JPH05317320A - Suturing device - Google Patents

Abstract

PURPOSE:To improve the operability of suturing operation by easily confirming an intended suturing region and simply joining tissue pieces at the time of suturing tissues. CONSTITUTION:A suturing device comprises a staple storing groove 8 which is provided in the interior of an insert part 2 provided in an operating part 1 to be inserted in a body cavity for storing plural staples 13, a staple emitting part 6 provided on the tip area of the insert part 2 for driving a staple 13 in a living body tissue to suture tissues, and a needle member 7 disposed in the vicinity of the staple emitting part 6 and hooked on the living body tissue.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical suture instrument using staples.

[0002]

BACKGROUND OF THE INVENTION A stapler is often used to suture living tissues. In order to suture the tissue pieces together, it is necessary to first draw the tissue pieces together with a grasping forceps or the like to bring the sutured portions into contact with each other or to overlap the sutured portions and then hit the staples. In order to simplify this operation, the following suturing devices have been developed.

USP 4,887,756 discloses a stapler provided with a forceps assembly near the staple forming position in cooperation with a staple forming mechanism. In this example, the structure of the stapler is complicated, and the suture site is not clearly visible because it is hidden by the skin grip portion at the tip of the forceps assembly. Further, if the tissues to be sutured are separated from each other, there is a problem that they cannot be grasped.

Further, in recent years, a stapler has come to use a hernia repair technique under a laparoscope. Japanese Patent Laid-Open No. 3-5
The 0167 publication can be used under a laparoscope,
A stapler is disclosed in which a tissue grasping means is provided in a portion extended from an operation portion in parallel with a staple forming mechanism. In this example, since the site to be sewn is far from the gripping position, the tissue cannot be completely adhered to the site to be sewn. Further, when the tissue to be sutured is separated by a distance that the grasping means can reach, there is a drawback that the tissue cannot be drawn and grasped. Further, it is necessary to operate the gripping means and the forming mechanism separately, and it is necessary to operate both hands, and especially in the operation under the laparoscope, the operator often operates different instruments with both hands, which is a big drawback.

[0005]

As described above, in the prior art, when the tissue is sutured using the staples, the incision portion is aligned with the grasping means, but the portion to be sutured by the grasping means is difficult to visually recognize. Also, the structure was complicated and the operability was poor.

The present invention has been made in view of the above circumstances, and an object thereof is to easily see a sutured portion when a tissue is sutured and to have a simple structure and to easily adjust the tissue with one hand. An object of the present invention is to provide a suture device that can be used.

[0007]

In order to achieve the above-mentioned object, the present invention provides a suture instrument body having an operating portion, a staple accommodating portion provided in the suture instrument body for accommodating a plurality of staples, and the suture instrument. The present invention is provided with a staple ejecting portion that is provided in the main body of the device and that drives the staples into the biological tissue to suture, and a projecting member that is provided in the vicinity of the staple ejecting portion and that is hooked to the biological tissue.

[0008]

[Function] When the staple releasing portion of the suture device main body is pressed against the suturing portion, the protruding member provided in the vicinity of the staple emitting portion is hooked on the living tissue in the vicinity of the suturing portion, and the suturing device main body is fixed to the suturing portion. Can be held for a long time, and in this state, staples are driven in from the staple discharging portion to sew the sutured portion.

[0009]

Embodiments of the present invention will be described below with reference to the drawings.

1 to 7 show a first embodiment. FIG. 7 shows the overall structure of the suturing device. An operating portion 1 is rotatably connected to an insertion portion 2 as a main body of the suturing device. The operation unit 1 is provided with a staple operation handle 3 and a bending operation lever 4.

A bending portion 5 is provided in the vicinity of the tip of the insertion portion 2, and a staple ejecting portion 6 and a protrusion attached to the staple ejecting portion 6 so as to project in the vicinity of the staple ejecting portion 6 on the end surface on the tip end side of the curved portion 5. A needle-shaped member 7 as a member is provided.

