JPH0630945A - 縫合器 - Google Patents

縫合器

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Publication number
JPH0630945A
JPH0630945A JP5117190A JP11719093A JPH0630945A JP H0630945 A JPH0630945 A JP H0630945A JP 5117190 A JP5117190 A JP 5117190A JP 11719093 A JP11719093 A JP 11719093A JP H0630945 A JPH0630945 A JP H0630945A
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JP
Japan
Prior art keywords
cartridge
suturing
staple
anvil
tissue
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
JP5117190A
Other languages
English (en)
Inventor
Shirou Bitou
士郎 備藤
Seiji Kuramoto
聖治 倉本
Shuichi Kimura
修一 木村
Minoru Tsuruta
稔 鶴田
Takeshi Tsukagoshi
壯 塚越
Akio Nakada
明雄 中田
Toshihiko Suzuta
敏彦 鈴田
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Corp
Original Assignee
Olympus Optical Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Optical Co Ltd filed Critical Olympus Optical Co Ltd
Priority to JP5117190A priority Critical patent/JPH0630945A/ja
Publication of JPH0630945A publication Critical patent/JPH0630945A/ja
Withdrawn legal-status Critical Current

Links

Abstract

(57)【要約】 【目的】例えば、経皮的に体腔内に挿入して体腔内組織
を縫合、切断する際に、その被縫合部に対して縫合部材
を容易にアプローチでき、操作性が簡単で、安全かつ確
実に縫合できる縫合器を提供することにある。 【構成】操作部１と、この操作部１に設けられた挿入部
２と、この挿入部２の先端部に設けられ複数のステープ
ルを収納するカートリッジ３およびこのカートリッジ３
に対向するアンビル４とからなる縫合部５と、前記ステ
ープルを組織へ打出し留置させるステープル放出手段と
してのプッシャとを具備した縫合器において、プッシャ
の少なくとも一部は、前記挿入部２または縫合部５の形
状に追従して変形可能に可撓性を有することを特徴とす
る。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】この発明は、腹壁等を貫通して体
腔内に挿入し、体腔内の生体組織を縫合する縫合器に関
する。
【０００２】
【従来の技術】例えば、胆のう結石手術等において、再
発防止のために胆のうごと摘出手術を行う場合、胆管と
胆のう管との接続部を切断するが、この胆のう管には胆
のう動脈、胆のう静脈が通っているため、胆のう管をナ
イフ等によって切断すると同時に縫合する必要がある。
【０００３】このような胆のう結石手術等においては腹
壁等を貫通して体腔内に挿入して体腔内の組織を縫合す
る縫合器が用いられている。この種の縫合器には従来、
例えば実公昭３８−１９２８２号公報、実公昭６０−４
１９２４号公報および特開平３−１２１２６号公報等で
知られている。
【０００４】実公昭３８−１９２８２号公報は、外科的
に胃の縫合に使用される縫合器であり、ステープルとス
テープル押出し機構を有するステープル把持部材とアン
ビル部材からなり、両者ともその形状が胃の大湾に沿う
ように湾曲しており、ステープル把持部材の末端のヒン
ジピンによってアンビル部材と開閉自在に接続されてい
る。
【０００５】実公昭６０−４１９２４号公報は、外科的
に癌核を縫合する縫合器であり、鋏状の結紮器本体で、
本体に支点を挟んだ一方を挟持部、他方を柄として十分
に長く形成し、嘴状に腹部が向い合い、一方にステープ
ルを保持し、他方がアンビルからなり、患部に合わせて
湾曲している挟持部からなり、前記柄を開閉することに
