JPH07171158A - Suturing device - Google Patents

Abstract

PURPOSE:To provide a suturing device which can safely guide a suturing needle having a curved form to an affected part without damaging the tissues other than the affected part and the trocar outer tube, and is enhanced in handling property and inserting property of the suturing needle. CONSTITUTION:A suturing device 30 has a suturing needle 3 having a curved form at least a part of which is formed from a super elastic alloy, a guide sheath 31 capable of housing the suturing needle 3 in such a manner as to be protruded and recessed by deforming the curved form of the super elastic alloy part of the suturing needle 3, and guiding the suturing needle 3 to the affected part tissue to be sutured, and a means 32 for protruding and recessing the suturing needle 3 to the guide sheath 31.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suturing device provided with a suture needle for suturing an affected tissue.

[0002]

2. Description of the Related Art Conventionally, for suturing an affected tissue in an endoscopic surgery, for example, a trocar outer tube is introduced into a body cavity through a hole formed in a living body wall, and the trocar outer tube is also inserted. Introduce the suture needle into the body cavity through the inner hole,
This is performed by sewing a suture thread onto the affected tissue while grasping the introduced suture needle with a treatment tool such as grasping forceps.

Thus, when the suture needle is introduced into the body cavity through the inner hole of the trocar outer tube, the size of the suture needle is generally limited to the inner diameter of the trocar outer tube. That is, if the trocar outer tube has a very small inner diameter of 10 mm or 11 mm, as a result, the suture needle is also formed to be small according to the inner diameter of the trocar outer tube.

However, when the suture needle is a bent needle bent in a hook shape, the bent needle is 10 mm or 11 mm.
If the small curved needle is formed so as to be inserted into the trocar outer tube having a very small inner diameter, the small curved needle cannot be properly grasped by the grasping forceps or the like, and the suturing work becomes very difficult.

Therefore, in order to easily insert such a bent suture needle into the trocar outer tube having a small diameter and to easily perform the suturing work, US Pat. No. 5,219,358 discloses: The suture needle is formed of a shape memory alloy so that the shape of the suture needle can be changed at the time of insertion into the trocar outer tube and after it is led out of the trocar outer tube. That is, this suture needle formed of a shape memory alloy is held in a straight shape when it is inserted into the trocar outer tube,
After being drawn out from the trocar outer tube, the bent shape is restored. With this configuration, when the suture needle is inserted into the trocar outer tube, the suture needle has a straight shape, so that the suture needle can be easily inserted into the trocar outer tube, and at the same time, after the suture needle is drawn out from the trocar, the suture is sutured. Since the needle can be restored to a shape or size that can be easily handled, suturing work becomes easy.

[0006]

By the way, in the conventional case including US Pat. No. 5,219,358, the suturing needle is directly inserted into the inner hole of the trocar outer tubular tube by itself, and the trocar is used. After being led out from the outer tube, the body cavity is pushed toward the affected area. When the suture needle is introduced toward the affected part in the body cavity by such a method, the suture needle is
Once pulled out from the trocar outer tube, the sharp part of the needle tip is always exposed in the body cavity, so the exposed sharp tip of the suture needle may be used in the process of reaching the affected area. Tissues other than the affected area may be damaged.

Further, when the suture needle is taken out from the body cavity through the trocar outer tube, the sharp tip of the suture needle is caught on, for example, the valve mechanism of the trocar outer tube. There is a risk of damage.

The present invention has been made in view of the above circumstances, and an object thereof is to safely apply a suture needle having a bent shape to an affected area without damaging a tissue other than the affected area or a trocar outer tube. Another object of the present invention is to provide a suturing device that can be guided with the above-described characteristics and that is easy to handle and insert.

[0009]

In order to solve the above-mentioned problems, the suturing device of the present invention has a suture needle having a bent shape, at least a part of which is formed of a superelastic alloy, and a superelasticity of the suture needle. A guide sheath capable of deforming the bent shape of the alloy part so that the suturing needle can be retracted and retracted and guiding the suture needle to the affected tissue to be sutured; and means for projecting and retracting the suture needle with respect to the guide sheath It is equipped with.

[0010]

With the above structure, the suture needle can be guided to the affected tissue while being housed in the guide sheath. Also,
Since the suture needle is made of a superelastic alloy, when the suture needle is housed in the guide sheath, the suture needle is easily elastically deformed into an elongated shape along the inner surface of the guide sheath.

