JPH05317322A - Suturing unit - Google Patents

Abstract

PURPOSE:To provide a suturing unit capable of surely pinching a tissue and surely suturing the tissue when it is percutaneously inserted into a body cavity and the tissue in the body cavity is sutured or cut. CONSTITUTION:A suturing unit is provided with a suturing member 5 constituted of a cartridge 3 having multiple staples 14 and a knife 10 arranged in the axial direction of an insertion section 2 at the tip section of the insertion section 2 inserted into a body cavity and an anvil 4 molding the leg section 14a of the staple 14 and fixing it in a tissue, a hook claw 20 and a hook shaft 22 coupling the cartridge 3 and the anvil 4 together, an opening/closing operation section 6 surely holding and fixing the cartridge 3 and the anvil 4 and opening or closing the suturing member 5 on this side of the insertion section 2, and a staple operation section 7 provided on this side of the insertion section 2, driving the staple 14 in the cartridge 3 into the tissue, and molding the leg section 14a of the staple 14.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suturing device which penetrates an abdominal wall or the like and is inserted into a body cavity to suture biological tissues in the body cavity.

[0002]

2. Description of the Related Art For example, in the operation of gallbladder calculi, etc., when the operation to remove the gallbladder is performed to prevent recurrence, the connection between the bile duct and the gallbladder duct is cut. Since it passes through, it is necessary to cut the gallbladder duct with a knife and sew it at the same time.

In such a cholecystectomy operation, a suture instrument is used which penetrates the abdominal wall or the like and is inserted into the body cavity to suture the tissue in the body cavity. Traditionally, this kind of suture device
For example, it is known from US Pat. No. 4,520,817, US Pat. No. 5,014,899 and the like.

[0004] US Pat. No. 4,520,817 is a suturing device for surgically suturing a tissue in a body cavity, including an operating portion and
An insert part, which is divided into two along the axial direction, one end of which is an anvil for forming staples, and the other end is a staple and a knife arranged in a plurality of rows in the axial direction of the insert part. A cartridge having means is provided.

Inside the cartridge, there is provided a support means for supporting the cartridge and the anvil by sliding while engaging with the anvil in synchronization with the knife means. The supporting means presses the anvil and the cartridge, and the tissue sandwiched between the both is surely pressed by the knife means when excising.

Further, US Pat. No. 5,014,899 discloses that a protrusion is provided at the tip of a knife guide groove of a cartridge so that when the tissue is sandwiched between the anvil and the cartridge, the protrusion does not move the tissue. It is configured to hold down.

[0007]

By the way, U.S. Pat. No. 4,520,817 discloses that a rail for guiding a support means in the anvil is provided over the entire length in the axial direction of the anvil and is also supported in the cartridge. There is a problem in that the structure of the anvil and the cartridge is complicated and space is required, and as a result, the outer diameter of the tip portion becomes large when the anvil and the cartridge are combined.

[0008] In US Pat. No. 5,014,899, when the tissue is cut by the knife means, the tissue is pressed and fixed at one of the protrusions of the cartridge.
There is a problem in that the tissue cannot be reliably fixed when the knife means escapes or the tissue is slippery away from the protrusion.

The present invention has been made in view of the above circumstances, and its object is to suture tissue in a body cavity,
An object of the present invention is to provide a suturing device that can securely grasp and fix the tissue when it is cut, has easy operability, and can suture safely and surely.

[0010]

In order to achieve the above object, the present invention provides a suturing member comprising a cartridge having a plurality of staples and an anvil for forming legs of the staples and fixing them in a tissue. A suturing device comprising an opening / closing operation part for opening / closing the suturing member and a staple operating part for driving the staples in the cartridge into the tissue to form the legs of the staple, in the cartridge and the anvil of the suturing member. There is provided an engaging means for engaging each other when both are closed.

[0011]

For example, the suturing member provided at the distal end of the insertion portion is percutaneously inserted into the body cavity, the suturing member is positioned at the sutured portion, and the opening / closing operation portion provided at the proximal side of the insertion portion is operated. When the tissue to be sutured is clamped by the cartridge and the anvil, the cartridge and the anvil engage with each other to grasp and fix the tissue, and in this state, the staple operating section ejects the staples in the cartridge into the tissue. The legs of the staple are shaped with an anvil to suture the tissue.

[0012]

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

1 to 4 show a first embodiment, and FIG. 4 shows the overall construction of a suturing device. Reference numeral 1 denotes an operation portion main body, and the base end portion of the insertion portion 2 is connected to the operation portion main body 1 so as to be rotatable in the arrow direction. A suturing member 5 including a cartridge 3 and an anvil 4 is provided at the tip of the insertion portion 2. The operation section body 1 is provided with an opening / closing operation section 6 for opening and closing the suturing member 5 and a staple operation section 7.

