JPH08154941A - Knot forming instrument - Google Patents

Abstract

PURPOSE: To enable suturing and ligating without requiring so much time and labor within an abdoominal cavity by forming a slit with a width enough to allow the passing of a suture at a bent part of a hollow pipe through which the suture is inserted having the bent part formed at the tip part of an upright part. CONSTITUTION: A knot forming apparatus has a hollow pipe 10 through which a suture S is inserted and an operating part 20 to turn the hollow pipe 10 and the hollow pipe 10 comprises an upright part 1 with a specified length and a bent part 12 formed at the tip part of the upright part 11 to be formed in a shape of J as a whole. A suture trapping part 12a having a slit with the width thereof enough to allow the passing of the suture S at the tip thereof is formed at the bent part 12 and a broad part 12b is formed with a broad slit enough to facilitate the coming off of the suture S to the tip part of the upright part 11 from the suture trapping par 12a. This enables suturing and ligating under an endoscope within an abdominal cavity without requiring time and labor for pulling the suture S out of a trocar, thereby allowing the carrying out of work of suturing or ligating a tissue under the endoscope with higher safety.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a knot forming device capable of suturing and ligating a thread in an abdominal cavity during endoscopic surgery.

[0002]

2. Description of the Related Art Recently, a surgical operation under an endoscope has been performed instead of an open surgical operation. In this operation, various treatment tools such as forceps and a scalpel are inserted from a trocar inserted into a puncture site on the abdominal wall, and a predetermined surgical treatment is performed under endoscopic observation.

[0003] The surgical operation under the endoscope has the advantages that the physical burden on the patient is light and the recovery after the operation is fast, but for the person who performs the surgery, it can be operated remotely under the observation by the endoscope. Since this requires a high level of skill, it is extremely troublesome to work on, and suturing and ligating a thread is extremely troublesome.

In the conventional suturing and ligation of a thread under an endoscope, first, a thread having a needle is held by a needle holder and passed through a trocar, and a forceps inserted from another trocar holds the needle. Hold the needle of the instrument and operate the forceps and the instrument to suture.
Then, the thread is once taken out of the trocar, a knot is formed, and it is returned to the abdominal cavity again and ligated.

[0005]

However, such suturing and ligation not only causes trouble in operation such as changing the needle, but also pulls the thread out of the abdominal cavity and returns it again. In addition, there are various unfavorable situations in which the yarn is entangled because the yarn feeding path is long.

Therefore, recently, for example, Japanese Patent Laid-Open No. 3-1
As described in Japanese Patent No. 2,126, there is also proposed an anastomosis / suturing instrument for performing anastomosis and suturing using U-shaped staples.

However, when such an anastomosis and suturing instrument is used, there is a risk of dropping the staple in the abdominal cavity, and because of the limited size of the staple, the anastomosis and suturing of a tissue bundle larger than the staple is performed. There is also a drawback that it becomes impossible.

The present invention has been made in order to solve the problems associated with the above-mentioned prior art, and enables sutures and ligations of threads in the abdominal cavity without any trouble, and drops foreign substances such as staples in the abdominal cavity. An object of the present invention is to provide a knot forming device that is not dangerous and is excellent in terms of safety and workability.

[0009]