より開閉自在に設けられている。
【０００６】特開平３−１２１２６号公報は、経皮的に
体腔内に挿入され、体腔内組織を縫合する縫合器で、挿
入部と、この挿入部の先端部に開閉自在に設けられ一方
がアンビル、他方がステープルを保持するカートリッジ
からなる縫合部材と、前記挿入部の先端部に設けられカ
ートリッジからステープルを打出すファイリングレバー
と、縫合部材を開閉せしめる縫合開閉レバーとから構成
されている。
【０００７】
【発明が解決しようとする課題】ところで、実公昭３８
−１９２８２号公報は、アンビルとステープル保持部材
のみで構成され、挿入部を持ってないため、経皮的に体
腔内に挿入できない。また、縫合部材に組織を切断する
切断手段がないため、組織を切断するときには別途切断
器を用意しなくてはならない。
【０００８】実公昭６０−４１９２４号公報は、体腔内
に経皮的に挿入して使用する際、縫合部材の開閉のため
の柄を開閉できるように体腔壁（腹壁、胸壁等）を切開
しなければならないため、侵襲が大きく、また切断手段
がないため、別途切断器を用意しなくてはならない。
【０００９】特開平３−１２１２６号公報は、縫合部材
が挿入部の中心軸に対してストレートに形成されてい
る。したがって、体腔内に癒着部があり、腔間が狭い時
には縫合部材をアプローチしにくく、また組織縫合部が
挿入部の軸方向に存在しない場合、別途把持鉗子等によ
って組織を縫合部材に挿入、把持してやらなければなら
ない。
【００１０】このように従来の縫合器は、いずれも操作
性が悪く、別の処置具が必要になったり、手術時間が長
くかかり、患者に与える負担が大きいという問題があ
る。また、ＵＳＰ５０４０７１５の縫合装置は、トラカ
ールに挿入可能な直径を有する細長い挿入部の先端に、
ステープル列とカッターが設けられた処置部があり、後
端側にはこの装置を把持、挿作する把持部が設けられて
いる。
【００１１】前記処置部と挿入部は直線状をなしてお
り、挿入部から処置部の方へ移動し、ステープルを放出
したり、カッターを走らせるための部材をその内部に有
している。
【００１２】しかしながら、図３３に示すように、内視
鏡下処置を行う場合、体壁ａに設けられた小孔または小
切開部ｂを通して前記縫合装置ｃを挿入するため、目的
の臓器ｄに対しての処置部ｅのアプローチ角度の自由度
が少なく、同図（ｂ）のように、Ｂ−Ｂ線またはＣ−Ｃ
線で切離を行おうとしても、同図（ａ）から解るように
Ａ−Ａ線でしか切離できない。Ｂ−Ｂ線で切離したい場
合には、Ａ−Ａ線となることにより、余分な部分を切ら
なければならない。また、Ｃ−Ｃ線で切りたい場合に
は、開腹手術をせざるを得ない。
【００１３】また、図３４のような場合、肺ｆに発生し
た腫瘍ｇをＤ−Ｄ線に沿って切り取りたいが、ステープ
ルを放出したり、カッターを走らせるための処置部ｅと
挿入部ｈは直線状であるため、Ｅ−Ｅのように切らざる
を得ず、必要以上に切離を行わざるを得ない。
【００１４】この発明は、前記事情に着目してなされた
もので、その目的とするところは、経皮的に体腔内に挿
入して体腔内組織を縫合、切断する際に、その組織縫合
部に対して縫合部を容易にアプローチでき、操作性が簡
単で、安全かつ確実に縫合でき、また手術時間を短縮す
ることができる縫合器を提供することにある。
【００１５】
【課題を解決するための手段】この発明は前記目的を達
成するために、請求項１は、操作部と、この操作部に接
続された挿入部と、この挿入部の先端部に設けられ複数
のステープルを収納する第１の挟持部材およびこの第１
の挟持部材に対向する第２の挟持部材とからなる縫合部
と、前記ステープルを組織へ打出し留置させるステープ
ル放出手段とを具備した縫合器において、ステープル放
出手段の少なくとも一部は、前記挿入部または縫合部の
形状に追従して変形可能に可撓性を有することを特徴と
する。
【００１６】請求項２は、操作部と、この操作部に接続
された挿入部と、この挿入部の先端部に設けられ複数の
ステープルを収納する第１の挟持部材およびこの第１の
挟持部材に対向する第２の挟持部材とからなる縫合部
と、前記ステープルを組織へ打出し留置させるステープ
ル放出手段とを具備した縫合器において、前記挿入部ま
たは縫合部の少なくとも一方には湾曲部が形成され、前
記ステープル放出手段の少なくとも一部は、前記湾曲部
の形状に追従して変形可能に可撓性を有することを特徴
とする。
【００１７】
【作用】例えば、挿入部の先端部に設けた縫合部を経皮
的に体腔内に挿入し、縫合部を被縫合部に位置決めし、
第１と第２の挟持部材によって被縫合部を挟持し、ステ
ープル放出手段によってステープルを組織内に打出し、
そのステープルを留置して組織を縫合する。
【００１８】
【実施例】以下、この発明の各実施例を図面に基づいて