[0011]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 4 show a first embodiment of the present invention. As shown in FIG. 1, the suturing device 1 of this embodiment
Is composed of a suture device body 10 having a suture needle 3 for suturing an affected tissue, and a guide sheath 6 which is inserted through the suture device body 10 so as to be capable of advancing and retracting.

The suturing device body 10 includes a rod 2 and a rod 2.
The suture needle 3 has a bent shape and is fixed to the distal end of the rod 2, and the operating portion 5 provided at the proximal end of the rod 2. Of these, the suture needle 3 is made of a superelastic alloy and has a curved shape in a plane perpendicular to the axial direction of the guide sheath 6 as shown in FIG. In addition, a threading hole 4 for passing a suture thread is provided at the needle tip portion of the suture needle 3.

On the other hand, the main body 10 of the suturing device is attached to the guide sheath 6.
An insertion hole 6a is provided to insert the insertion hole 6a so as to freely move back and forth. Further, the guide sheath 6 has a distal end opening 6b, and the suture needle 3
The tip side portion of the suturing device body 10 including the above can be projected and retracted from the tip opening 6b.

Next, a case of suturing an affected tissue in a body cavity using the suturing device 1 having the above-described configuration will be described with reference to FIGS. 3 and 4. In order to perform the suturing operation in the body cavity, first, the suturing device 1 must be introduced into the body cavity. Therefore, for example, the trocar outer tube is introduced into the body cavity through the hole formed in the living body wall, and the suture instrument 1 is introduced into the body cavity through the inner hole of the trocar outer tube.
In this case, the suturing device body 10 is inserted into the insertion hole 6a of the guide sheath 6 while the suture thread 7 is passed through the thread passing hole 4 of the suture needle 3 and the operating portion 5 of the suture device body 10 is grasped. The suture needle 3 is completely accommodated in the insertion hole 6a of the guide sheath 6 by pulling the suturing device body 10 toward the hand side. Then, in this state, the suture instrument 1 is inserted into the inner hole of the trocar outer tube from the tip opening 6b side of the guide sheath 6.

By the way, when the suture needle 3 made of a superelastic alloy is housed in the insertion hole 6a of the guide sheath 6, the suture needle 3 has an elongated shape along the inner surface of the guide sheath 6 as shown in FIG. Easily elastically deforms. Therefore, even when the guide sheath 6 having a small outer diameter is used because the inner diameter of the trocar outer tube is very small, the suture needle 3 is easily elastically deformed, and the thin guide sheath 6 is used. 6 is easily accommodated in the insertion hole 6a.

[0016] The suture instrument 1 inserted through the outer tube of the trocar
While being guided by the inner hole of the trocar outer tubular tube, is guided out from the inside opening of the body cavity inner side of the trocar outer tubular tube and introduced into the body cavity. The suturing device 1 introduced into the body cavity has the suturing needle 3
While being accommodated in the guide sheath 6, it is pushed toward the affected tissue 12 to be sutured. That is, during this period, the suture device body 10 is guided to the affected tissue 12 while being surrounded by the guide sheath 6.

When the distal end of the suturing device 1, that is, the distal end of the guide sheath 6 reaches near the site of the affected tissue 12, the operating portion 5
The rod 2 is pushed forward in a state where the needle is grasped, and the suture needle 3 is projected from the distal end opening 6b of the guide sheath 6.
At this time, the projecting suture needle 3 elastically restores its original bent shape because the force from the inner surface of the guide sheath 6 is released. After the suture needle 3 is restored to the bent shape, the suture thread 7 is sewn to the diseased tissue 12 while observing the suture needle 3 with the grasping forceps 8 under endoscopic observation.

This sewing work is first performed by (a) of FIG.
As shown in FIG. 5, the suture needle 3 is passed through the suture thread 7 and pierced from one side of the affected tissue 12 to be sutured and projected from the other side. At this time, one end of the suture thread 7 passed through the thread passing hole 4 of the suture needle 3 is present on one side of the affected tissue 12, and the other end of the suture thread 7 is the other end of the affected tissue 12 together with the tip of the suture needle 3. Since it is in a state of protruding to the side, when the suturing needle 3 is rotated in the direction of detaching from the diseased tissue 12 while the other end side of the suture thread 7 is grasped by the grasping forceps 8 as shown in FIG. 4B, The suture needle 3 can be removed from the tissue while the suture thread 7 is passed through the affected tissue 12. In this state, this time, the suture thread 7 passed through the affected tissue 12 is tied by a treatment tool such as grasping forceps to ligate the affected tissue 12.