FIGS. 1 to 4 show the tip structure of the insertion section 2, in which the staple storage groove 8 as a staple storage section is provided in the lower half inside the insertion section 2, and the anvil storage is provided in the upper half. Grooves 9 are provided, and these are provided along the longitudinal direction of the insertion portion 2. Staple storage groove 8
A staple track 10 made of a metal plate having elasticity is housed inside, and the inclined rising surface 1 is provided at the tip of the staple track 10.
There is provided a cam surface 11 bent in a U shape through 0a.

A pressing plate 12 is provided above the staple track 10, and the staple track 1 is provided.
A plurality of staples 1 between 0 and the presser plate 12.
3 is accommodated, and the staple 13 is made up of a thin wire with a substantially ω
Which is formed into a shape and is arranged with the tip leg portions facing toward the tip side and is provided in the staple storing groove 8
Is biased in the direction of the staple outlet 15a.

On the upper part of the pressing plate 12, there is provided a forming member 16 slidable in the front-rear direction on a forming track 16a communicating with the staple outlet 15a. The molding member 16 has a molding portion 17 having a U-shaped notch at the tip thereof.
Is provided, and a projection 18 is provided on the upper portion. The forming member 16 is connected to the staple operating handle 3 provided on the operating portion 1, and can be moved back and forth between the staple outlet 15a and the staple forming portion 15b by the staple operating handle 3.

An anvil 19 which is movable in the front-back direction is provided inside the anvil housing groove 9 above the molding member 16.
Is provided. The anvil 19 has the protrusion 18
It has an anvil groove 20 that engages with, and a protrusion piece 22 that engages with an anvil restriction groove 21 provided in the anvil housing groove 9.

Further, a flange 23 is provided at the tip of the anvil 19 for contacting the center of the staple 13 when the staple 13 is deformed, and a slit 24 is provided on the upper surface. A release spring 25 made of a linear body is inserted into the slit 24 and projects downward in a triangular shape. After the staple 13 is deformed, the staple 1
3 is ejected from the flange 23 of the anvil 19.

The staple ejection portion 6 on the tip surface of the insertion portion 2 is provided with a staple ejection opening 26 and a staple ejection groove 27 communicating with the staple ejection opening 26 below the staple ejection opening 26. The staple ejection groove 27 is deformed. Staple 1
It is wide enough for 3 to pass.

FIG. 5 shows the structure of the curved portion 5.
The insertion portion distal end side 2a and the insertion portion distal end side 2b are rotatably connected. That is, the insertion portion distal end side 2a is covered with the cylindrical distal end side cover 31, and the insertion portion distal end side 2b is covered with the cylindrical distal end cover 32. The covers 31 and 32 are rotatably supported by a hinge portion 33.

A bending operation wire 34 connected to the bending operation lever 4 provided on the operation portion 1 is inserted through the upper portion of the terminal side cover 32, and the bending operation wire 34 is inserted.
Passes through the hinge portion 33 and is connected to the tip side cover 31. A spring member 35 provided between the tip side cover 31 and the terminal side cover 32 is provided on the lower side of the hinge portion 33, and urges the bending portion 5 to return to the straight state.

Further, a through hole 36 is provided in the axial direction at the axial center portion on the distal end side 2a of the insertion portion, and the end portion of the molding member 16 is axially slidably inserted into the through hole 36. The molding member 16 is urged toward the operation unit 1 by a spring 37.

A through hole 38 is provided in the axial center portion of the insertion section distal side 2b in the axial direction, and an operation wire 39 connected to the staple operation handle 3 of the operation section 1 is inserted through the through hole 38. Is connected to the molding member 16.

The operation wire 39 is covered with a coil sheath 40, and the outer side thereof is covered with an operation tube 41 made of a soft material. The coil sheath 40 and the operation tube 41 pass through the hinge portion 33 and are connected to the distal end side 2a of the insertion portion.

Therefore, the bending operation lever 4 of the operation portion 1
When is pulled toward the hand side, the bending operation wire 34 is pulled toward the operation portion 1 side, the distal end side cover 31 is rotated around the hinge portion 33 with the distal end side cover 32, and the bending portion 5 of the insertion portion 2 is bent. .. Further, the bending portion 5 is biased by the spring member 35 so as to always be in a straight state, and when the bending operation lever 4 is released, the insertion portion 2 is in a straight state.