説明する。図１〜図８は第１の実施例で、図１は縫合器
の全体構成を示す。１は操作部本体で、この操作部本体
１には挿入部２の基端部が矢印方向に回転自在に連結さ
れている。挿入部２の先端部には第１の挟持部材として
のカートリッジ３と第２の挟持部材としてのアンビル４
とからなる縫合部５が設けられている。操作部本体１に
は縫合部５を開閉する開閉操作部６とステープル操作部
７が設けられている。
【００１９】図２〜図７に示すように、前記挿入部２
は、内筒８とこの内筒８に対して軸方向に進退自在に嵌
合された外筒９とから構成されている。この内筒８の先
端部における両側部には広角Ｖ字状のばね材からなる一
対の継手１０の基端部が枢支され、これら継手１０の先
端部間には内筒８と直交する方向にヒンジピン１１が架
設されている。このヒンジピン１１の両端部は外筒９の
側壁に設けられた略Ｔ字状のスリット１２に挿入され、
外筒９の進退時および継手１０の上下時のガイド部を形
成している。
【００２０】さらに、内筒８の先端部における上部内面
には係合凹部１３が設けられているとともに、この係合
凹部１３の近傍に位置する先端には前方に突出する突出
片１４が設けられ、この突出片１４の上面には板ばね１
５が設けられている。
【００２１】一方、前記カートリッジ３の基端部には基
端側に開口するＬ字状のヒンジ溝１６が設けられ、この
ヒンジ溝１６には開口から挿入することにより、前記ヒ
ンジピン１１が上下方向に回動自在および着脱自在に係
合されている。
【００２２】また、前記アンビル４の基端部の上面には
前記係合凹部１３に係合する係合凸部１７が設けられ、
アンビル４の基端部の下面は前記板ばね１５に弾性的に
圧接されている。つまり、板ばね１５の弾性押圧力によ
ってアンビル４の係合凸部１７を係合凹部１３に係合す
る方向に付勢している。
【００２３】したがって、前記挿入部２の内筒８にはカ
ートリッジ３とアンビル４がその基端部を支点として上
下方向に回動（開閉）自在であり、カートリッジ３は継
手１０の弾性力によって、アンビル４は板ばね１５の弾
性力によって開方向に付勢され、内筒８に対して進退自
在な外筒９を前進することにより、カートリッジ３とア
ンビル４の基端部が外筒９に嵌合して縫合部５が閉じら
れるように構成されている。
【００２４】さらに、カートリッジ３とアンビル４とか
らなる縫合部５は、その長手方向の略中間部から挿入部
２の軸方向に対して略９０゜湾曲している。そして、こ
のカートリッジ３とアンビル４の幅方向の中間部には長
手方向に亘ってカッタガイド溝１８，１９が湾曲して設
けられ、このカッタガイド溝１８，１９の内部を後述す
るワイヤカッタ２０がスライドするようになっている。
【００２５】前記カートリッジ３の内面にはカッタガイ
ド溝１８を挟んで両側には複数のスリット２１…が２列
配置され、これらスリット２１…にはプッシャ２１ａが
突没自在に収納され、このプッシャ２１ａの上面にはス
テープル２２が１個づつ脚部２２ａを上向きにし、しか
も上方へ突出自在に収納されている。さらに、カートリ
ッジ３の内部にはプッシャ２１ａ…に対向してプレート
ガイド溝２３が設けられ、このプレートガイド溝２３の
内部を後述するステープル放出手段としてのプッシャプ
レート２４がスライドするようになっている。
【００２６】前記アンビル４の内面にはカッタガイド溝
１９を挟んで両側に前記スリット２１…と対応して列を
なした凹溝からなる成形溝２５…が設けられ、この成形
溝２５はステープル２１の脚部２１ａを互いに内側に折
曲することができるように底面が円弧面に形成されてい
る。
【００２７】前記ワイヤカッタ２０およびプッシャプレ
ート２４は前記挿入部２の内筒８の内部に収納されてい
る。まず、ワイヤカッタ２０について説明すると、内筒
８には前記カートリッジ３とアンビル４に設けられたカ
ッタガイド溝１８，１９と対応する凹溝２６，２７が設
けられ、これら凹溝２６，２７には可撓性を有するカッ
タホルダ２８，２８がスライド自在に収納されている。
そして、このカッタホルダ２８，２８の先端部間には上
下方向にワイヤからなるナイフ部２９が張設されてい
る。
【００２８】また、内筒８の底面には前記カートリッジ
３とアンビル４に設けられたプレートガイド溝２３と対
応するプレートガイド面３０が設けられ、このプレート
ガイド面３０には帯状の金属板からなるプッシャプレー
ト２４が立位状態で、しかもスライド自在に支持され、
このプッシャプレート２４の先端部には先端に向かって
下り勾配の傾斜面２４ａが形成されている。
【００２９】以上のように、カッタホルダ２８、プッシ
ャプレート２４は可撓性を有する材料で構成されてお
り、湾曲するカッタガイド溝１８，１９、プレートガイ
ド面３０の曲率に対応して各々変形するようになってい
