JPH05317323A - Suturing unit - Google Patents

Abstract

PURPOSE:To provide a suturing unit capable of making a suturing member and an insertion section small in diameter and capable of being percutaneously inserted into a body cavity and suturing or cutting a tissue in the body cavity. CONSTITUTION:A suturing unit is provided with a suturing member 5 constituted of a cartridge 3 having multiple staple 22 and a wire cutter 20 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 22a of the staple 22 and fixing it in a tissue, and an opening/closing operation section 6 opening or closing the suturing member 5 on this side of the insertion section 2 and the staple 22 in the cartridge 3 provided on this side of the insertion section 2 are arranged diagonally to the sliding direction of the wire cutter 20.

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, Japanese Patent Laid-Open No. 3-12126 and Japanese Utility Model Publication No. 47.
It is known from Japanese Patent Publication No. -11908.

Japanese Unexamined Patent Publication (Kokai) No. 3-12126 is a suturing device which is percutaneously inserted into a body cavity and sutures tissue in the body cavity, and includes an insertion portion, an operation portion connected to the insertion portion, and an insertion portion. The front end portion is openably and closably provided, one of which is an anvil, and the other is a suturing member including a cartridge containing staple and knife means.

The staples arranged in the cartridge are arranged in three rows on both sides of the knife means. The staples are struck in the tissue by a filing lever to sew the tissue in three rows by the staples. The tissue at the center of the suture row is cut off by knife means.

Japanese Utility Model Publication No. 47-11908 discloses surgically suturing and excising tissue, and comprises a gripping portion, an anvil that is opened and closed by opening and closing the gripping portion, and a cartridge. A plurality of staples are provided inside the cartridge. And knife means are built-in. The staples are inclined with respect to the center axis of the cartridge and the ends of the staples are in close contact with each other.

[0007]

By the way, JP-A-3-
As disclosed in Japanese Patent No. 12126, the staples contained in the cartridge are composed of three staple lines on both sides centering on knife means provided on the central axis of the cartridge. Therefore, the cartridge has a total of 6 rows of staple lines on both sides, which makes the cartridge itself wider, and as a result,
When the anvil is closed, the outer diameter becomes large, and the distal end is percutaneously inserted into the body cavity, which causes a problem of increased invasion.

In Japanese Utility Model Publication No. 47-11908, a staple guide groove is provided for each staple, which guides the position at which the staple is ejected, in order to eject the staple to the tissue so that the ends of adjacent staples overlap. Since the adjacent staple guide grooves are joined without
There is a problem that adjacent staples interfere with each other because the staples are pushed up by the pusher and driven into the tissue.

The present invention has been made in view of the above circumstances, and an object thereof is to make it possible to reduce the diameter of a suturing member, for example, percutaneously inserting into a body cavity to suture tissue in the body cavity. Another object of the present invention is to provide a suturing device that can be safely and reliably sutured and excised when cutting.

[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 suture including a cutting means that slides in the suturing member, an opening / closing operation unit that opens and closes the suturing member, and a staple operation unit that drives the staple in the cartridge into the tissue and forms the leg of the staple. In the container, the staples in the cartridge are arranged in at least one row on both sides of the cutting means with at least a part of adjacent staples being wrapped, and the staples are arranged with respect to the sliding direction of the cutting means. It is arranged obliquely with an angle.

[0011]

The cutting means is positioned by positioning the suturing member on the portion to be sutured, operating the opening / closing operation portion to sandwich the portion to be sutured by the suturing member, and driving the staple in the cartridge into the living tissue by the staple operating portion. Staples having an angle with respect to the sliding direction are punched and sewn to the portion to be sewn in the biological tissue.

[0012]

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

1 to 9 show the first embodiment, and FIG. 8 shows the overall construction of the 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. As shown in FIG. 9, at the tip of the insertion portion 2,
A suturing member 5 including a cartridge 3 and an anvil 4 is provided. 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 7, 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. A base end portion of a pair of joints 10 made of wide-angle V-shaped spring material is pivotally supported on both sides of the tip end portion of the inner cylinder 8, and a direction perpendicular to the inner cylinder 8 is provided between the tip end portions of the joints 10. A hinge pin 11 is installed on the. Both ends of the hinge pin 11 are inserted into a substantially T-shaped slit 12 provided on the side wall of the outer cylinder 9,
An escape portion is formed when the outer cylinder 9 advances and retracts and when the joint 10 moves up and down.

Further, an engaging recess 13 is provided on the inner surface of the upper portion of the tip of the inner cylinder 8, and a projecting piece 14 projecting forward is provided at the tip located near the engaging recess 13. , The leaf spring 1 is provided on the upper surface of the protruding piece 14.
5 are provided.