Note that the bending operation lever 4 may be provided with a lock mechanism so that the bending state can be maintained. Further, even in a curved state, the staple operating handle 3 is operated to apply the force of the operating wire 39 to the forming member 16.
Since the path to be transmitted to the flexible cable is configured as described above, the staple 13 can be deformed.
Next, the operation of the suture instrument configured as described above will be described.

FIG. 1 shows the state when the staples are loaded, and FIG. 2 shows the state when the staples are deformed. When the staple operating handle 3 of the operating portion 1 is operated to move the operating wire 39 forward, the forming member 16 connected to the operating wire 39 moves in the tip direction. At the staple outlet 15a, the forming member 16 is abutted against the staple 13 pushed up from the tip of the staple track 10 to move the staple 16 in the tip direction.

Thereafter, the staple 13 is butted against the rear side of the bent portion 25a provided so as to project into the forming track 16a of the release spring 25. At this time, since the release spring 25 and the avil 19 are fixed, the anvil 1
At the same time, 9 also receives a force in the tip direction and starts moving.

In the staple forming portion 15b, a protruding piece 22 on the upper surface of the anvil 19 is provided on the tip side of the anvil regulating groove 21.
And the movement of the anvil 19 stops. Further, the forming member 16 and the staple 13 move toward the leading end side. At this time, the release spring 25 abutted against the central portion of the staple 13 is pushed away, and the central portion of the staple 13 contacts the flange 23.

Further, the molding member 16 moves to the tip side,
The staple 13 is deformed between the forming portion 17 of the forming member 16 and the flange 23 to be in a closed state. At this time, the operating handle 3 is completely closed. After that, when the staple operating handle 3 is operated to retract the operating wire 39, the forming member 16 starts to move to the operating portion 1 side, the force holding the deformed staple 13 disappears, and the downward movement by the release spring 25 occurs. Due to the force applied to the closed staple 13, the closed staple 13 is discharged from the tip of the insertion portion 2 through the staple discharge portion 6 by the flange 23. Since the staple discharge portion 6 has a discharge groove 27 downward through which the deformed staple 13 passes, the deformed staple 13 is discharged through the discharge groove 27.

After the staple 13 is deformed, the forming member 16 first moves to the operating portion 1 side, and the projection 18 of the forming member 16 is abutted against the rear end portion of the anvil groove 20 to form the anvil 19.
Also moves to the rear end side. This anvil 19 and forming member 16
Is stopped at a position where the protruding piece 22 on the upper surface of the anvil 19 abuts on the rear end of the anvil restriction groove 21. At this time,
The staple outlet 15a covered by the forming member 16 is opened, and the next staple 13 is pushed up to the tip of the forming member 16 by the elastic force of the front end of the staple track 10.

Further, the leading end of the forming track 16a closes the staple outlet 15a and the staple receiving groove 8 to prevent the next staple 13 from moving to the staple outlet 15a. When the forming member 16 passes over the staple outlet 15a, the lower surface of the forming member 16 and the cam surface 11 integral with the staple track 10 come into contact with each other, and the tip end of the staple track 10 is pushed back into the staple storing groove 8. The next staple 13 moves to the tip of the staple track 10.

Therefore, when suturing a sutured portion of a living tissue using the suturing device configured as described above, as shown in FIG. 7A, before the staple 13 is deformed,
The needle-shaped member 7 at the tip of the insertion portion 2 is inserted near the sutured portion b of the tissue a. After inserting the needle-shaped member 7 into the tissue a, as shown in (b) of the same figure, the incision (wound) c is brought close to the tissue piece on the opposite side so as to be closed. Next, as shown in (c) of the same figure, the staple 13 is punctured and deformed into the tissue a by the above-described operation while the tissue pieces are in close contact with each other, and the incision c is sutured.