As described above, the suturing device 1 of this embodiment
Can guide the suture needle 3 to the diseased tissue 12 with the suture needle 3 accommodated in the guide sheath 6, and thus can prevent the trocar outer tube for guiding the suturing device 1 into the body cavity from being damaged by the suture needle 3. At the same time, it is possible to prevent the normal tissue other than the diseased tissue from being damaged by the suture needle 3 even after it is led out from the trocar outer tube and reaches the affected tissue. That is, the suture needle 3 having a bent shape can be safely guided to the affected tissue 12.

Since the suture needle 3 is made of a superelastic alloy, the suture needle 3 is inserted through the insertion hole 6 of the guide sheath 6.
When stored in a, the suture needle 3 is easily elastically deformed into an elongated shape along the inner surface of the guide sheath 6. Therefore, even when the guide sheath 6 having a small outer diameter is used because the inner diameter of the trocar outer tube is very small, the suture needle 3 is easily elastically deformed, and the thin guide sheath 6 is used. 6 is easily accommodated in the insertion hole 6a. In other words, it is possible to easily insert the bent suture needle 3 into the thin guide sheath 6 and thus the trocar outer tube, which has been difficult to insert into the thin trocar outer tube in the past. After being pulled out from the sheath 6, the suturing needle 3 is restored to the original shape or size that is easy to handle, so that the suturing operation becomes easy.

Next, an example in which only the suture needle made of a superelastic alloy is inserted into the guide sheath 6 and introduced into the body cavity will be described with reference to FIGS. 5 to 9. The suture needle 3a shown in FIG. 5 is a curved needle made of a superelastic alloy that is bent into a curved shape, and the suture thread 7 is attached to its rear end. As shown in FIG. 6, the suture needle 3a has a suture thread 7 projecting outward from a distal end opening portion 6b of the guide sheath 6 and an insertion hole 6a of the guide sheath 6 in a state where its bent shape is elastically extended. It is housed inside and is guided into the body cavity by the guide sheath 6.

The guide sheath 6 containing the suture needle 3a is
As shown in FIG. 7, the hole 14 is formed in the living body wall 14.
It is guided into the body cavity through the inner hole of the trocar outer tube 15 introduced into the body cavity through a.

When the guide sheath 6 is introduced into the body cavity through the trocar outer tubular tube 15 and the tip of the guide sheath 6 reaches the vicinity of the site of the affected tissue 12, this time, it projects from the tip of the guide sheath 6. The suture 7 is taken out of the guide sheath 6 by sandwiching the suture 7 with gripping forceps and pulling it. Suture needle 3 taken out from inside of guide sheath 6
The a is sandwiched by the needle holders 16. Usually, the curved suture needle 3a is sandwiched perpendicularly to the axial needle direction of the needle holder 6. Therefore, when the suturing needle 3a is formed of a normal metal having no superelasticity, the suturing needle 3a is sandwiched as shown in FIG. 8 (a). In such a state, the suturing needle 3a rotates and slips when gripping, so that it cannot be gripped well. A certain degree of skill is required to surely grip. However, since the suturing needle 3a of this embodiment is made of a superelastic alloy, when it is sandwiched by the needle holders 6, it is deformed by the gripping force of the needle holders 6 as shown in FIG. 8B. Therefore, the grip performance is very good.

The suture needle 3a sandwiched by the needle holders 6 is
As shown in FIG. 9, by operating the needle holder 6, the affected tissue 1
2 is penetrated from one side to the other side. As a result, the suture thread 7 at the rear end of the suture needle 3a is passed from one side of the diseased tissue 12 to the other side and sewn to the diseased tissue 12 in this manner. Since the needle 3a can be accommodated in the guide sheath 6 while being elastically deformed into the elongated shape, the guide sheath 6 having a small outer diameter is used because the inner diameter of the trocar outer tube is very small. Suture needle 3
Is easily elastically deformed and easily accommodated in the insertion hole 6a of the thin guide sheath 6. That is, it is possible to easily insert the bending-shaped suture needle 3a, which has been difficult to be inserted into the small diameter trocar outer tube into the guide sheath 6 of the small diameter and thus the trocar outer tube, in the past. After being pulled out from the sheath 6, the suturing needle 3a is restored to the original shape or size that is easy to handle, so that the suturing operation becomes easy. Further, when the suture needle 3a is sandwiched by the needle holders 6, it can be easily deformed by the gripping force of the needle holders 6, so that the gripping performance becomes very good.

In order to facilitate taking out the suture needle from the guide sheath 6, the suture needle may be formed into a shape as shown in FIG. That is, the suture needle 3b is
It is composed of a curved portion 19 on the distal end side and a linear portion 20 on the proximal end side, and the suture thread 7 is attached to the base side of the linear portion 10.