According to the present invention for achieving the above object, a straight portion having a predetermined length and a bent portion formed at a tip portion of the straight portion are provided. A hollow tube through which the thread is inserted is provided inside, and the bent portion has a slit that extends a predetermined length from the tip toward the straight portion and has a width that allows the thread to pass therethrough. The present invention according to claim 2 is characterized in that the bent portion has a front end that is substantially parallel to the straight portion or faces away from the straight portion. The present invention as set forth in claim 3 is characterized in that the hollow tube further has a yarn supplementing portion capable of detachably capturing the yarn so as not to come off from the slit. In the present invention according to claim 4, the slit is formed such that a tip portion thereof has a width such that the thread can be inserted to form the thread catching section, and the thread catching section extends from the thread catching section toward the straight section. Is characterized in that it is formed in a wide portion so that the thread can be easily removed. The present invention according to claim 5 is characterized in that the hollow tube has a rigidity such that it is difficult to deform easily. The present invention according to claim 6 is characterized in that the straight portion has an operation portion for rotating the hollow tube at a base portion. The present invention according to claim 7 is characterized in that the operation portion has a position holding means for stopping and holding the hollow tube at a predetermined rotation position. The invention according to claim 8 is characterized in that the position holding means comprises a disk member for rotating the hollow tube, and a fitting means for fitting the disk member at a predetermined position. According to a ninth aspect of the present invention, the operating portion has a yarn operating mechanism that holds the yarn so that it can be moved forward and backward, stopped, and released. According to the tenth aspect of the present invention, the yarn operating mechanism separates the straight portion from a yarn supply pipe coaxially provided with the straight portion by a predetermined distance, and Between the thread supply pipe,
A pair of pulleys, which are rotatable to face the yarn supplied from the yarn supply pipe toward the straight portion, are installed, and both pulleys are configured to be relatively close to and apart from each other and at least one pulley is A driving member is provided.
According to the eleventh aspect of the present invention, the thread operating mechanism can operate the thread from the outside by attaching the straight portion to one of the opposing frame members of the rectangular annular frame and the thread supply pipe to the other. It is characterized by doing so. According to a twelfth aspect of the present invention, the yarn operating mechanism is provided with a yarn winding at an end portion of the yarn supply pipe.

[0010]

In the present invention as set forth in claim 1, the thread is inserted over the entire length of the hollow tube, and the thread is projected from the tip of the bent portion.
Attach a needle to the tip of this thread. And for the needle position,
For example, when this hollow tube is rotated at a predetermined angle, for example, about 180 degrees with the tip of the bent portion positioned on the right side, a loop-shaped portion is formed by the yarn drawn from the tip of the bent portion and the bent portion. . A first knot is formed by passing a needle after inserting suture tissue through the loop-shaped portion and removing the thread from the hollow tube through the slit of the bending portion.

Next, when the hollow tube is rotated again at a predetermined angle, for example, about 180 degrees while the yarn is being stretched and again positioned in the bent portion, the hollow tube is drawn between the drawn yarn and the bent portion. A loop-shaped part is formed. A second knot is formed by passing the needle through the loop-shaped portion, and the suture and ligation of the thread can be performed under the endoscope without trouble in the abdominal cavity.

[0012] Here, when the rotation direction of the hollow tube is made different between the first knot and the second knot, a forward knot and an inverse knot are generated, which enables strong suturing.

As described above, according to the present invention, since the tissue is sewn and ligated without using a foreign substance such as a staple,
There is no risk of dropping foreign matters such as staples into the abdominal cavity, and the operation of suturing or ligating the tissue under the endoscope with high safety can be easily performed.

According to the second aspect of the present invention, since the tip of the bent portion is oriented substantially parallel to the straight portion or away from the straight portion, when the hollow tube is rotated, the yarn The knot can be smoothly moved and removed along the periphery of the bent portion, so that the work for forming the knot becomes smoother.

According to the third aspect of the present invention, the yarn can be retained in the hollow tube according to the stage of the operation for tying the yarn, and the yarn can be removed from the slit, so that the operability is improved.

According to the present invention described in claim 4, the yarn can be captured and released smoothly and surely.

According to the present invention of claim 5, since the hollow tube is made of a material having a rigidity such that the hollow tube is not easily deformed, the bending portion is deformed by the tension of the thread when the thread is tied. It is possible to keep the bent shape without doing and tie the thread securely even in the abdominal cavity.

According to the sixth aspect of the present invention, since the operating portion is provided at the base of the straight portion, the operability when the hollow tube is rotated by operating the operating portion is improved.

According to the seventh aspect of the present invention, when the hollow tube is rotated by a predetermined angle by the operating portion, for example, approximately 180 degrees, the position holding means can hold the hollow tube at a predetermined rotational position. So, if you have surgery,
Even if the knot forming device side is not operated, with the hollow tube as a reference, only the thread to which the needle is attached can be operated for suturing or ligating.

