fulcrum by the expansion and contraction of the link mechanism 8. Note that 9 is a wire connecting portion for connecting the tip of the operating wire 3 to the link mechanism 8.

An elliptical fitting recess 10 is formed in the center of the opening/closing surface of one of the opening/closing parts 6.

A slit 12 (equivalent to a groove) corresponding to the outer shape of the suture needle 11 is provided linearly in the center of the crotch portion on both sides in parallel with the pivot shaft 6a. There are 13 accommodation forceps. In other words, the structure is such that the proximal side of the suture needle 11 can be accommodated using the slits 12 and 12.

Further, a flat elliptical convex portion 14 (corresponding to a suppressing portion) that can be fitted into the fitting recess 10 is integrally provided on the opening/closing surface of the other opening/closing portion of the switch 6, and the opening/closing portion The needle suppression forceps 1
It is set at 5. In other words, the structure is such that the suture needle 11 accommodated in the needle accommodation forceps 15 can be fixed from being pressed down as the opening/closing element 6 moves to close.

On the other hand, the operation section 5 has a groove 19 formed in the middle part of the operation section main body 18 to constitute two guide rods 20.20, and the operation member 21 is slidably attached to the guide rods 20.20. It has a similar structure. Specifically, the operating member 21 has a pair of sliding holes 22, 22 that pass through the guide rod 20.20, and a collar portion 23 for finger rests at both ends in the moving direction.
．． 24 are integrally formed in the shape of a chain, and the central portion serves as a holding part for holding with fingers. This operating member 21 is connected to the rear end of the operating wire 3.

Further, a locking ring 18a for inserting the thumb is provided at the rear end (hand end) of the operation section main body 18. When the thumb is inserted into the locking ring 18a, the gripping portion of the operation member 21 is held by the index and middle fingers. The opening/closing member 6 can be opened and closed by sliding the operating member 21 back and forth between the two.

Furthermore, ratchet portions 25.25 are formed along the longitudinal direction on the side end surfaces of the guide rods 4.4.
The collar portion 24 on the proximal side has a built-in ratchet pawl 26 that can be engaged with and disengaged from the ratchet portion 25, 25 at the front. Further, the flange portion 24 is provided with an operation button 27 for engaging and disengaging the flange portion 24, and has a structure in which the engagement can be released by pushing the operation button 27. Specifically, ``Figures 3 and 4
As shown in the figure, in the releasing structure, a hole 28 is bored along the diameter direction of the collar portion 24, and an operation button 27 is attached to this hole 28. In addition to installing the ratchet pawl 26 inside the hole 28 so as to engage with the ratchet part 25.25, the ratchet pawl 26 is constantly urged by a biasing coil spring 29 in the direction of locking the ratchet part 25.25. It has such a structure that when the operation button 27 is pressed, it comes off from the ratchet portion 25.25 of the operation section main body 18.

In addition, hook portions 31.31 are provided on the interior end portion 30 of the operation button 27 and the inner wall surface of the hole 28 facing thereto, which are protrusions that engage with each other. Furthermore, a spring piece 32 is cut and raised in the interior end portion 30 to push the interior end portion 30 toward itself in a direction in which both hook portions 31 and 31 engage with each other. When removed from the ratchet part 25.25, both hook parts 31.3 are pulled to one side by the elasticity of the spring piece 32.
1 is automatically engaged, and even if the finger is released from the operation button 27, the ratchet pawl 26 is held in the released state. Of course, the operation button 2 is pressed against the biasing force of the spring piece 32.
7 to the side, the hook portions 31, 31 are disengaged from each other, so the operating button 27 is pushed out by the biasing coil spring 29, and the ratchet pawl 26 engages with the ratchet portion 25, 25. In order to prevent the operation button 27 from falling out when it protrudes in this manner, a stopper portion 33, 33 is provided between the insertion end portion 30 and the inner wall of the hole 28.

Therefore, when suturing and stopping bleeding in a body cavity using the suture forceps configured in this way, it is necessary to
Before inserting 34 into the endoscope m34, closed suture forceps are first inserted into the channel 35 of the endoscope m34. When the opening/closing element 6 protrudes from the tip of the endoscope 34, the operating section 5 is moved forward and backward to open the opening/closing element 6, and the square part at the base of the suture needle 11 is accommodated as shown in FIG. Insert into the slits 12.12 of the forceps 13. Thereafter, operate the operating section 5 to close the opening/closing member 6 and close the protrusion 14 of the needle pressing forceps 15.
When the suturing needle 11 is pressed, the suturing forceps will hold the suturing needle 11 as shown in FIG.

However, the suturing needle 11 can be held by a simple operation of accommodating the suturing needle 11 in the slit 12 and pressing the suturing needle 11 with the convex portion 14.

Of course, since no external force is applied to the suture needle 11 to cause it to deform, the suture needle 11 will not be bent.

During such fixing, if the operating button 27 is pulled toward the user's hand and the urging coil spring 29 is used to elastically and automatically project the ratchet pawl 26, the operating member 21 does not have to return. That is, the operation button 27 is pressed so that the ratchet pawl 26 is always engaged with the ratchet portion 25.25 of the operation section main body 18, and from this state the operation member 21 is pressed.
If you pull it toward your hand, even if you stop the operating member 21 at any position, the ratchet pawl 26 will immediately engage the ratchet portion 25, 25, so it will not return to its original position. This results in
The opening/closing element 6 continues to hold the suture needle 11.