When the suture needle 3b having this structure is arranged in the insertion hole 6a of the guide sheath 6, the linear portion 10 is projected from the tip opening 6a of the guide sheath 11 to the outside. In this state, the guide sheath 6 is inserted into the body cavity, and the straight portion 10 protruding from the distal end opening 6b of the guide sheath 6 is inserted.
The suture needle 3b by pulling it out by sandwiching it with grasping forceps or the like.
Take out.

11 to 14 show a second embodiment of the present invention. As shown in FIG. 11, the suturing device 30 of the present embodiment includes a suturing device body 39 including a suture needle 3 for suturing an affected tissue and a tubular connecting rod 34, and the suturing device body 39 in the insertion hole 31a. The guide sheath 31 is slidable with respect to the main body 39 of the inserted suture instrument, and the guide sheath slide mechanism 32 and the proximal portion 33 are provided on the proximal end side of the guide sheath 31, and the guide sheath slide mechanism is described later. When the guide sheath 31 is slid back and forth by 32, the distal end side portion of the suturing device body 39 including the suture needle 3 is projected and retracted from the distal end opening 31b of the guide sheath 31.

The suture needle 3 is made of a superelastic Ni--Ti alloy and has the same bent shape as that of the first embodiment. The suture needle 3 is connected to the connecting rod 3
4 is detachably fixed to a needle fixing portion 35 provided at the tip of the nozzle 4.

Next, the guide sheath slide mechanism 32
The configuration will be described with reference to FIGS. 13 and 14. The guide sheath slide mechanism 32 includes a rotating ring 41, a cam ring 41, and a cam ring 41 as shown in the drawing.
The cam groove 50 formed in the above, a series of members such as a cam pin 42 fixed to the annular member 60 and engaged with the cam groove 50, and the like.

That is, the hand portion 33 is a large-diameter grip portion 33.
a and a slide mechanism mounting portion 33b having a small diameter, the proximal end portions of the guide sheath 31 and the connecting rod 34 are inserted into the inner holes of the slide mechanism mounting portion 33b, and the base end of the connecting rod 34 is a grip portion. It is inserted and fixed in the blind hole 48 of 33a. An annular member 60 is attached to the proximal end of the guide sheath 31, and the annular member 60 is fitted on the outer periphery of the proximal end portion of the connecting rod 34 so as to be rotatable and movable back and forth.

Further, a cam ring 41 and a rotary ring 40 are successively fitted on the outer periphery of the slide mechanism mounting portion 33b. The cam ring 41 and the rotating ring 40 have a pin 63 (see FIG. 14) on the outer periphery of the tip of the slide mechanism mounting portion 33b.
It is held between the ring-shaped holding member 55 fixed and attached by the gripping portion 33a, and is connected to each other by the connecting pin 62 so that it can rotate integrally with the hand portion 33. The connecting pin 62
Is the pin mounting hole 7 of the rotary ring 40 and the cam ring 41.
2, 71, and the pin 63 is attached to the slide mechanism mounting portion 33b and the mounting holes 76 and 75 of the holding member 55.

The cam ring 41 has a substantially spiral cam groove 50. An annular member 60 is provided in the cam groove 50.
The cam pin 42 fixed to the mounting hole 73 and protruding in the radial direction from the slit 49 of the slide mechanism mounting portion 33b is engaged. Further, the annular member 60 is fitted into the outer periphery of the base end portion of the connecting rod 34, and the blind hole 48 of the grip portion 33a is provided.
A compression spring 43 disposed inside constantly urges the compression spring 43 toward the tip side.

Therefore, the suture needle 3 is attached to the guide sheath 31.
The cam ring 4 is rotated by rotating the rotary ring 40 from the basic position shown in FIG.
When 1 is rotated, the cam pin 42 fixed to the annular member 60 is guided by the cam groove 50 and the slit 49.
Along with the annular member 60.
The guide sheath 31, which is integral with, is pushed forward by the urging force of the compression spring 43. As a result, the suture needle 3 is housed in the guide sheath 31. When the rotating ring 40 is rotated in the opposite direction, the guide sheath 31 slides backward, and the suture needle 3 again projects from the distal end opening 31b of the guide sheath 31.

In such a structure, the suturing needle 30 is housed in the guide sheath 31 by rotating the rotating ring 40 from the basic position shown in FIG. Guide sheath 3
When the distal end opening 31b of No. 1 is brought close to the diseased tissue to be sutured, the rotating ring 40 is reversely rotated to cause the suturing needle 3 to protrude from the distal end opening 31b of the guide sheath 31, and the suturing operation is started.