According to the eighth aspect of the present invention, since the disc member is held in position by the fitting means, the person performing the surgery can operate the disc member to arbitrarily change the hollow tube. Even if the hollow tube is rotated, the hollow tube can be held at a predetermined position by the fitting means, and the stop position can be known while rotating the hollow tube by the disc member, and operability is improved.

According to the present invention of claim 9, since the operating portion has a thread operating mechanism for holding the thread so that it can be advanced, retracted, stopped and released, the operability of the thread is improved and a long thread is used. However, the threads are not entangled or entangled.

According to the tenth aspect of the present invention, the yarn operating mechanism coaxially installs the straight portion and the yarn supply pipe at a predetermined distance from each other, and the yarn operating mechanism is provided between the straight portion and the yarn supply pipe. Since a pair of pulleys, which are rotatable to face the yarn supplied from the supply pipe toward the straight portion, are provided, and the yarn is held between these pulleys to advance, retreat, stop, and open, the entire device is straight. The extended shape makes it easy to handle, the amount of thread to be taken in and out can be reliably controlled, and the thread operation is extremely simple, resulting in excellent operability.

According to the eleventh aspect of the present invention, since the straight portion is attached to one of the opposing frame members of the rectangular annular frame and the yarn supply pipe is attached to the other, the yarn can be operated from the outside.
Operations such as thread cutting are facilitated.

According to the twelfth aspect of the present invention, since the yarn manipulating mechanism is provided with the yarn winding at the end of the yarn supply pipe, it is not necessary to handle the long yarn even when the long yarn is required. ,
The yarn can be smoothly operated or controlled without being entangled or entangled, and the operability is also improved in this respect.

[0025]

An embodiment of the present invention will be described below with reference to the drawings. 1 is a schematic perspective view of a knot forming device according to an embodiment of the present invention, FIG. 2 is a schematic cross-sectional view showing a bent portion which is a main part of the same embodiment, and FIG. 3 is a schematic view showing an operating portion of the same embodiment. FIG. 4 is a cross-sectional view, FIG. 4 is a cross-sectional view taken along line 4-4 of FIG. 3, and FIG. 5 is a schematic explanatory view showing the order of forming two knots by process.

In FIG. 1, the knot forming device has a hollow tube 10 into which the thread S is inserted, and an operating portion 20 for rotating the hollow tube 10.

The hollow tube 10 is composed of a straight portion 11 having a predetermined length and a bent portion 12 formed at the tip of the straight portion 11, and has a J-shape as a whole. As shown in FIG. 2, the bent portion 12 has a yarn catching portion 12a having a slit having a width that allows the yarn S to pass through, and the straight portion is formed from the yarn catching portion 12a. A wide portion 12b having a wide slit is formed so that the thread S can be easily removed from the tip of the portion 11.

In particular, it is preferable that the bent portion 12 is formed so that its tip is substantially parallel to or away from the straight portion 11. In other words, it is preferable that the extension line A at the tip of the bent portion 12 is formed so as to be parallel to or away from the straight portion 11. By doing so, when the hollow tube 10 is rotated, the thread S can be smoothly slid along the bending portion 12, easily removed, and the wide portion 12 can be easily removed.
It can be taken into the inside of b and handling of the yarn becomes easy. In the illustrated example, the bent portion 12 is formed in an arc shape. However, in the present invention, the bent portion 12 does not necessarily have to have an arc shape, and may have various other shapes such as a relatively rounded L-shape or U-shape depending on the case.

Further, it is preferable that the hollow tube 10 has a certain degree of rigidity so that the bent portion 12 will not be deformed by, for example, the tension of the yarn at the time of the operation of tying the yarn described later. However, the present invention is not limited to this, and may be made of a material having a certain degree of flexibility so as to be inserted into the trocar and enter the abdominal cavity well.