As shown in FIGS. 1 to 3, the insertion portion 2
Is composed of an inner cylinder 8 and an outer cylinder 9 fitted to the inner cylinder 8 so as to be movable back and forth in the axial direction. The base end of the cartridge 3 and the base end of the anvil 4 are rotatably connected to the tip of the inner cylinder 8.

The cartridge 3 and the anvil 4 are urged in the opening direction by urging means (not shown) such as a spring, and the outer cylinder 9 which can move forward and backward with respect to the inner cylinder 8 is moved forward to move the cartridge 3 and the cartridge 3 together. The base end portion of the anvil 4 is fitted into the outer cylinder 9 so that the suturing member 5 is closed.

Further, knife guide grooves 10 and 10 are provided in the middle of the suturing member 5 composed of the cartridge 3 and the anvil 4 in the width direction, and the inside of the knife guide grooves 10 and 10 will be described later. A knife 11 as a cutting means for sliding is adapted to slide.

A plurality of slits 12 ... Are arranged in two rows on both sides of the knife guide groove 10 on the inner surface of the cartridge 3, and pushers 13 are housed in these slits 12 ... Each of the staples 14 is accommodated on the upper surface of the above so that the leg portions 14a face upward and can protrude upward. Further, a plate guide groove 15 is provided inside the cartridge 3 so as to face the pushers 13 ... And a pusher plate 16 described later slides inside the plate guide groove 15.

Formed on the inner surface of the anvil 4 on both sides of the knife guide groove 10 is a forming groove 17 formed of concave grooves arranged in rows corresponding to the slits 12 ... The bottom surface is formed into an arc surface so that the leg portions 14a of the can be bent inward.

Further, inside the cartridge 3, two operation members 18 are provided on both sides of the knife guide groove 10 so as to be movable back and forth along the knife guide groove 10. A link 18a is provided at the tip of the operating member 18, and the link 18a is connected to two locking claws 20 that are rotatably provided inside the cartridge 3 with a pivot pin 19 as a fulcrum. The locking claw 20 is formed in a hook shape having a pointed end, is housed inside the cartridge 3 when the operating member 18 is retracted, and is pivoted when the operating member 18 is advanced.
It rotates around 9 as a fulcrum and projects from the inner surface of the cartridge 3.

Inside the anvil 4 facing the locking claw 20, the storage recess 2 in which the locking claw 20 is stored while rotating.
1 is provided, and the storage recess 21 is provided with a locking shaft 22 that is locked with the locking claw 20. That is, when the locking claw 20 rotates and projects from the inner surface of the cartridge 3, the locking claw 20 locks the locking shaft 22 and engages the leading ends of the cartridge 3 and the anvil 4 in a locked state. ing.

The proximal end side of the operating member 18 is housed inside the inner cylinder 8 of the insertion portion 2 together with the knife 11 and the pusher plate 16. And knife 1
1, the pusher plate 16 and the operating member 18 are connected to the staple operating portion 7 provided on the operating portion main body 1, and the knife 11 and the pusher plate 16 are inserted by pulling the staple operating portion 7 with a finger. The operation member 18 is moved forward while advancing inside the tube 8 and protruding to the cartridge 3 and the anvil 4.

Further, the opening / closing operation portion 6 provided in the operation portion main body 1 is connected to the outer cylinder 9 of the insertion portion 2 and the outer cylinder 9 is moved forward with respect to the inner cylinder 8 so that the cartridge 3 and the anvil 4 are connected. The proximal end portion is fitted to the outer cylinder 9 to close the suturing member 5, and the outer cylinder 9 is retracted with respect to the inner cylinder 8 so that the proximal ends of the cartridge 3 and the anvil 4 project from the outer cylinder 9, The suturing member 5 is opened by the biasing means.

Next, the operation of the suture instrument constructed as described above will be described. A part of the abdominal wall or the like of the living body is incised, the suture member 5 is pressed against the incised portion, and the suture member 5 and the insertion portion 2 are inserted into the abdominal cavity while pushing the incised portion open.

Then, the insertion portion 2 is further pushed to advance the suturing member 5 toward the portion to be sutured of the living tissue a, and the opening / closing operation portion 6 of the operation portion main body 1 is pulled, whereby the outer cylinder 9 of the insertion portion 2 is pulled.
Is retracted and the base ends of the cartridge 3 and the anvil 4 project from the outer cylinder 9.