Also in the case of this embodiment, as in the first embodiment,
When the suture needle 3 formed of a superelastic alloy is housed in the insertion hole 31 a of the guide sheath 31, the suture needle 3 is easily elastically deformed into an elongated shape along the inner surface of the guide sheath 31. Therefore, even when the guide sheath 31 having a small outer diameter is used because the inner diameter of the trocar outer tube is very small, the suture needle 3 is easily elastically deformed and the thin guide sheath is used. It is easily accommodated in the insertion hole 31a of the hole 31.

As described above, the suturing device 3 of this embodiment
0 can guide the suture needle 3 to the affected tissue in a state where the suture needle 3 is housed in the guide sheath 31, so that it is possible to prevent the trocar outer tube for guiding the suturing device 30 into the body cavity from being damaged by the suture needle 3. At the same time, it is possible to prevent the normal tissue other than the diseased tissue from being damaged by the suture needle 3 even after it is led out from the trocar outer tube and reaches the affected tissue. That is, the suture needle 3 having a bent shape can be safely guided to the affected tissue.

Further, since the suture needle 3 is made of a superelastic alloy, when the suture needle 3 is housed in the insertion hole 31a of the guide sheath 31, the suture needle 3 can easily be extended along the inner surface of the guide sheath 31. Elastically deforms. Therefore, even when the guide sheath 31 having a small outer diameter is used because the inner diameter of the trocar outer tube is very small, the suture needle 3 is easily elastically deformed and the thin guide sheath is used. It is easily accommodated in the insertion hole 31a of the hole 31. In other words, it is possible to easily insert the bent suture needle 3 into the thin guide sheath 6 and thus the trocar outer tube, which has been difficult to insert into the thin trocar outer tube in the past. After being pulled out from the sheath 6, the suturing needle 3 is restored to the original shape or size that is easy to handle, so that the suturing operation becomes easy.

FIG. 15 shows a third embodiment of the present invention. The suturing device 80 of the present embodiment has an insertion portion 94 and an operating portion 9.
It consists of 6 and 6. The insertion portion 94 includes a suture instrument body 91 having a suture needle 85 formed of a superelastic alloy at its tip, and a hard guide sheath 81 that is inserted into the suture instrument body 91 and slidable with respect to the suture instrument body 91. Become.

The main body 91 of the suturing device is made of heat-treated Ni-T.
A bending sheath 82 that is formed of a superelastic alloy such as i and holds a curved shape in a state where no force is applied, a coil sheath 83 that is arranged over the entire length of the bending sheath 82, and can move back and forth in the coil sheath 83. A long connecting member 86 rotatably inserted, a needle fixing portion 84 provided at the tip of the connecting member 86, and a needle fixing portion 8
4 and a suture needle 85 that is detachably fixed.

The guide sheath 81 is connected to a guide sheath slide mechanism constructed in the same manner as in the second embodiment, and the suturing device main body 91 is associated with the rotation operation of the rotary ring 40.
The suturing device body 9 including the suturing needle 85 slid with respect to
The distal end side portion of No. 1 can be projected and retracted from the distal end opening of the guide sheath 81.

On the other hand, the operating portion 96 has an operating portion main body 99, and a rotary lever 89 for rotating the needle fixing portion 84 is attached to the operating portion main body 99 via a connecting member 86.
Further, the operation portion main body 99 is provided with an advancing / retreating operation ring 88 for advancing / retreating the connecting member 86, and by rotating the advancing / retreating operation ring 88, the connecting member 86 is slid back and forth, so that the suturing needle 85 is attached. The coil sheath 83 can be made to project and retract from the opening at the distal end.

In the above structure, when the rotating ring 40 is operated to slide the guide sheath 81 forward, the curved sheath 82 is housed in the guide sheath 81 and the curved shape thereof is forced to be a substantially straight shape. Is transformed into. When the rotating ring 40 is rotated in the reverse direction, the curved sheath 82 projects from the distal end opening of the guide sheath 81,
The force from the guide sheath 81 is released, and the original curved shape is restored.