Thereafter, as shown in FIG. 5, the suture needle 11 is arranged so as not to protrude from the front surface 34a of the insertion portion of the endoscope 34.
The endoscope 34 is inserted into the body cavity. Then, as shown in FIG. 7, the suturing forceps are arranged so that the bleeding site 36 is located in the tangential direction of the suturing forceps, and the operating section 5 (including the insertion section 1) of the suturing forceps is rotated. As a result, the opening/closing element 6 at the tip of the suture forceps rotates following the rotation, and the suture needle 11 pierces the bleeding site 36 and passes the thread 37 attached to the suture needle 11, thereby removing the bleeding site 36. Suture and stop the bleeding.

Note that after inserting the suture needle 11, use grasping forceps (not shown).
We will treat it with. Then, the thread 37 is placed and the endoscope 3
4 is removed from the body cavity along with the suture needle 11 and suture forceps, hemostatic treatment is performed.

Here, when suturing the bleeding site 36, there is a concern that the suture needle 11 may move due to external force. The suture needle 11 does not move back and forth or rotate.

Thus, it can be seen that the suture needle 11 can be easily held without being moved or deformed inadvertently.

Note that the present invention is not limited to the first embodiment described above, but includes the second embodiment shown in FIG. 8, the third embodiment shown in FIG. 9, and the third embodiment shown in FIG. The fourth embodiment or the fifth embodiment shown in FIG. 11 may be used.

That is, the second embodiment has slits 12 of different sizes.
This uses needle-accommodating forceps 13 provided with needles a and 12b.

Such a structure has the advantage of being able to hold suturing needles 11 of various thicknesses.

In the third embodiment, a rubber protrusion 40 made of a rubber member is provided instead of a metal protrusion. Further, in this embodiment, a multi-thread coil is employed in the sheath 2 to improve the rotation followability of the switch 6.

In the fourth embodiment, the needle holding forceps 13° and the needle pressing forceps 15 are arranged so that each fitting recess 10 and the convex part 14 are left with a flat part 45 on the front side.
The needle receiving forceps 13 are formed in each plane part 45.45.
．． When the needle pressing forceps 15 are assembled, elastic bodies such as plate-shaped rubber pieces 46 and 46 are provided, and the opening/closing member 6 is
A grip portion 47 is configured on the tip side of the handle.

With this structure, after the suturing needle 11 is inserted into the bleeding site 36, the suturing needle 11 is released one degree and the tip of the suturing needle 11 is gripped by the gripping part 47 composed of the rubber pieces 46 and 46. By pulling it, the thread 37 can be threaded. In other words, threading the thread 37 can be done at once without changing the forceps.

In the fifth embodiment, a lever mechanism is used instead of a link mechanism to open and close the switch 6.

Specifically, arms 51a and 51b, which are smooth and have a large circular arc and are bifurcated, are connected to the tip of the operating wire 3 via a stopper member 50. Needle accommodation forceps 13 are attached to the tips of these arms 51a and 51b. In addition to connecting the needle pressing forceps 15, a metal tip 52 is attached to the tip of the sheath 2.
It has a structure with Then, by operating the operating unit 5, pull the operating wire 3 toward you and insert the arms 51a, 51b, and the metal tip 52 will open the 6 arms 51a.

51b are displaced in the direction in which they are brought together, and the needle-accommodating forceps 13. The needle pressing forceps 15 are combined to hold the suturing needle 11. Of course, once the control wire 3 is released, the elasticity of the arms 51a and 51b allows each needle accommodation forceps 13. The needle pressing forceps 15 protrude while moving away from each other.

[Effects of the Invention] As explained above, according to the present invention, the suture needle can be held by a simple operation of storing the suture needle in the groove, closing the closure, and pressing the suture needle with the pressing part. Can be done.

Moreover, the held suture needle can be securely fixed without moving back and forth, rotating, or deforming by regulating it with the groove and pressing it with the suppressing part, making it more suitable for suturing. Forceps can be provided.

[Brief explanation of the drawing]

1 to 7 show a first embodiment of the invention,
Fig. 1 is a perspective view showing the tip of the suturing forceps, Fig. 2 is a sectional view showing the entire suturing forceps, and Fig. 3 is the second view A of the suturing forceps.
- A cross-sectional view taken along line A, Fig. 4 is a cross-sectional view taken along line B-B in Fig. 2, Fig. 5 is a perspective view showing an endoscope with suturing forceps attached, and Fig. 6 shows the suturing A perspective view showing a suturing needle being held with forceps, FIG. 7 is a front view showing when the bleeding site is sutured with a suturing needle, and FIG. 8 shows a main part of a second embodiment of the present invention. 9 is a perspective view showing the main part of the third embodiment of the invention, FIG. 10 is a perspective view showing the main part of the fourth embodiment of the invention, and FIG. 11 is the main part of the fourth embodiment of the invention. Fifth
FIG. 12 is a side sectional view showing the main parts of an embodiment of the present invention; FIG. 12 is a side view showing forceps conventionally used for suturing bleeding sites;
The figure is a perspective view showing a different conventional forceps. 1... Sheath (mantle tube), 5... Operation section, 6...
Opener, 11... Suture needle, 12... Slit (groove)
, 14...Convex portion (suppressing portion). Applicant's Representative Patent Attorney Atsushi Tsuboi Figure 3 - Figure 4 Figure 5 Figure 6 Figure 7 Figure 8q Figure 9 Figure 11 Figure 12 Figure 13

Claims (1)

[Claims] a flexible mantle tube into which an operating wire is inserted; an operating section provided on the proximal side of the manipulating wire for moving the manipulating wire forward and backward; and a mantle provided at the tip of the mantle tube for moving the manipulating wire forward and backward. a pair of opening/closing elements that open and close in response to motion; a groove for accommodating the suture needle provided in the opening/closing surface of one of the opening/closing elements in a direction crossing the opening/closing direction; and a groove provided in the other opening/closing element for accommodating the suture needle. 1. A suturing forceps characterized by comprising a pressing portion for pressing a closed suture needle as an opening/closing member moves to close the suture needle.