Here, although not particularly limited, in a preferred embodiment, the hollow tube 10 is made of aluminum, brass, copper, stainless steel, tungsten, carbon steel, a superelastic alloy such as Ti Ni alloy, or the like. Of a metal material or a hard resin such as polycarbonate, polyethylene, polypropylene, hard polyvinyl chloride, polyester, etc., and an inner diameter d of 0.5 to 2.0 mm, more preferably,
1.0-1.5 mm, outer diameter D is 1.5-4.0 m
m, more preferably, a pipe having a diameter of about 1.8 to 3.0 mm is used, and the straight portion 11 has a length L of 35 to 55 mm, and more preferably 40 to 50 mm. The radius of curvature r of the bent portion 12 is 1.8 to 3.0 mm, and more preferably,
It is 2.0 to 2.5 mm.

Below the above range, the suture needle N will bend in the bent portion 1.
It becomes difficult to pass through the loop of No. 2, and if it exceeds it, it becomes difficult to pass through the trocar tube.

Further, the width of the wide portion 12b is 1.0 to 2.5 mm, more preferably 1.5 to 2.0 mm in consideration of the extent that the thread does not come off, and the width of the thread catching portion 12a. The width is 0.7 to 1.2 mm, more preferably 0.8 to
It is 1.0 mm.

Further, in the illustrated example, the slit is formed to have a narrow width at the tip portion, but the present invention is not limited to this, and the slit may have the same width over the whole.
Even in such a case, the knot of the thread can be formed by performing a series of operations by hooking the thread on the tip of the bent portion 12 excluding the portion where the slit is formed. Further, the yarn catching portion 12a is not limited to the one shown in the figure, and for example, a slit may be provided at the tip of the bending portion 12 in addition to the slit, and the yarn may be detachably sandwiched in this slit.

As shown in FIGS. 1 and 3, the operation portion 20 is centered on a front outer casing 21 for supporting the straight portion 11 of the hollow tube 10 from the tip and a base end portion of the straight portion 11. A disk member 22 fixed to the disk member for rotating the hollow tube 10.
And a thread operating mechanism 24 that is provided in the rectangular annular frame 23 and holds the thread S so that it can be moved forward and backward, stopped, and opened, and position holding means 25 that holds the hollow tube 10 at a predetermined stop position.
And a yarn supplying portion 26 having a yarn supplying pipe 11a provided coaxially with the base of the straight portion 11.

The front mantle box 21 is a closed hollow box body, and the base of the straight portion 11 is rotatably supported by a sleeve 21a provided inside the front mantle box 21. The U-shaped connecting member 28 (see FIG. 1) provided so as to make a detour is integrally connected to the rectangular annular frame 23 of the thread operating mechanism 24.

As described above, the operating portion 20 is provided on the base portion of the straight portion 11.
If the hollow tube 10 is stably rotated by the front jacket box 21, the hollow tube 10 can be smoothly and stably rotated around the straight portion 11, and the hollow tube 10 can be considerably separated. The operation of the bent portion 12 can be relatively easily performed.

The disc member 22 is provided between the front outer casing 21 and the front frame member 23f of the rectangular annular frame body 23, and the base end of the straight portion 11 penetrates and is fixed to the central portion. .

The outer peripheral surface of the disk member 22 is preferably provided with knurled grooves or the like in order to prevent slippage during rotation operation.

Between the disk member 22 and the front frame member 23f of the rectangular annular frame body 23, the rotational position of the disk member 22 is temporarily held, and the position of the hollow tube 10 is held at a predetermined position. The position holding means 25 is provided. As will be described later, the hollow tube 10 rotates approximately 180 degrees to form a loop-shaped portion, but the state when rotated 180 degrees is held by the position holding means 25 and the knot forming instrument side is operated. Even without doing so, the needle side can be operated.

The position holding means 25 is, for example, a pair of convex portions 2 formed at symmetrical positions on the back side of the disk member 22.
9 and 29 and one recess 30 formed in the front frame member 23f of the rectangular annular frame 23. The protrusion 29 elastically fits into the recess 30. It is like this. The concave-convex fitting by the position holding means 25 has the function of temporarily holding the rotational position of the hollow tube 10 described above, and the disk member 22 is rotated by a click feeling generated when the convex portion 29 and the concave portion 30 are concave-convex fitted. position,
That is, the rotational position of the hollow tube 10 can be notified to the person who is performing the surgery.