Therefore, in the case of the suturing device 80 of this embodiment, the advancing / retreating operation ring 88 is rotated to accommodate the suture needle 85 in the coil sheath 83, and the rotating ring 40 is operated to move the curved sheath 82 into the guide sheath 81. When the insertion portion 94 is introduced into the body cavity and the distal end opening portion of the guide sheath 81 is brought close to the diseased tissue to be sutured, the rotating ring 40 is rotated in the reverse direction so that the curved sheath 82 is accommodated. A desired amount is projected from the distal end of the guide sheath 81, and the advancing / retreating operation ring 88 is reversely rotated to project the suture needle 85 from the distal end of the coil sheath 83 to start the suturing operation. As in the second embodiment, the suture needle 85 made of a superelastic alloy is easily elastically deformed into an elongated shape along the inner surface of the coil sheath 83 when it is accommodated in the coil sheath 83. Further, when the suturing operation is performed, by closing the rotating lever 89 to rotate the suturing needle 85 via the needle fixing portion 84, the tip of the suturing needle 85 is punctured into the tissue.

As described above, the suturing device 80 of this embodiment has the same effects as those of the second embodiment, but the amount of protrusion of the bending sheath 82 protruding from the distal end of the guide sheath 81 can be adjusted. Since the direction of the suturing needle 85 can be freely changed and the suturing needle 85 can be rotated, the suturing needle 85 can always be pierced perpendicularly to the suture line, and good suturing work can be performed. It also has the excellent effect of being able to.

Although the suturing needle of each of the above-described embodiments is entirely formed of a superelastic alloy, if it can be easily accommodated in the guide sheath, only a part of the superelastic alloy is used. You may form by.

By the way, the superelastic alloy described so far can be applied not only to the above-mentioned treatment tools such as the suturing device but also to various medical treatment tools, thereby ensuring safety to the living body. Can be planned. Hereinafter, a case where the superelastic alloy is applied to a repulsion device which is a medical treatment tool will be described.

The expulsion member 100 shown in FIG. 16 has a first operating portion 101 and a second operating portion 102 located on the hand side, a pipe 111 connected and fixed to the first operating portion 101, and the inside of this pipe 111. And a pair of organ holders 116, 116 provided at the distal end of the shaft 112. The shaft 112 is inserted into the first and second operation units 101 and 102 so that its proximal side is connected and fixed to the first operation unit 101 and the second operation unit 102. It consists of and. Axis 1
A groove-shaped accommodating portion 115 capable of accommodating the organ holding portions 116, 116 is provided at the tip of the accommodating portion 12.
The proximal side of each organ holding portion 116 is fixed to 15 by brazing or the like. Organ holding parts 116, 116
Is made of a superelastic alloy and is constantly urged in a direction of widening outward.

In this structure, the second operation section 102 is set to the first
16B, the shaft 112 is housed in the pipe 111, and the organ holders 116, 116 are forcibly housed in the housing 115.
Housed inside. On the contrary, when the second operation unit 102 is pushed toward the distal end side with respect to the first operation unit 101, FIG.
As shown in (a) of FIG. 7, the organ holding parts 116, 116 spread out from the storage part 115 in a fan shape.

Therefore, first, the second operating portion 102 is pulled toward the hand side with respect to the first operating portion 101, and the shaft 11
In the state where 2 is accommodated in the pipe 111, the expulsor 100 is inserted into the body cavity using the trocar outer tube as a guide, and then the second operation portion 102 is pushed toward the distal end side with respect to the first operation portion 101. When the shaft 112 is projected from the tip of the pipe 111, the organ holding parts 116, 116 fan out outward from the storage part 115, and the organ holding parts 116, 116 and the shaft 112 cause the intestinal tract located around the affected area. The organs such as the liver, the uterus, etc. are pushed away, and the field of view of the affected area is secured.

Conventionally, the organ holders 116, 116 were formed of a general metal such as stainless steel, so that the opening angle could not be ensured beyond the elastic limit. However, according to this configuration, the organ holders 116, 116 are provided. Is made of a super elastic alloy, the elastic deformation limit of the organ holding portions 116, 116 becomes large, and a larger opening angle can be secured as compared with the conventional case. Since the organ holders 116, 116 can be urged to open further outward than ever,
The internal organs such as the intestinal tract and the liver are easily pushed away, and the visual field of the affected area is easily secured.

Expulsor 120 shown in FIGS. 17-19.
Is a first operating portion 121 and a second operating portion 123 located on the hand side, a pipe 124 inserted into the first operating portion 121 and fixed by a set screw 128, the pipe 124 and the first operating portion 121. It has a shaft 140 which is inserted through the inside of the operation portion 121 and is connected and fixed to the second operation portion 123.

The proximal ends of the pair of first organ holding parts 129, 129 are rotatably connected to the tip of the pipe 124 via a pin 125, and the pair of second organs is connected to the tip of the shaft 140. The distal ends of the organ holders 130, 130 are rotatably connected via pins 132, and the organ holders 129, 12
9 and the organ holders 130, 130 are rotatably connected via a pin 131. That is, the first organ holders 129 and 129 and the second organ holders 130 and 130 are
The link mechanism is configured as a whole.