By providing the needle-like member 7 at the tip of the insertion portion 2 in this manner, the sutured portion b of the tissue a can be easily confirmed, and the operator can easily combine the tissue pieces with one hand and perform the suturing. it can.

8 to 10 show a second embodiment, and the same components as those of the first embodiment are designated by the same reference numerals and the description thereof will be omitted. An insertion portion cover 51 is provided on the outside of the insertion portion 2,
Inside the insertion portion cover 51, a slide cover 52 slidable in the longitudinal direction of the insertion portion 2 is provided, and the slide cover 52 covers the needle member 7 at the tip of the insertion portion 2.

In the operation portion 1, a connecting pin 53 is attached to a part of a staple operation handle 3 pivotally supported with respect to the main body 1a.
A hinge groove 55 of an L-shaped pusher link 54 is rotatably connected to the connecting pin 53.
A slide cam 56 having a cam surface 56a at one end thereof and an L-shaped slide member 57 in contact with the cam surface 56a of the slide cam 56 are movably connected to the staple operation handle 3 by a U-shaped pin 58, and the pusher link 54 is The slide member 57 is connected to the molding member 16, and the slide member 57 is connected to the slide cover 52. Further, the pusher link 54 is provided with a spring member 59 for urging the staple operating handle 3 in the arrow x direction.

Therefore, when the staple operating handle 3 is rotated in the direction of the arrow y, the slide cam 56 moves upward and the slide member 57 moves rearward by the cam surface 56a. The slide cover 52 connected to the slide member 57 slides backward, and the needle member 7 provided at the tip of the insertion portion 2 is exposed. Further, when the staple operating handle 3 is further rotated in the direction of the arrow y, the pusher link 54 is rotated, the forming member 16 is moved to the distal end side, the staple 13 is deformed, and the tissue is sutured.

With the above construction, when the insertion section 2 is inserted into the body cavity, the needle-shaped member 7 does not unnecessarily damage the tissue in the body cavity, and the handling is safe. In this embodiment, the stapling operation handle 3 may be of a ratchet type so that the slide cover 51 can be fixed while being slid to the operation portion 1 side.

FIG. 11 shows a third embodiment, which is an example in which a needle member 60 having a bent portion 60a is provided at the tip of the insertion portion 2. According to this embodiment, since the bent portion 60a is provided so that the tissue a can be easily drawn, the incision c of the tissue a can be surely aligned.

FIG. 12 shows a fourth embodiment, in which a needle accommodation hole 61 is provided at the distal end portion of the insertion portion 2 and a needle-like member 62 is accommodated in the needle accommodation hole 61 so as to be retractable. That is, the needle-shaped member 62 is biased in the retracted direction by the spring 63, and can be projected by the control member 64 extending from the operation unit 1, and the needle-shaped member 62 unnecessarily scratches the tissue in the body cavity. There is no risk of attachment and safe handling.

FIG. 13 shows a fifth embodiment, which is an example in which two needle-like members 65 are provided so as to project in parallel on one side of the distal end of the insertion portion 2. According to this embodiment, the two needle-shaped members 65 can match the incised portions of the tissue with an equal force and can perform good suturing. The needle-shaped member 6
The number 5 is not limited to two, and two or more may be provided as long as the distal end space of the insertion portion 2 and the tissue are not significantly affected.

FIG. 14 shows another suturing device, which is adjacent to the staple discharging portion 6 at the tip of the insertion portion 2 and has a suction port body 66.
Is provided and the suction port body 66 is connected to a suction pump or the like. According to this suturing device, the suction port body 66 is brought into close contact with one of the tissue pieces d to perform suction. In this state, the tissue pieces d and e are brought into close contact with another tissue piece e, and then the staple 13 is driven. Therefore, the tissue pieces d and e can be joined together without damaging the tissue. In addition, it is easy to check the incision site and the operability is improved.