It is desirable that the U-shaped connecting member 28 has elasticity to some extent so that the convex portion 29 and the concave portion 30 can be smoothly fitted and separated.

The position holding means 25 is not limited to the above-mentioned concave and convex fitting, but may be one in which the projection and the concave are simply fitted.

The thread operating mechanism 24 includes a rectangular annular frame 23.
A through hole 31 is formed in the front frame member 23f of the
1, the straight portion 11 is penetrated, and the straight portion 11 and
The yarn supply pipe 11a, which is provided through the through hole 32 of the rear frame member 23b, is provided coaxially with a predetermined distance. Between the straight portion 11 and the yarn supply pipe 11a, the yarn S supplied from the yarn supply pipe 11a toward the straight portion 11 is provided.
A pair of pulleys 33, 34 that are rotatable so as to face each other are installed to face each other. The both pulleys 33, 34 are configured to be relatively close to and separated from each other, and the right pulley 34 is provided with a rotating handle 35 as a driving member.

Therefore, when the thread S is inserted between the pulleys 33, 34 and the thread S is held by the pulleys 33, 34, the rotary handle 35 is operated to rotate the right pulley 34. By the frictional force between the yarn S and the yarn S, the yarn S is moved forward and backward, and the pulleys 33 and 34 are separated from each other, so that the yarn S is in a free state and the supply of the yarn S can be stopped. It has become.

In the right pulley 34, a rotary shaft 34a is rotatably held at the tip of a support plate 36 protruding from the right side frame member 23r, and the rotary handle 35 is attached to the upper end of the rotary shaft 34a. ing.

On the other hand, the left pulley 33 has a left side frame member 23l.
More protruding support plate 37 (indicated by a chain line in FIG. 3)
In the long hole 38 (see FIG. 4) opened at the tip of the rotary shaft 33
a is displaceably and rotatably held, and the rotary shaft 3
Displacement means 39 for displacing the position of the left pulley 33 is provided at the upper and lower ends of 3a. This displacement means 39
Although various types using a cam, a motor, or the like are conceivable, the screw mechanism shown in the figure is preferable in consideration of easiness of operation and safety.

The displacing means 39 of this embodiment has a bracket 40 having a U-shaped cross section for supporting the upper and lower end portions of the left pulley 33.
1 is abutted, and a tension spring 42 is interposed between the contact plate 41 and the left side frame member 23l. This spring 4
The operation screw shaft 43 screwed into the left side frame member 23l is projected against the pulling force of 2, and the vertical piece 40a of the bracket 40 is pressed by the pressing piece 43a provided at the tip of the operation screw shaft 43. Then, the left pulley 33 is brought closer to the right pulley 34.

In the figure, reference numeral "44" is a bottom support plate. In addition, the operating screw shaft 43 has the pressing piece 43a.
A contact member 43b may be provided at a position spaced a predetermined distance from the left pulley 33 to prevent the left pulley 33 from retracting unnecessarily. Further, the base end portion of the straight portion 11 is expanded into a trumpet shape to facilitate the insertion of the thread S, the tip of the thread supply pipe 11a is narrowed, and the thread S to be supplied is surely attached to the straight portion 11. It goes to the trumpet-shaped entrance.

A pair of rotatable pulleys 33 and 34 are provided between the straight portion 11 in which the yarn operating mechanism 24 is coaxially provided and the yarn supply pipe 11a, and the yarn is interposed between the pulleys 33 and 34. Since it is configured to hold the yarn, and to advance, retreat, stop, and open, the entire device has a straight elongated shape, which makes it easy to handle the device, and not only can the yarn withdrawal amount be reliably controlled, but also the yarn operation It is extremely easy and has excellent operability.

Further, by using the rectangular annular frame body 23 whose upper end is open, the thread S in the thread operating mechanism 24 can be operated from the outside, and the operation of the thread S between the left and right sheaves 33 and 34, for example, the outside. A thread cutting member (not shown) such as scissors can be inserted to easily cut the thread S, and the thread S can be easily connected if necessary. However, it goes without saying that a lid that can be opened and closed to cover the rectangular annular frame body 23 whose upper end is open may be provided.