A pin slide groove 145 is formed on the tip side of the shaft 140, and the pin slide groove 145 is formed.
The pin 125 can be slid along. Here, the organ holders 129, 129 and the organ holder 1
30 and 130 are made of a superelastic alloy.

When the gripping portion 122 is gripped from the closed state shown in FIG. 17 and the first operating portion 121 is moved in the distal direction with respect to the second operating portion 123, the organ displacement holding portion 129 is constructed. , 130 opens as shown in FIG.
Since it spreads in the shape as shown in FIG. 9, it is possible to push away the internal organs of the body cavity and secure the visual field.

Further, the repulsion device 120 is composed of the organ holder 12
Since 9,130 is made of superelastic alloy,
Even if a strong force is applied when the organ holding parts 129, 130 are pushed away from the body cavity, elastic deformation tends to occur more easily than conventional general metal, so it is difficult to apply excessive force to the organ, and there is less risk of damaging the organ. Has the effect of becoming. If the tip of the shaft 140 is also made of a superelastic alloy, the above effect is further enhanced.

The expulsion member 150 shown in FIG.
1, a pipe 152 connected to the operating portion 151, a shaft 154 inserted through the operating portion 151 and the pipe 152 so as to be able to move forward and backward, and a loop-shaped excluding portion 158 fixed to the tip of the shaft 154. Have

The excluding portion 158 includes a tip side portion formed by expanding a plurality of thin pipe-shaped members made of a superelastic alloy in a large loop shape, and the end portions of the plurality of pipe-shaped members at once. And a proximal end portion formed in a bundled state, and the proximal end portion is fixed to the tip of the shaft 154.

Further, when the shaft 154 moves forward and backward, a plurality of locking grooves 157 provided on the shaft 154 and the locking member 1 provided on the operating portion 151 in a state of being engageable with the locking grooves 157.
It is controlled by a ratchet mechanism constituted by 56 and. The shaft 154 is a biasing member 155 fixed to a connecting member 153 provided at the base end of the shaft 154 and an operating portion 151.
Is always urged toward the hand side. Therefore, when the ratchet mechanism is released, the biasing member 155
The shaft 154 moves toward the hand side with respect to the pipe 152 by the urging force of.

When inserting the excluding member 150 having the above-mentioned configuration into the body cavity, the ratchet mechanism is released, the shaft 154 is pulled to the full side by the urging force of the urging member 155, and the excluding portion 158 is inserted into the pipe 152. To house. After that, in the body cavity, the shaft 154 is moved toward the distal end side with respect to the pipe 152, and the excluding portion 158 is projected to the outside of the pipe 152. The excluding portion 158 protruding to the outside of the pipe 152 spreads in a loop shape and pushes away the internal organs in the body cavity to secure a visual field around the affected area. This state is maintained by the engagement between the engagement groove 157 and the engagement member 156 in the ratchet mechanism.

As described above, if the excluding portion 158 is formed of a superelastic alloy in a loop shape, the loop can be formed in a large size, and the efficiency of securing a visual field is improved. In addition, the looped shape prevents the internal organs in the body cavity from being crushed and damaged, thus improving safety.

[0061]

As described above, the suture instrument of the present invention can guide the suture instrument into the body cavity because the suture needle can be guided to the affected tissue while the suture needle is accommodated in the guide sheath. Can be prevented from being injured by the suture needle, and it is also possible to prevent normal tissue other than the diseased tissue from being injured by the suture needle even after it is led out of the trocar outer tube and reaches the affected tissue. it can. That is, the suture needle having a bent shape can be safely guided to the affected tissue.

Further, since the suture needle is made of a super elastic alloy, when the suture needle is housed in the guide sheath,
The suture needle easily elastically deforms into an elongated shape along the inner surface of the guide sheath. Therefore, even when a guide sheath with a small outer diameter is used because the inner diameter of the trocar outer tube is very small, the suture needle is easily elastically deformed to be contained in this thin guide sheath. Easily accommodated. In other words, it is possible to easily insert a bending-shaped suture needle into the thin guide sheath and thus into the trocar outer tubular tube, which has been difficult to insert into the thin trocar outer tubular tube in the past. After being drawn out, the suturing needle is restored to the original shape or size that is easy to handle, so that the suturing operation becomes easy.