On the other hand, an L-shaped hinge groove 16 is formed at the base end of the cartridge 3 and opens toward the base end side. By inserting the hinge groove 16 from the opening, the hinge pin 11 is vertically moved. Rotatably and detachably engaged with.

Further, an engaging projection 17 that engages with the engaging recess 13 is provided on the upper surface of the base end of the anvil 4.
The lower surface of the base end portion of the anvil 4 is elastically pressed against the leaf spring 15. That is, the elastic pressing force of the leaf spring 15 urges the engaging projection 17 of the anvil 4 in the direction of engaging the engaging recess 13.

Therefore, the cartridge 3 and the anvil 4 can be freely rotated (opened and closed) in the vertical direction about the base end of the inner cylinder 8 of the insertion section 2 as a fulcrum, and the cartridge 3 is moved by the elastic force of the joint 10. The anvil 4 is urged in the opening direction by the elastic force of the leaf spring 15, and the outer cylinder 9 that can move back and forth with respect to the inner cylinder 8 is moved forward, so that the base ends of the cartridge 3 and the anvil 4 are fitted to the outer cylinder 9. The suturing member 5 is configured to be closed together.

Further, a cutter guide groove 1 extends in the longitudinal direction at the widthwise intermediate portion between the cartridge 3 and the anvil 4.
8 and 19 are provided in a curved shape, and this cutter guide groove 1
A wire cutter 20, which will be described later, slides in the insides of 8 and 19.

On the inner surface of the cartridge 3, a plurality of slits 21 are arranged in a row on both sides of the cutter guide groove 18 and are obliquely arranged at a constant angle with respect to the sliding direction of the wire cutter 20. Has been done. Furthermore, the slit 21 ...
Are adjacent to each other at least partially wrapped.

Pushers 21a are housed in these slits 21 so that they can be projected and retracted. On the upper surface of the pushers 21a, one table 22 is housed so that each leg 22a faces upward and can be projected upwards. There is. further,
A plate guide groove 23 is provided inside the cartridge 3 so as to face the pushers 21a, and a pusher plate 24, which will be described later, slides inside the plate guide groove 23.

On the inner surface of the anvil 4, there is a row corresponding to the slits 21 on both sides of the cutter guide groove 19 and diagonally recessed at a constant angle with respect to the sliding direction of the wire cutter 20. Forming grooves 25, which are formed by grooves, are provided, and the forming grooves 25 have a bottom surface formed into an arc surface so that the leg portions 21a of the staples 21 can be bent inward.

The wire cutter 20 and the pusher plate 24 are housed inside the inner cylinder 8 of the insertion portion 2. First, the wire cutter 20 will be described. The inner cylinder 8 is provided with concave grooves 26 and 27 corresponding to the cutter guide grooves 18 and 19 provided in the cartridge 3 and the anvil 4, respectively. Cutter holders 28, 28 having flexibility are stored slidably.
A knife portion 29 made of a wire is stretched vertically between the tip ends of the cutter holders 28, 28.

Further, a plate guide surface 30 corresponding to the plate guide groove 23 provided on the cartridge 3 and the anvil 4 is provided on the bottom surface of the inner cylinder 8, and the plate guide surface 30 is made of a strip-shaped metal plate. The pusher plate 24 is supported upright and slidably,
An inclined surface 24a having a downward slope toward the tip is formed at the tip of the pusher plate 24.

The wire cutter 20 and the pusher plate 24 are connected to the staple operating section 7 provided on the operating section main body 1. By pulling the staple operating section 7 with a finger, the wire cutter 20 and the pusher plate 24 are connected. Moves in the inner cylinder 8 and projects 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 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, whereby the proximal ends of the cartridge 3 and the anvil 4 project from the outer cylinder 9 and are sewn together. The member 5 is adapted to open.

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. At this time, since the suturing member 5 is curved at about 90 ° with respect to the axial direction of the insertion portion 2, the tip of the suturing member 5 is pressed against the incision portion, and the insertion portion 2 is reversed from the bending direction of the suturing member 5. It can be easily inserted into the abdominal cavity by pushing open the incised portion while rotating in the direction.

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

Therefore, the cartridge 3 is expanded by the restoring force of the joint 10 and the anvil 4 is expanded by the restoring force of the leaf spring 15, and the suturing member 5 is opened. Then, when the portion to be sewn 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 to fit the outer cylinder 9 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 portion to be sewn is sandwiched by the suturing member 5.