The yarn supplying section 26 is provided with a yarn winding 45 at the rear end portion of the yarn supplying pipe 11a (see FIG. 1), and the yarn S can be fed from the yarn winding 45 between the left and right pulleys 33, 34. Therefore, even if a long yarn is used, the yarn is not entangled or entangled, and the yarn can be smoothly operated.

Next, the operation of the above embodiment will be described. First, the operation screw portion 43 is retracted, and the left pulley 33 is moved to the right pulley 34.
And the yarn S drawn from the spool 45 is guided to a space between the left and right pulleys 33, 34 through the yarn supply pipe 11a. Therefore, even when the long thread S is required, the thread S is pulled out from the thread winding 45 one after another, so that the thread S is not entangled or entangled.

Then, after the operation screw portion 43 is moved forward to bring the left and right pulleys 33 and 34 into contact with each other, the right pulley 3
By rotating the handle 35 of No. 4, the yarn S is fed through the straight portion 11 to the bending portion 12, and the needle N is attached to the yarn S that has come out from the tip of the bending portion 12 (state of FIG. 5a). When the thread is passed through the hollow tube 10, the thread is easily inserted up to the tip of the straight portion 11, and the thread reaching the tip is bent by the bending portion 1.
It is pulled out from the wide portion 12b of No. 2 and passes through the slit of the yarn catching portion 12a and is pulled out from the tip.

The hollow tube 10 is inserted into the abdominal cavity through the trocar. In this case, since the hollow tube 10 has a certain degree of flexibility, even if it has the bent portion 12, it can be easily inserted into the trocar.

The tip of the bent portion 12, that is, the yarn catching portion 12a is positioned, for example, on the right side with respect to the position of the needle. In this state, the hollow tube 10 is operated by the operating portion 20 at a predetermined angle, for example, about 180 degrees. When rotated, the loop S R1 is formed by the yarn S drawn from the tip of the bent portion 12 and the bent portion 12 (state of FIG. 5b).

Here, when the operating section 20 rotates the hollow tube 10 by a predetermined angle, for example, about 180 degrees, the hollow tube 1
Since 0 is temporarily held at its rotational position by the position holding means 25, a person performing an operation can easily operate the thread S to which the needle N is attached with the hollow tube 10 in a stationary state as a reference. .

The needle after inserting the sutured tissue H into the loop-shaped portion R1 is passed by grasping it with forceps, for example (state of FIG. 5c), and further inverting the hollow tube 10 at a predetermined angle, for example, about 180 degrees. When the yarn S is removed from the hollow tube 10 through the slit of the yarn catching portion 12a while being allowed to move, a first knot (forward knot) is formed (states of FIGS. 5d and 5e).

Next, while the yarn S is being stretched, and the yarn S is put in the yarn catching portion 12a of the bending portion 12 again, the hollow tube 10 is inverted by a predetermined angle, for example, about 180 degrees, and is pulled out. The twisted yarn S is located behind the bent portion 12, where a loop-shaped portion R2 is formed (state of FIG. 5f). The needle N is passed through the loop-shaped portion R2 (state of FIG. 5g), the bending portion 12 is moved slightly to the left as shown in FIG. 5h, and then the bending portion 12 is removed from the yarn catching portion 12a. When inverted, a knot opposite to the knot is formed as shown in FIG. 5i.

Therefore, the thread S can be sewn or ligated under the endoscope in the abdominal cavity without the trouble of pulling the thread S out of the trocar, and since foreign matters such as staples are not used, the staple or the like in the abdominal cavity can be avoided. There is no danger of dropping a foreign object, and it is possible to perform suturing and ligating work of a tissue under an endoscope with high safety.

The present invention is not limited to the above-mentioned embodiments, but can be appropriately modified and used within the scope of the claims. For example, in the above-described embodiment, the disk member 22 that is manually rotated is used as the operation unit 20 that rotates the hollow tube 10. It is also possible to use those that rotate, and the rotation angle of this hollow tube 10 is not limited to rotation or reversal of 180 degrees, but can be appropriately selected depending on the case.