Therefore, the cartridge 3 and the anvil 4 are
Is spread by the biasing means, and the suture member 5 is opened.
Then, when the living tissue a is inserted between the cartridge 3 and the anvil 4 and then the opening / closing operation portion 6 is pushed in, the outer cylinder 9 advances and the outer cylinder 9 is fitted to the proximal end portions of the cartridge 3 and the anvil 4. Then, the cartridge 3 and the anvil 4 are closed, and the living tissue a is sandwiched by the suture member 5.

In this state, when the staple operating portion 7 of the operating portion main body 1 is pulled, the operating member 18 inserted in the insertion portion 2,
The pusher plate 16 and the knife 11 move forward, the pusher plate 16 moves forward while being guided by the plate guide groove 15, and the knife 11 moves forward while being guided by the knife guide grooves 10, 10.

By the forward operation of the operating member 18, the locking claw 20
Rotates clockwise around the pivot pin 19 as a fulcrum, protrudes from the inner surface of the cartridge 3 and penetrates the biological tissue a, is locked by the locking shaft 22 of the anvil 4, and is the tip portion of the cartridge 3 and the anvil 4. Is engaged in the locked state.

As the pusher plate 16 advances, the pusher 13 inside the cartridge 3 is pushed up, the staples 14 inside the slits 12 project, and are pushed out to the portion to be sutured of the living tissue a. The leg portions 14a of the staples 14 that have been punched out penetrate the living tissue a, and the leg portions 14a are bent inwardly by the forming grooves 17 provided in the anvil 4, so that the portion to be sewn is stapled 14a.
Suture by.

As described above, the staples 14 are sewn in parallel at two positions in two rows, and at the same time, the knife 1 is sewn.
Since 1 also advances, the living tissue a located between the two suture portions is cut by the knife 11. Therefore,
Suture and cutting can be performed simultaneously.

In this case, since the locking claw 20 of the cartridge 3 and the locking shaft 22 of the anvil 4 are engaged with each other to grasp and fix the tip portions of the cartridge 3 and the anvil 4, the living tissue a is slippery. Even if it does not escape, the target site can be reliably sutured and cut.

Although the locking claw 20 of the cartridge 3 and the locking shaft 22 of the anvil 4 are engaged with each other before the staple 14 is driven into the living tissue a, the cartridge 3 of the cartridge 3 is driven after the staple 14 is driven into the living tissue a. The locking claw 20 and the locking shaft 22 of the anvil 4 may be engaged to grip and fix the tip portions of the cartridge 3 and the anvil 4.

When the staple operating portion 7 is released after the living tissue a is sewn and cut, the operating member 18 is retracted, and the locking claw 2 is released.
0 and the engagement shaft 22 are disengaged, the engagement claw 20 is housed inside the cartridge 3, and the knife 11 and the pusher plate 16 are also retracted. Further, when the opening / closing operation portion 6 is pulled toward the front side, the outer cylinder 9 is retracted and the cartridge 3 and the anvil 4 are opened by the biasing means and released from the living tissue a.

According to the first embodiment, the locking claw 20 of the cartridge 3 and the locking shaft 22 of the anvil 4 are engaged with each other so that the tips of the cartridge 3 and the anvil 4 are gripped and fixed. Even if the living tissue a is slippery, and even if the living tissue a is thick, the living tissue a does not escape, and there is an effect that the target site can be reliably sutured and cut.

FIG. 5 and FIG. 6 show the 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. A locking claw 30 is provided inside the cartridge 3 so as to be rotatable around a pivot pin 31 as a fulcrum. The locking claw 30 is connected to the operating member 18 via the link 32.
Is linked to.

Inside the anvil 4 facing the locking claw 30, there is provided a storage recess 33 for storing the locking claw 30 while rotating, and the storage recess 33 is locked with the locking claw 30. A locking portion 34 is provided. That is, the locking claw 30
When the lever rotates and protrudes from the inner surface of the cartridge 3, it engages with the engaging portion 34 and constitutes an engaging means for engaging the leading ends of the cartridge 3 and the anvil 4 in a locked state.

Therefore, when the operating member 18 advances before or at the same time as the staple 14 is driven into the living tissue a by operating the staple operating portion 7, the locking claw 30 causes the pivot pin 3 to move.
When it is rotated clockwise about 1 as a fulcrum, protrudes from the inner surface of the cartridge 3 and penetrates the biological tissue a, is inserted into the storage recess 33 of the anvil 4, and then the operating member 18 is retracted, the locking claw 30 Rotates counterclockwise around the pivot pin 31 as a fulcrum and engages with the engaging portion 34 to engage the leading ends of the cartridge 3 and the anvil 4 in a locked state.