In this state, when the staple operating portion 7 of the operating portion main body 1 is pulled toward the hand side, the pusher plate 24 and the wire cutter 20 inserted into the inner cylinder 8 of the inserting portion 2 advance,
The pusher plate 24 is guided by the plate guide groove 23 to move forward, and the wire cutter 20 moves to the wire guide groove 18,
You will be guided by 19 and move forward.

As the pusher plate 24 advances, the pusher 21a inside the cartridge 3 is pushed up by the inclined surface 24a, and the staple 2 inside the slit 21 is pushed up.
2 projects and is hammered out to the sutured portion. The leg portions 22a of the staples 22 punched out penetrate the living tissue, and the leg portions 22a are bent inwardly by the forming grooves 25 provided in the anvil 4, so that the portion to be sutured is stapled 22
Suture by.

In this way, the staple 22 is sewn diagonally in one row at two locations, and at the same time, the wire cutter 20 is also advanced. Therefore, the living tissue located between the two stitches has a knife portion of the wire cutter 20. It is cut by 29.

Therefore, since the stitching and the cutting can be performed at the same time, and the staples 22 are arranged in one row inside the cartridge 3 with the wire guide groove 18 interposed therebetween, the suturing member 5 and the insertion portion 2 are arranged. It is possible to provide a suture instrument that can be formed to have a small diameter, is small, and has excellent operability.

FIGS. 10 to 12 show a second embodiment. In the first embodiment, the leg portions 22a of the staple 22 are bent inwardly by the forming grooves 25 of the anvil 4, but in this embodiment, The forming groove 31 is provided in a direction opposite to the inner surface of the anvil 4.

With this structure, the leg portion 22a of the staple 22 ejected from the cartridge 3 is formed.
After penetrating the living tissue, the leg portion 22a is bent in the opposite direction by the forming groove 31 of the anvil 4, and the portion to be sewn can be sewn with the staple 22. Therefore, at the time of tissue suturing, it is possible to surely suture so that blood, lymph, etc. do not flow out from between the staples 22 from the stitched tissue.

FIGS. 13A and 13B show the third embodiment. FIG. 13A shows the staple 32 alone, and FIG. 13B shows the arrangement state. This staple 32 has leg portions 32b bent downward at right angles at both ends of a head portion 32a which is curved in an arc shape in a plan view. And this staple 32
The lower end portion of the leg portion 32b is formed at a right angle to the head portion 32a and the leg portion 32b at the time of hitting, and is formed in an arc shape like the head portion 32a.

The staples 32 having such a shape are displaced by half pitches on both sides of the cutter guide groove 18 so that the arcs of the head 32a face each other.
By arranging in a row, the portion to be sewn can be reliably sewn.

FIG. 14 shows a fourth embodiment. FIG. 14A shows the staple 33 alone, and FIG. 14B shows the arrangement state. The staple 33 includes leg portions 3 that are bent downward at right angles to both ends of a head portion 33a that is straight in a plan view.
3b. When the staple 33 is ejected, the lower end portion of the leg portion 33b is formed outward at a right angle to the leg portion 33b, and at the same time as the head portion 33a.

The staples 33 having such a shape should be arranged on both sides of the cutter guide groove 18 and at a right angle to the head 33a with respect to the cutter guide groove 18, and should be arranged at such an interval that the legs 33b are wrapped by molding. The part to be sewn can be reliably sewn.

FIG. 15 shows the fifth embodiment. FIG. 15A shows the staple 34 alone, and FIG. 15B shows the arrangement state. The staple 34 includes leg portions 3 that are bent downward at right angles to both ends of a head portion 34a that is straight in a plan view.
4b. When the staple 34 is ejected, the lower end portion of the leg portion 34b is formed outside at a right angle to the leg portion 34b and at an angle with respect to the head portion 34a.

The staples 34 having such a shape are arranged on both sides of the cutter guide groove 18 and inclined with respect to the cutter guide groove 18, and the leg portions 34b are overlapped with the head portion 34a of the staple 34 by molding. By arranging them at the intervals, the portion to be sewn can be reliably sewn.

FIG. 16 shows a sixth embodiment. In FIG. 16A, the molding groove 35 provided in the anvil 4 is curved in a V shape in a plan view. Therefore, even in the case of the ordinary U-shaped staple 36, the leg portion 36 a of the staple 36 is bent and formed along the forming groove 35 in a V shape when the staple 36 is ejected.

FIG. 17 shows a seventh embodiment, and FIG. 17 (a) is a plan view of the molding groove 37 provided in the anvil 4 and is curved in an arc shape. Therefore, even with a normal U-shaped staple 38, when the staple 38 is ejected, its leg portions 38a are bent and formed so as to face each other along the forming groove 37.

18 to 20 show an eighth embodiment, and a staple holding member 40 having a slit groove for engaging the staple 22 is provided on the upper portion of the pusher 21a incorporated in the cartridge 3. ..