る。
【００３０】そして、ワイヤカッタ２０およびプッシャ
プレート２４は前記操作部本体１に設けられたステープ
ル操作部７に連結されており、ステープル操作部７に手
指を掛けて引くことにより、ワイヤカッタ２０およびプ
ッシャプレート２４が内筒８の内部を前進し、カートリ
ッジ３およびアンビル４まで突出するようになってい
る。
【００３１】また、操作部本体１に設けられた開閉操作
部６は挿入部２の外筒９と連結され、内筒８に対して外
筒９を前進させることにより、カートリッジ３とアンビ
ル４の基端部が外筒９に嵌合して縫合部５が閉じ、内筒
８に対して外筒９を後退させることにより、カートリッ
ジ３とアンビル４の基端部が外筒９から突出して縫合部
５が開くようになっている。
【００３２】次に、前述のように構成された縫合器の作
用について説明する。生体の腹壁等の一部を切開し、そ
の切開部分に縫合部５を押し当て、切開部分を押し開き
ながら縫合部５および挿入部２を腹腔内に挿入する。こ
のとき、縫合部５は挿入部２の軸方向に対して略９０゜
湾曲しているため、縫合部５の先端部を切開部分に押し
当て、挿入部２を縫合部５の湾曲方向と逆方向に回動し
ながら切開部分を押し開くことにより、容易に腹腔内に
挿入することができる。
【００３３】そして、図８（ａ）に示すように、挿入部
２をさらに押し進めて縫合部５を生体組織の被縫合部Ａ
に向かって前進させる。図１に破線で示すように、操作
部本体１の開閉操作部６を引くと、挿入部２の外筒９が
後退してカートリッジ３とアンビル４の基端部が外筒９
から突出する。
【００３４】したがって、カートリッジ３は継手１０の
復元力によって、アンビル４は板ばね１５の復元力によ
って押し広げられ、縫合部５が開く。そして、被縫合部
Ａをカートリッジ３とアンビル４との間に入れ、次に開
閉操作部６を図１の実線に示すように押し込むと、外筒
９が前進してカートリッジ３とアンビル４の基端部に外
筒９が嵌合し、カートリッジ３とアンビル４が閉じて縫
合部５によって被縫合部Ａを挟持する。
【００３５】この状態で、操作部本体１のステープル操
作部７を図１の矢印ａ方向に引くと、挿入部２の内筒８
に内挿されたプッシャプレート２４とワイヤカッタ２０
が前進し、プッシャプレート２４はプレートガイド溝２
３に案内されて前進し、ワイヤカッタ２０はワイヤガイ
ド溝１８，１９に案内されて前進する。
【００３６】プッシャプレート２４の前進に伴ってカー
トリッジ３の内部のプッシャ２１ａは傾斜面２４ａによ
って押し上げられ、スリット２１の内部のステープル２
２は突出し、被縫合部Ａに打ち出される。打ち出された
ステープル２２の脚部２２ａは生体組織を貫通し、その
脚部２２ａはアンビル４に設けられた成形溝２５によっ
て互いに内側に折り曲げられ、被縫合部Ａをステープル
２２によって縫合する。
【００３７】このようにステープル２２によって被縫合
部Ａが２列づつ平行に２箇所縫合されると同時にワイヤ
カッタ２０も前進するため、図８（ｂ）に示すように、
２箇所の被縫合部の間に位置する生体組織はワイヤカッ
タ２０のナイフ部２９によって切断される。したがっ
て、縫合と切断が同時に行うことができる。
【００３８】また、縫合部５が挿入部２の軸方向に対し
て略９０゜湾曲しているため、被縫合部Ａが挿入部２の
軸線に対して平行もしくは垂直の方向に無いときに特に
アプローチしやすく、また、操作部本体１に対して挿入
部２が回転自在であるため、縫合部５を任意の方向に向
けることができる。
【００３９】図９および図１０は第２の実施例を示し、
第１の実施例と同一構成部分は同一番号を付して説明を
省略する。操作部本体１の内部にはワイヤカッタ２０に
接続する導電性部材３１が設けられ、この導電性部材３
１は操作部本体１の外部に突出する高周波接続ピン３２
に接続されている。
【００４０】この高周波接続ピン３２には高周波接続ケ
ーブル３３の一端部に設けられたコネクタ３４が接続さ
れ、この高周波接続ケーブル３３の他端は高周波焼灼装
置３５に接続されている。
【００４１】この実施例によれば、高周波焼灼装置３５
から高周波接続ケーブル３３を介して高周波接続ピン３
２に高周波電流が流れ、さらに導電性部材３１を介して
ワイヤカッタ２０のナイフ部２９に高周波電流が通電さ
れるため、被縫合部Ａの縫合時に生体組織を焼灼しなが
ら縫合することができる。また、生体組織の切除を通電
止血しながら行うので出血の恐れがないという効果があ
る。
【００４２】図１１〜図１８は第３の実施例を示し、第
１の実施例と同一構成部分は同一番号を付して説明を省
略する。カートリッジ３はステープル２２の打出される
向きと垂直をなす平面上にて湾曲する湾曲部４０を有し
ている。
【００４３】第１の実施例においては、プッシャープレ
ート２４及びワイヤカッター２０は、挿入部２側に設け