Further, in the above embodiment, the position holding means 25
Is composed of a disk member 22 and fitting means for fitting the disk member 22 in a concavo-convex shape. The operation unit 20 for rotating the hollow tube 10 is temporarily stopped and held. Any mechanism may be used as long as it is a ratchet type mechanism or a mechanism using a retractable pin.

Further, in the above embodiment, the thread operating mechanism 24
The pulleys 33 and 34 are used to stop the supply of the yarn S and the like, but other than this, a friction wheel such as a roller may be used.

[0063]

As described above, according to the present invention as set forth in claim 1, the straight portion having a predetermined length and the bent portion formed at the tip of the straight portion are provided. When the hollow tube through which the thread is inserted is appropriately rotated, a loop-shaped portion is easily formed due to the relationship between the thread and the bent portion. When a needle is passed through this loop-shaped portion, a knot is easily formed. So
It is possible to suture and ligate a thread under an endoscope with a simple device without taking time and effort in the abdominal cavity.

In this case, since the tissue is sewn and ligated without using foreign matter such as staples, there is no risk of dropping foreign matter such as staples into the abdominal cavity, and the suturing of tissue under the endoscope is highly safe. And ligation work can be performed.

According to the second aspect of the present invention, since the tip of the bent portion is oriented substantially parallel to the straight portion or away from the straight portion, the thread is smooth when the hollow tube is rotated. And the knot forming work becomes smooth.

According to the third aspect of the present invention, since the hollow tube has a thread catching portion capable of detachably catching the thread so that the thread does not come off from the slit, the step of tying the thread According to the above, the thread can be retained in the hollow tube, and the thread can be removed from the slit, which improves the operability.

According to a fourth aspect of the present invention, the slit is formed such that the distal end portion has a width that allows the thread to be inserted therethrough to form the thread catching section. Since the yarn is formed in a wide portion so that the yarn can be easily detached, the yarn can be captured and released smoothly and reliably.

According to the fifth aspect of the present invention, since the hollow tube is made of a material having rigidity such that the hollow tube is not easily deformed, the bending portion is deformed by the tension of the thread when the thread is tied. It is possible to keep the bent shape without doing and tie the thread securely even in the abdominal cavity.

According to the sixth aspect of the present invention, since the operating portion is provided at the base of the straight portion, the operability when the hollow tube is rotated by operating the operating portion is improved.

According to the seventh aspect of the present invention, when the hollow tube is rotated by a predetermined angle by the operating portion, for example, approximately 180 degrees, the position holding means can hold the hollow tube at a predetermined rotational position. A person performing an operation can perform suture or ligation by operating only the thread to which the needle is attached, using the hollow tube as a reference, without operating the knot forming device side.

According to the eighth aspect of the present invention, since the disc member is held in position by the fitting means, the person performing the surgery can operate the disc member to arbitrarily change the hollow tube. Even if the hollow tube is rotated, the hollow tube can be held at a predetermined position by the fitting means, and the stop position can be known while rotating the hollow tube by the disc member, and operability is improved.

According to the ninth aspect of the present invention, since the operating portion has the thread operating mechanism for holding the thread so that it can be advanced, retracted, stopped and released, the operability of the thread is improved and a long thread is used. Also, the threads are not entangled or entangled.

According to the tenth aspect of the present invention, the yarn operating mechanism coaxially installs the straight portion and the yarn supply pipe at a predetermined distance apart from each other, and the yarn operating mechanism is provided between the straight portion and the yarn supply pipe. Since a pair of pulleys, which are rotatable to face the yarn supplied from the supply pipe toward the straight portion, are provided, and the yarn is held between these pulleys to advance, retreat, stop, and open, the entire device is straight. The extended shape makes it easy to handle, the amount of thread to be taken in and out can be reliably controlled, and the thread operation is extremely simple, resulting in excellent operability.

According to the eleventh aspect of the present invention, since the straight portion is attached to one of the opposing frame members of the rectangular annular frame and the yarn supply pipe is attached to the other, the yarn can be operated from the outside.
Operations such as thread cutting are facilitated.