By thus providing the staple holding member 40, the living tissue is sandwiched between the cartridge 3 and the anvil 4, and when the staple 22 is driven out by the pusher plate 24, the staple 22 is not driven into the living tissue. Staple 22
Even if the leg portions 22 a of the staple 22 are bent by the anvil 4, the staple 22 is held by the staple holding member 40. Therefore, the staple 22 that has not been driven into the living tissue
It does not fall into the body cavity and is highly safe.

FIGS. 21 and 22 show the ninth embodiment, and inside the forming groove 25 provided in the anvil 4, a staple drop-off preventing member 41 such as silicone rubber is provided.

By thus providing the staple drop-off preventing member 41, the living tissue is sandwiched between the cartridge 3 and the anvil 4, and the staple 22 is ejected when the staple 22 is ejected by the pusher plate 24.
Is not driven into the living tissue, the leg portion 22a of the staple 22 bites into the staple drop-off preventing member 41 and is retained in the forming groove 25 even if it is bent by the anvil 4 of the staple 22. Therefore, the staple 22 that has not been driven into the living tissue does not drop into the body cavity, and there is an effect that the safety is high.

In each of the above-described 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 and cut the tissue in the body cavity has been described. It can also be used for surgery.

[0049]

As described above, according to the present invention, there is an effect that the diameter of the suturing member can be reduced and the living tissue can be sutured and excised safely and reliably when suturing or cutting the living tissue.

[Brief description of drawings]

1A and 1B show a cartridge according to a first embodiment of the present invention, in which FIG. 1A is a plan view and FIG. 1B is a sectional view taken along line aa in FIG.

FIG. 2 is a side view of the cartridge according to the embodiment.

FIG. 3 shows the anvil of the same embodiment, (a) is a side view,
(B) is a plan view.

FIG. 4 is a vertical sectional side view of a distal end portion of the insertion portion of the embodiment.

FIG. 5 is a cross-sectional front view of the insertion portion of the embodiment.

FIG. 6 is a vertical sectional side view showing a state in which a suturing member is connected to the insertion portion of the embodiment.

FIG. 7 is a vertical sectional side view showing a part of the cartridge of the embodiment.

FIG. 8 is an overall perspective view of the suturing device of the embodiment.

FIG. 9 shows the suturing member of the same embodiment, (a) is a side view,
(B) is a front view.

FIG. 10 is a plan view of the anvil showing the second embodiment of the present invention.

FIG. 11 is a perspective view showing a sutured state with staples by the suturing device of the embodiment.

FIG. 12 is a plan view of staples of the suturing device of the embodiment.

13A and 13B show a stapler according to a third embodiment of the present invention, FIG. 13A is a perspective view of a staple alone, and FIG. 13B is a plan view showing an array state of staples.

14A and 14B show a stapler according to a fourth embodiment of the invention, FIG. 14A is a perspective view of a staple alone, and FIG. 14B is a plan view showing an array state of staples.

15A and 15B show a stapler according to a fifth embodiment of the invention, FIG. 15A is a perspective view of a staple alone, and FIG. 15B is a plan view showing an array state of staples.

16A and 16B show a sixth embodiment of the present invention, wherein FIG. 16A is a plan view of a forming groove, and FIG. 16B is a plan view of a formed staple.

FIG. 17 shows a seventh embodiment of the present invention, (a) is a plan view of a forming groove, and (b) is a plan view of a formed staple.

FIG. 18 is a vertical sectional side view showing a part of a cartridge showing an eighth embodiment of the invention.

FIG. 19 is a side view of the suturing member of the embodiment.

FIG. 20 is a perspective view of the staple holding member of the embodiment.

FIG. 21 is a side view of the suturing member showing the ninth embodiment of the present invention.

FIG. 22 is an enlarged side view showing a part of the embodiment.

[Explanation of symbols]

3 ... Cartridge, 4 ... Anvil, 5 ... Suture member, 6 ...
Opening / closing operation section, 7 ... Staple operation section, 20 ... Wire cutter, 22 ... Staple.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Shuichi Kimura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Minor Tsuruta 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 molding the leg portions of the staple to fix it in the tissue, a cutting means for sliding in the suture member, and the suture member. In the suturing device, which comprises an opening / closing operation unit for opening and closing the stapler, and a staple operation unit for driving the staples in the cartridge into the tissue to form the legs of the staple, the staples in the cartridge are at least adjacent to each other. At least one row is arranged on both sides of the cutting means in a state of being partially wrapped, and each staple is obliquely arranged at an angle with respect to the sliding direction of the cutting means. Suture device.