られていたが、本実施例においては、プッシャープレー
ト２４に相当するプッシャ部材４１，４２及び、ワイヤ
カッター２０に相当するカット部材４３は共にカートリ
ッジ３内に収納されている。
【００４４】また、プッシャ部材４１，４２及びカット
部材４３の各々はワイヤ４４，４５，４６により接続部
材４７に連結され、フレキシブル組立体４８を構成して
いる。フレキシブル組立体４８はこの接続部材４７に設
けた係合溝４９と本体側のピン（図示しない）との係合
により挿入部２に固定されている。なお、カートリッジ
３と挿入部２が着脱自在でない場合にはこのような構成
は不要で、ワイヤ４４，４５，４６は操作部１内まで延
長して固定してもよい。
【００４５】フレキシブル組立体４８の各要素は各々カ
ートリッジ３内に設けられたガイド溝５０，５１、カッ
タガイド溝１８、ガイド孔５２，５３，５４によりガイ
ドされている。また、接続部材４７はカートリッジ３の
手元側部５５内にてガイド孔５６によりガイドされてい
る。フレキシブル組立体４８の各要素は、弾性部材によ
り形成され、各カッタガイド溝１８、ガイド孔５２，５
３，５４の湾曲に追従して変形可能である。
【００４６】前記ワイヤ４４，４５，４６の材質は、例
えばステンレス製撚りワイヤである。なお、ワイヤ４
４，４５，４６のガイドは手元側部材５５内のガイド孔
５６によらず、チューブ、コイル等のフレキシブルな部
材により行ってもよい。
【００４７】図１１において、スリット２１及びこれに
対応するステープル２２（図示しない）の数は、湾曲の
外側列の方が、内側列よりも多い。また数の大小とは別
に、一個一個のスリット２１及びステープル２２の長さ
を湾曲の外側列のものを長く形成してもよい。
【００４８】図１６に示すように、本縫合器と組み合わ
せて使用するトラカール５７は、口金部５８とシース部
５９とから構成されている。シース部５９はフレキシブ
ルであり、縫合部５および挿入部２の湾曲形状に応じて
変形可能である。材質は例えばＰＴＦＥのようなチュー
ブである。なお、図示しないが、トラカール５７の口元
に体腔内のガスの漏れを遮断する弁手段を設け、この弁
手段はフレキシブルはシース部５９に対して着脱自在と
なっている。
【００４９】プッシャ部材４１，４２、カット部材４３
は、弾性部材からなるベース６０に固定され、ベース６
０の先端と接続部材４７はワイヤ６１に接続されてい
る。これらとは別にカートリッジ３の先端部内に設けた
ピン６２があり、ワイヤ６１はこのプーリにより折り返
して係合している。この構成の場合は、接続部材４７を
手元側へ引く動作により、プッシャ部材４１，４２、カ
ット部材４３を作動できる。
【００５０】したがって、図１６に示すように、カート
リッジ３、アンビル４を閉じた状態にて体腔内へ導入す
る。この際、トラカール５７のシース部５９は従来の硬
性のものと異り、カートリッジ３、アンビル４の湾曲に
応じて変形可能であるため湾曲部の通過が可能である。
【００５１】ここで、第１の実施例と異なる点のみ述べ
ると、図８（ａ）のに示すように、アンビル４、カート
リッジ３にて被縫合部Ａを挟持する操作部１のハンドル
７の操作により、カートリッジ３内の接続部材４７を介
してプッシャ部材４１，４２、カット部材４３が各ガイ
ド部材内を移動してステープル２２の押し出し、組織の
切離を行う。
【００５２】したがって、目的の被縫合部Ａの形状に応
じた湾曲を有するカートリッジ３、アンビル４を用いる
ため、必要最小限の量の切除にとどめることができる。
縫合器の湾曲部分及び直線部分を摺動する各部材が湾曲
に応じて変形可能なため、湾曲部、直線部の双方に対し
て軽い力で摺動が可能である。
【００５３】図１９および図２０は第４の実施例を示
し、第１の実施例と同一構成部分は同一番号を付して説
明を省略する。カートリッジ３はステープル２２の打ち
出される向きと挿入部２の軸線とを含む平面内にて湾曲
する湾曲部６３を有している。
【００５４】プッシャ部材４１，４２、カット部材４３
の下面は、図２０に示すように、カートリッジ３の湾曲
と等しい湾曲をしている。またワイヤ部材４４，４５，
４６との接続部分は回転自在となっている。
【００５５】したがって、被縫合部Ａの目的部位へのア
プローチ性が高い。つまり腹腔内、胸腔内の底部に存す
る臓器（腸や子宮より卵管系に移行する部位、肺門部）
をすくい上げて把持することができる。また、これによ
りカートリッジ３の先端部が良く見えて臓器の縫合した
い部位がカートリッジ３の先端部の内側にあるかどうか
を内視鏡で視認することができ手技の確実性向上にな
る。
【００５６】図２１は第５の実施例を示し、第１の実施
例と同一構成部分は同一番号を付して説明を省略する。
本実施例は挿入部２に湾曲部６３が設けられている。ハ