[Brief description of drawings]

FIG. 1 is a perspective view of a suturing device according to a first embodiment of the present invention.

2A is a front view of the main body of the suturing device shown in FIG. 1, and FIG. 2B is a side view of the main body of the suturing device shown in FIG.

FIG. 3 is a side sectional view showing a state in which the main body of the suturing device is housed in the guide sheath in the suturing device of FIG.

FIG. 4 is a schematic view showing a state where the affected tissue is sutured using the suturing device of FIG.

FIG. 5 is a schematic view of a suture needle formed of a superelastic alloy.

6 is a cross-sectional view showing a state in which the suture needle of FIG. 5 is deformed and accommodated in a guide sheath.

7 is a schematic cross-sectional view showing how the guide sheath with the suture needle of FIG. 5 accommodated therein is introduced into a body cavity through a trocar.

FIG. 8 (a) is a front view showing a state in which a suture needle made of a normal metal is grasped by a needle device, and FIG. 8 (b) is a suture needle made of a superelastic alloy grasped by a needle device. It is a front view which shows a state.

FIG. 9 is a diagram showing a state in which a suturing operation is performed while holding the suture needle of FIG. 5 with a needle device.

FIG. 10 is an explanatory view showing another mode in which the suture needle is housed and arranged in the guide sheath.

FIG. 11 is a perspective view showing the suturing device according to the second embodiment of the present invention and showing a state in which the suture needle is projected from the guide sheath.

FIG. 12 is a perspective view showing a state in which a suture needle is housed in a guide sheath in the suturing device of FIG. 11.

FIG. 13 is a side sectional view of a proximal portion of the suturing device of FIG.

FIG. 14 is an exploded view of the suturing device of FIG.

FIG. 15 is a view showing the suturing device of the third embodiment of the present invention and showing the state in which the suture needle is projected from the guide sheath.

FIG. 16 is a cross-sectional view showing a first configuration example of an expulsion element.

FIG. 17 is a side view showing a second configuration example of the displacement device and showing a state in which the organ holding portion at the tip is closed.

FIG. 18 is a side view showing a state in which the organ holding portion of the expulsor of FIG. 17 is being expanded.

FIG. 19 is a side view showing the final state of the expansion operation of the organ holder in the expulsor of FIG.

FIG. 20 is a cross-sectional view showing a third configuration example of the expulsion element.

[Explanation of Codes] 1,30,80 ... Suturing device, 3,3a, 3b, 85 ... Suture needle, 6,31, 81 ... Guide sheath, 32 ... Guide sheath slide mechanism.

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[Procedure amendment]

[Submission date] April 7, 1994

[Procedure Amendment 1]

[Document name to be amended] Statement

[Name of item to be corrected] 0029

[Correction method] Change

[Correction content]

Next, the guide sheath slide mechanism 32
The configuration will be described with reference to FIGS. 13 and 14. The guide sheath slide mechanism 32 includes a rotary ring 40 , a cam ring 41, and a cam ring 41 as shown in the drawing.
The cam groove 50 formed in the above, a series of members such as a cam pin 42 fixed to the annular member 60 and engaged with the cam groove 50, and the like.

[Procedure Amendment 2]

[Document name to be amended] Statement

[Correction target item name] 0034

[Correction method] Change

[Correction content]

In such a structure, the suturing needle 30 is housed in the guide sheath 31 by rotating the rotating ring 40 from the basic position shown in FIG. Guide sheath 3
When the distal end opening 31b of No. 1 is brought close to the diseased tissue to be sutured, the rotating ring 40 is reversely rotated so that the suturing needle 3 is projected from the distal end opening 31b of the guide sheath 31.
Similar to the embodiment of the above, the threading hole 4 (not shown) at the tip of the needle
With the thread passed through, start the sewing operation.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Kiyotoshi Sakashita 2-43-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Inventor Tsukakoshi 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Tsugio Okazaki 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Hideyuki Adachi 2-43 Hatagaya, Shibuya-ku, Tokyo No. 2 Olympus Optical Co., Ltd. (72) Inventor Kazuhiko Ozeki 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. 2 Olympus Optical Co., Ltd. (72) Inventor Shinichi Omori 2-43 Hatagaya, Shibuya-ku, Tokyo No. 2 Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A suture needle having a bent shape, at least a portion of which is formed of a superelastic alloy, and a bent shape of a superelastic alloy portion of the suture needle is deformed to allow the suture needle to be retractably housed. A suture instrument comprising: a guide sheath capable of guiding a suture needle to a diseased tissue to be sutured; and means for projecting and retracting the suture needle with respect to the guide sheath.