In this way, by pulling the operating member 18 backward, the anvil 4 is pulled toward the cartridge 3 side by the locking claw 30, so that the living tissue a can be strongly clamped.

When the staple operating section 7 is released,
The operating member 18 interlocking with this reciprocates once in the front-rear direction, and the locking claw 30 temporarily rotates rearward about the pivot pin 31 as a fulcrum, so that the locking claw 30 is disengaged from the locking portion 34 and stored in the cartridge 3. It

FIG. 7 shows a third embodiment. A plurality of locking claws 30 having the same structure as those of the second embodiment are arranged in the longitudinal direction of the cartridge 3, and these locking claws 30 are arranged. Correspondingly, the anvil 4 is provided with the engaging portion 34, so that there is an effect that the cartridge 3 and the anvil 4 can be reliably held even if they are structured to be long in the axial direction.

FIG. 8 shows a suturing device according to a fourth embodiment. A plurality of protrusions 36 ... Are provided on the inner surface of the anvil 35 and along the knife guide groove (not shown), and the inner surface of the cartridge 37 is provided. Is provided with projection receiving portions 38, which are concave portions facing the projections 36.

By closing the anvil 35 and the cartridge 37, a plurality of projections 36 ... Are pierced into the living tissue a, and the living tissue a can be securely sandwiched, and the displacement of the living tissue a can be prevented during suturing and cutting. .. FIG. 9 shows a suturing device according to a fifth embodiment, in which wavy corrugated portions 41 and 42 which engage with each other are provided on the inner surface of the anvil 39 and the inner surface of the cartridge 40.

By closing the anvil 39 and the cartridge 40, the living tissue a can be sandwiched in a wave shape,
The sandwiching area is widened, and the displacement of the living tissue a can be prevented during suturing and cutting.

FIG. 10 shows a suturing device according to a sixth embodiment. An outer cylinder 45 that opens and closes the cartridge 43 and the anvil 44 is joined to a joint portion 4 of the cartridge 43 and the anvil 44.
6 and a slit 4 having a length corresponding to the suture length
7 is provided.

When the outer cylinder 45 is moved forward, the cartridge 4
3 and the anvil 44 are closed, and at the same time, the living tissue a is clamped, and the cartridge 43 and the anvil 44 can be grasped from the entire circumference by the outer cylinder 45.
It is possible to prevent the displacement of the living tissue a during cutting.

In each of the above-mentioned embodiments, the case where the suturing member is provided at the tip of the insertion portion and is percutaneously inserted into the body cavity to suture the tissue in the body cavity has been described. Is also available.

[0046]

As described above, according to the present invention, by engaging the cartridge and the anvil by the engaging means, it is possible to securely grasp and fix the tissue when the living tissue is sutured, The operability is simple, and there is an effect that suture can be performed safely and surely.

[Brief description of drawings]

FIG. 1 is a partially cutaway side view of a suturing device according to a first embodiment of the present invention when a suturing member is opened.

FIG. 2 is a partially cutaway side view of the suturing member of the embodiment when closed.

FIG. 3 is a plan view of the cartridge of the embodiment.

FIG. 4 is an overall perspective view of the suturing device of the embodiment.

FIG. 5 is a side view of the suturing device according to the second embodiment of the present invention, which is partially cut away when the suturing member is opened.

FIG. 6 is a partially cutaway side view when the suturing member of the embodiment is closed.

FIG. 7 is a partially cutaway side view of the suturing device according to the third embodiment of the present invention when the suturing member is closed.

FIG. 8 is a side view showing the suturing device showing the fourth embodiment of the present invention.

FIG. 9 is a side view showing a suture instrument showing a fifth embodiment of the present invention.

FIG. 10 is a side view and a front view showing a suturing device showing a sixth embodiment of the invention.

[Explanation of symbols]

3 ... Cartridge, 4 ... Anvil, 5 ... Suture member, 6 ...
Opening / closing operation part, 7 ... Staple operation part, 20 ... Locking claw,
22 ... Locking shaft.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor, Tsukagoshi Iso 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Akio Nakata 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Shiro Bito 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A suture member comprising a cartridge having a plurality of staples and an anvil for forming legs of the staples and fixing the staples in a tissue, an opening / closing operation section for opening and closing the suture member, and an inside of the cartridge. A suturing device comprising a staple manipulating section for embossing staples into a tissue and forming leg portions of the staples, wherein the cartridge and the anvil of the suturing member are provided with engaging means for engaging each other when they are closed. A suturing device characterized in that