ンドル操作に応じて挿入部２内を摺動するワイヤ部材
（図示しない）は湾曲可能で、またこれをガイドするチ
ューブ部材（図示しない）も同様に可撓性を有してお
り、湾曲可能である。
【００５７】図２２〜図２４は第６の実施例を示す。図
２２に示すように、縫合器は、操作部７０とこの操作部
７０に接続された挿入部７１とから構成されている。操
作部７０には開閉レバー７２とハンドル７３が設けられ
ている。
【００５８】前記挿入部７１は筒状に形成され、その挿
入部７１の先端部には湾曲したカートリッジ７４が接続
されている。カートリッジ７４に対向してアンビル７５
が設けられている。アンビル７５は開閉レバー７２と接
続されているとともに、アンビル７５はピン７６により
カートリッジ７４に回転可能に取り付けられている。
【００５９】カートリッジ７４内には複数列のステープ
ル２２と、ステープル２２を押し出すプッシャー２１ａ
と、プッシャー２１ａを押し上げるプッシャープレート
２４と、カット部材４３が内蔵されている。プッシャー
プレート２４とカット部材４３はハンドル７３と接続さ
れている。プッシャープレート２４は、軟性の部材で構
成されている。
【００６０】切除する肺組織等の被縫合部Ａをアンビル
７５とカートリッジ７４の間に入れる。開閉レバー７２
を回転させると、アンビル７５が回転して閉じ、アンビ
ル７５とカートリッジ７４の間に組織が挟まる。
【００６１】ハンドル７２を引くと、カートリッジ７４
内をプッシャープレート２４が湾曲しながら移動し、プ
ッシャー２１ａが押し上げられ、ステープル２２が押し
上げられると共に、ステープル２２がアンビル７５に当
たり、アンビル７５によりステープル２２が閉じられ
る。一方、前記ハンドル７３の操作によりカッターもカ
ートリッジ７４内を移動し、組織の切除が行われる。
【００６２】このように組織を切除する際、切除縫合線
が曲がっているため、正常な組織を切りとる面積を少な
くでき、必要な部分だけ切除することができる。アンビ
ル７５の先端とカートリッジ７４の先端が固定されてい
るため、組織を把持する力が大きくなる。また、閉じる
際にアンビル７５がカートリッジ７４に対して手元から
先端まで確実に閉じることができるため、均一に縫合す
る事ができる。
【００６３】図２６および図２７は第７の実施例を示
す。本実施例の縫合器は、操作部７７にアングルノブ７
８が回動自在に設けられている。挿入部７９の一部には
湾曲部８０が設けられている。アングルノブ７８の回動
軸７８ａには同軸的にアングルプーリ８１が固定され、
このアングルプーリ８１の外周にアングルワイヤ８２が
巻き付けられている。
【００６４】湾曲部８０の内部には複数の湾曲駒８３が
湾曲ピン８４により各々回動可能に接続されており、先
端の湾曲駒８３の内周には操作部７７より伸びるアング
ルワイヤ８２が固定されている。湾曲部８０は樹脂製の
軟性チューブ８０ａで覆われている。
【００６５】したがって、操作部７７のアングルノブ７
８を操作することにより、アングルワイヤ８２を介して
湾曲部８０を湾曲することができ、腹腔内にて所望の角
度を取る事により目的部位に対して最良のアプローチを
とる事ができる。角度を変えて設定できるので、固定湾
曲のものに較べて様々な症例に対して、様々な部位に対
してこれ１本で対応できる。
【００６６】図２８〜図３２は第８の実施例を示す。ア
ンビル４、カートリッジ３は、開閉用カム８５の挿入部
２の軸方向に進退自在で、この前後動により開閉される
ようになっている。すなわち、アンビル４、カートリッ
ジ３は付勢ばね（図示しない）により開方向へ付勢さ
れ、開閉用カム８５が前進すると閉じ、後退すると開く
ようになっている。
【００６７】挿入部２の左右両側部には板ばね８６が添
設され、この板ばね８６の先端が開閉カム８５に固定さ
れ、板ばね８６により開閉カム８５が前後動されるよう
になっている。また、板ばね８６は湾曲駒８７に摺動可
能に係止され、板ばね８６の片方を摺動させることで湾
曲駒８７が湾曲するようになっている。
【００６８】したがって、前記板ばね８６の位置関係を
変えずに（湾曲状態を保ちながら）両板ばね８６を同時
に摺動させ、先端方向に移動することで湾曲したまま開
閉用カム８５がアンビル４またはカートリッジ３を閉じ
ることができる。
【００６９】前記カートリッジ３は挿入部２に対して交
換可能であり、図２９〜図３２に示すようにカートリッ
ジ側継手９０，９１により挿入部２に接続されている。
すなわち、挿入部側継手９２，９３はそれぞれ前記カー
トリッジ側継手９０，９１に対して着脱自在に接続され
ている。挿入部側継手９２，９３はすり割りばね構造
で、閉じるように付勢され、カートリッジ側継手９０，
９１が先端部側から押し込まれることでロックし、挿入