According to the twelfth aspect of the present invention, since the yarn manipulating mechanism has the yarn winding at the end of the yarn supply pipe, it is not necessary to handle the long yarn even when the long yarn is required. ,
The yarn can be smoothly operated or controlled without being entangled or entangled, and the operability is also improved in this respect.

[Brief description of drawings]

FIG. 1 is a schematic perspective view showing an embodiment of the present invention.

FIG. 2 is a schematic cross-sectional view showing a bent portion of the same embodiment.

FIG. 3 is a schematic cross-sectional view showing an operating unit of the embodiment.

FIG. 4 is a sectional view taken along line 4-4 of FIG.

FIG. 5 is a schematic explanatory view showing the order of forming a knot by steps.

[Explanation of symbols]

10 ... Hollow tube, 11 ... Straight part, 11a ... Thread supply tube, 12
... bent portion, 12a ... thread catching portion, 12b ... wide portion, 20 ...
Operation part, 22 ... Disc member, 23 ... Rectangular annular frame, 23f
... front frame member, 23b ... rear frame member, 24 ... thread operating mechanism, 25 ... position holding means, 29 ... convex portion, 30 ... concave portion, 3
3, 34 ... Pulley, 35 ... Rotating handle (driving member), 4
5 ... spool, S ... thread.

[Procedure amendment]

[Submission date] March 16, 1995

[Procedure Amendment 1]

[Document name to be corrected] Drawing

[Correction target item name] All drawings

[Correction method] Change

[Correction content]

FIG.

[Fig. 2]

[Figure 3]

[Figure 4]

[Figure 5]

Claims (12)

[Claims] 1. A hollow tube having a straight portion having a predetermined length and a bent portion formed at a tip end of the straight portion, the hollow tube having a thread inserted therein, and the bent portion. Is a knot forming device having a slit having a width through which the yarn extending from the tip toward the straight portion by a predetermined length can pass. 2. The knot forming device according to claim 1, wherein a tip of the bent portion is substantially parallel to the straight portion or faces away from the straight portion. 3. The knot forming device according to claim 1, wherein the hollow tube further has a yarn catching portion capable of detachably catching the yarn so as not to come off from the slit. 4. The slit has a tip portion formed to have a width such that the thread can be inserted to form the thread catching section, and the thread easily moves from the thread catching section toward the straight section. The knot forming device according to any one of claims 1 to 3, wherein the knot forming device is formed in a wide portion that is detachable. 5. The knot forming device according to claim 1, wherein the hollow tube has rigidity such that the hollow tube is not easily deformed. 6. The straight portion has an operation portion for rotating the hollow tube at a base portion thereof.
The knot forming device according to any one of 1. 7. The knot forming device according to claim 6, wherein the operation portion has position holding means for stopping and holding the hollow tube at a predetermined rotation position. 8. The knot according to claim 7, wherein the position holding means includes a disk member for rotating the hollow tube and a fitting means for fitting the disk member at a predetermined position. Forming instrument. 9. The knot forming device according to claim 6, wherein the operating portion has a thread operating mechanism that holds the thread so that it can be moved forward and backward, stopped, and released. 10. The yarn operating mechanism separates the straight portion and a yarn supply pipe coaxially provided with the straight portion by a predetermined distance, and the straight portion and the yarn supply pipe are separated from each other. A pair of pulleys, which are rotatable to face the yarn supplied from the yarn supply pipe toward the straight portion, are provided between the pulleys, and both pulleys are configured to be relatively close to and apart from each other and at least one of the pulleys is arranged. The knot forming device according to claim 9, wherein the pulley is provided with a drive member. 11. The thread manipulating mechanism is configured such that the straight portion is attached to one of the opposing frame members of the rectangular annular frame and the thread supply pipe is attached to the other, so that the thread can be operated from the outside. The knot forming device according to claim 9 or 10. 12. The knot forming device according to claim 9, wherein the thread operating mechanism includes a thread winding at an end of the thread supply tube.