FIG. 15 shows a further different suturing device, in which a spatula-shaped member 67 having a blunt tip is projected adjacent to the staple discharging section 6 at the tip of the insertion section 2. According to this suturing device, the tissue piece d near the sutured portion is hooked by the spatula-like member 67 before the staple 13 is deformed, and the tissue piece d is brought into close contact with another tissue piece e to be brought into close contact therewith. Then staple 1
By deforming 3 and performing suturing, the tissue pieces d and e can be matched without obstructing the visual field of the suturing site,
There is no risk of damaging the tissue. The shape is not limited to the spatula shape, and any shape that easily catches on the tissue can be similarly used.

In the embodiment of the present invention, the one having an elongated insertion portion has been described as being usable under the laparoscope, but the present invention is not limited to this, and the one used in general surgery can be used. Needless to say, it can be applied.

[0043]

As described above, according to the present invention,
When suturing a tissue, there is an effect that the target suturing site can be easily confirmed, the tissue pieces can be easily aligned with each other, and the operability of the suturing operation can be improved.

[Brief description of drawings]

FIG. 1 is a vertical cross-sectional side view showing an insertion portion of a suturing device according to a first embodiment of the present invention when a staple is loaded.

FIG. 2 is a vertical cross-sectional side view showing the insertion portion of the suturing device of the embodiment when the staple is deformed.

FIG. 3 is a front view of the insertion portion of the embodiment.

FIG. 4 is an exploded perspective view of the insertion portion of the embodiment.

FIG. 5 is a vertical sectional side view of a bending portion of the insertion portion of the embodiment.

FIG. 6 is a perspective view showing the entire suturing device of the embodiment.

FIG. 7 is an explanatory view of the operation of the embodiment.

FIG. 8 is a vertical cross-sectional side view showing an insertion portion of the suturing device according to the second embodiment of the present invention.

FIG. 9 is a perspective view of an operation unit of the embodiment.

FIG. 10 is a vertical cross-sectional side view of the operation unit according to the embodiment.

FIG. 11 is an operation explanatory view of the suturing device according to the third embodiment of the present invention.

FIG. 12 is an explanatory view of the operation of the suturing device according to the fourth embodiment of the present invention.

FIG. 13 is a perspective view of an insertion portion of a suturing device according to a fifth embodiment of the present invention.

FIG. 14 is an operation explanatory view of another suturing device.

FIG. 15 is an explanatory view of the action of a different suturing device.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Operation part, 2 ... Insertion part, 3 ... Staple operation handle, 4 ... Curving operation part, 6 ... Staple discharge part, 7 ... Needle-like member (projecting member), 8 ... Staple storing groove (staple storing part), 13 ... staples.

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[Procedure amendment]

[Submission date] July 10, 1992

[Procedure Amendment 1]

[Document name to be amended] Statement

[Correction target item name] 0004

[Correction method] Change

[Correction content]

Recently, laparoscopic hernia repair is performed.
Has come to the stapler is used to. JP-A-3
No. 505167 discloses a stapler that can be used under a laparoscope and that includes a tissue grasping unit in a portion extended from an operation unit in parallel with a staple forming mechanism. In this example, since the site to be sewn is far from the gripping position, the tissue cannot be completely adhered to the site to be sewn. Further, when the tissue to be sutured is separated by a distance that the grasping means can reach, there is a drawback that the tissue cannot be drawn and grasped. In addition, the gripping means and the molding mechanism must be operated separately, which requires two-handed operation.
Particularly in the operation under the laparoscope, the operator often operates separate instruments with both hands, which is a big drawback.

[Procedure Amendment 2]

[Document name to be corrected] Drawing

[Correction target item name] Figure 8

[Correction method] Change

[Correction content]

[Figure 8]

 ─────────────────────────────────────────────────── --- Continuation of the front page (72) Inventor Shuichi Kimura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Akio Nakata 2-43-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Inventor, Tsukagoshi Iso 2-23-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A main body of a suturing device having an operation part, a staple storing part provided in the main body of the suturing device for storing a plurality of staples, and a staple provided in the main body of the suturing device for striking and suturing staples to a biological tissue. A suturing device comprising: a discharging part; and a projecting member which is provided in the vicinity of the staple discharging part and which is hooked on a living tissue.