部２に設けた解除ボタン８８を押すことにより、付勢が
はずれ解除される。
【００７０】挿入部側継手９２とカートリッジ側継手９
０を結合することにより、ステープル放出手段として先
端方向に移動し、ステープル２２の放出等の動作を伝達
することができ、この動きの際、コイルワイヤ９４の中
を通るが、挿入部側継手９２のすり割り付きばねはコイ
ルワイヤ９４の中で、軸中心に圧迫されるので、ロック
が解除されない。このような構成によれば、先端部が湾
曲している状態でコイルヤイヤ９５、コイルワイヤ９６
が湾曲しつつステープル放出手段の動きを伝達するので
力の伝達がスムースに行われる。
【００７１】また、本構成によれば、図示しないが、ア
ンビル４およびカートリッジ３が先端部の長手軸を略中
心として回転するような動作の時も同様に力の伝達がス
ムースに行われる。先端部が回転することによって臓器
へのアプローチ性が高くなるので本構成の応用性が高い
事を示すものである。
【００７２】したがって、目的の被縫合部Ａの形状に応
じた湾曲を有するカートリッジ３、アンビル４を用いる
ため、必要最小限の量の切除にとどめることができる。
縫合器の湾曲部分及び直線部分を摺動する各部材が湾曲
に応じて変形可能なため、湾曲部、直線部の双方に対し
て軽い力で摺動が可能である。
【００７３】なお、この発明は金属製のステープルを使
用する縫合器に適用するのに限定されるものではなく、
樹脂製のステープル、例えばＵＳＰ５１５６６１４に示
される生体吸収性樹脂を材質とするファスナー、リテー
ナーを用いる縫合器に適用してもよい。
【００７４】
【発明の効果】以上説明したように、この発明によれ
ば、生体組織を縫合する際に、その被縫合部に対して縫
合部を容易にアプローチでき、操作性が簡単で、安全か
つ確実に縫合できる。
【００７５】したがって、より多くの症例に低侵襲の内
視鏡下手術を適用でき、また腫瘍等を切除する際に不必
要な切除部分を少なく、低侵襲の手術を短時間に行うこ
とができるという効果がある。
【図面の簡単な説明】
【図１】この発明の第１の実施例を示す縫合器の全体の
斜視図。
【図２】同実施例の縫合部の分解斜視図。
【図３】同実施例の縫合部の斜視図。
【図４】同実施例の挿入部の先端部の縦断側面図。
【図５】同実施例の挿入部の先端部の縦断側面図。
【図６】同実施例の挿入部の横断正面図。
【図７】同実施例の縫合部の縦断側面図。
【図８】同実施例の縫合器の使用状態の斜視図。
【図９】この発明の第２の実施例を示す縫合器の全体の
斜視図。
【図１０】同実施例の操作部本体の一部切欠した斜視
図。
【図１１】この発明の第３の実施例を示す縫合部の斜視
図。
【図１２】同実施例のフレキシブル組立体を示す側面
図。
【図１３】図１２の矢印Ｆ方向から見た正面図。
【図１４】図１１のＧ−Ｇ線に沿う断面図。
【図１５】図１１のＨ−Ｈ線に沿う断面図。
【図１６】同実施例の縫合器の使用状態図。
【図１７】同実施例の変形例を示すフレキシブル組立体
の側面図。
【図１８】図１７に示すフレキシブル組立体の平面図。
【図１９】この発明の第４の実施例を示す縫合部の斜視
図。
【図２０】（ａ）は同実施例のプッシャ部材の側面図、
（ｂ）は縫合部の斜視図。
【図２１】この発明の第５の実施例を示す縫合器の側面
図。
【図２２】この発明の第６の実施例を示す縫合器の斜視
図。
【図２３】同実施例の縫合作用説明図。
【図２４】同実施例の縫合作用説明図。
【図２５】同実施例の縫合部の縦断側面図。
【図２６】この発明の第７の実施例を示す縫合器の斜視
図。
【図２７】同実施例の湾曲部の一部切欠した斜視図。
【図２８】この発明の第８の実施例を示す縫合部の斜視
図。
【図２９】同実施例のカートリッジと挿入部の接続構造
を示す斜視図。
【図３０】同実施例のカートリッジと挿入部の接続構造
を示す斜視図。
【図３１】同実施例のコイルワイヤ相互の接続構造を示
す縦断側面図。
【図３２】（ａ）は同実施例のコイルワイヤと操作部と
の接続構造を示す縦断側面図、（ｂ）は（ａ）のＩ−Ｉ
線に沿う断面図。
【図３３】（ａ）（ｂ）従来の縫合器の作用説明図。
【図３４】従来の縫合器の作用説明図。
【符号の説明】
１…操作部 ２…挿入部 ３…カートリッジ ４…アンビル ５…縫合部 ２２…ステープル。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 鶴田 稔 東京都渋谷区幡ヶ谷２丁目43番２号 オリ ンパス光学工業株式会社内 (72)発明者 塚越 壯 東京都渋谷区幡ヶ谷２丁目43番２号 オリ ンパス光学工業株式会社内 (72)発明者 中田 明雄 東京都渋谷区幡ヶ谷２丁目43番２号 オリ ンパス光学工業株式会社内 (72)発明者 鈴田 敏彦 東京都渋谷区幡ヶ谷２丁目43番２号 オリ ンパス光学工業株式会社内

Claims (2)

    【特許請求の範囲】
  1. 【請求項１】 操作部と、この操作部に接続された挿入
    部と、この挿入部の先端部に設けられ複数のステープル
    を収納する第１の挟持部材およびこの第１の挟持部材に
    対向する第２の挟持部材とからなる縫合部と、前記ステ
    ープルを組織へ打出し留置させるステープル放出手段と
    を具備した縫合器において、 ステープル放出手段の少なくとも一部は、前記挿入部ま
    たは縫合部の形状に追従して変形可能に可撓性を有する
    ことを特徴とする縫合器。
  2. 【請求項２】 操作部と、この操作部に接続された挿入
    部と、この挿入部の先端部に設けられ複数のステープル
    を収納する第１の挟持部材およびこの第１の挟持部材に
    対向する第２の挟持部材とからなる縫合部と、前記ステ
    ープルを組織へ打出し留置させるステープル放出手段と
    を具備した縫合器において、 前記挿入部または縫合部の少なくとも一方には湾曲部が
    形成され、前記ステープル放出手段の少なくとも一部
    は、前記湾曲部の形状に追従して変形可能に可撓性を有
    することを特徴とする縫合器。
JP5117190A 1992-05-19 1993-05-19 縫合器 Withdrawn JPH0630945A (ja)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP5117190A JPH0630945A (ja) 1992-05-19 1993-05-19 縫合器

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
JP4-126246 1992-05-19
JP12624692 1992-05-19
JP5117190A JPH0630945A (ja) 1992-05-19 1993-05-19 縫合器

Publications (1)

Publication Number Publication Date
JPH0630945A true JPH0630945A (ja) 1994-02-08

Family

ID=26455356

Family Applications (1)

Application Number Title Priority Date Filing Date
JP5117190A Withdrawn JPH0630945A (ja) 1992-05-19 1993-05-19 縫合器

Country Status (1)

Country Link
JP (1) JPH0630945A (ja)

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