JPH08308847A - Ligating tool - Google Patents

Abstract

PURPOSE: To provide a ligating tool of general purpose use by which a knot which is difficult to be loosened can be formed by an easy operation and which is suitable for ligation and suture. CONSTITUTION: This ligating tool 52 is provided with a tubular member of long length which can be inserted into an organism, an arc part which is provided on the head end of the tubular member and has a shape with a part of the closed loop notched at the head end, a knot forming member capable of setting a suturing thread 3, a grasping means 23 which is inserted into the tubular member forward/backwardly and is capable of grasping the suturing thread on its head, and a forceps member 10 which can be inserted into the loop of the arc part, as well.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a ligature used for suturing and ligating in a surgical operation.

[0002]

2. Description of the Related Art In a general operation, a work of ligating a number of blood vessels and stitching body tissues is frequently performed. In particular, much time is spent on knotting.

In recent years, a surgical operation performed under observation with an endoscope, a so-called endoscopic surgical operation has been actively performed. In such an endoscopic surgery, a blood vessel is ligated or body tissues are sewn together while viewing an endoscopic image displayed on a monitor. However, it is very difficult to sew and ligate a thread in a body cavity with limited movement, and many ligatures have been developed in the past to facilitate this operation.

In general, in endoscopic surgery, sutures and
When ligating, three methods are used: (1) extracorporeal ligation, (2) intracorporeal ligation, and (3) suturing / ligating with a clip or stapler.

Of these, in the extracorporeal ligation, a thread is passed under the target tissue (the back of the target tissue), a knot is made outside the body with both ends of the thread pulled out of the body, and this knot is knot pusher (knot driver). ) Is called a thread feeder and is fed into the body and tightened. Normally,
This operation is repeated several times, but in this case, each time a knot is formed, its knot direction (thread entanglement) is reversed to form a knot that is not loose and is called a "male knot".

Internal ligature was introduced into the body cavity.
The knot is formed by the forceps of a book.
Of course, even in the case of this internal ligation, it is desired to make a nodule called a "male knot" that is not loose.

In addition, suturing with a clip or stapler
The ligation is advantageous in that complicated operations performed in the internal ligation and the external ligation can be omitted. By the way, the extracorporeal ligation is quite troublesome to operate because the tools need to be changed or taken in and out frequently. There is also a drawback that the tissue is rubbed with the thread when the thread is pulled out of the body.

In addition, suturing with a clip or stapler
Although the ligation can save complicated operations, the device is expensive and foreign matter such as a clip is left in the body, so that its application range is limited. That is, depending on the type and site of living tissue, suture / ligation with a clip or stapler may not be applicable.

On the other hand, the internal ligature has advantages that there is no problem such as suturing and ligating with a clip or a stapler, and that frequent tools are not taken in and out unlike the external ligature. However, on the other hand, the forceps must be operated in a limited environment inside the body cavity, and work must be performed through a monitor that does not give a sense of depth. Is very different. Therefore, it is technically quite difficult and requires considerable skill.

For this reason, US Pat. No. 5,281,236 and German Patent DE3413744C2 propose a ligature that can be easily ligated in the body. That is, US Pat.
No. 1 inserts a tubular catheter in a long sheath so as to be able to advance and retreat, and provides a curved portion with a bending tendency so as to form an occlusion loop at the distal end of the catheter protruding from the distal end of the sheath, One end side of the thread or suture thread inserted into the catheter is made to project from the tip of the bending portion. In this configuration, the knot is formed by passing the free end of the thread or suture protruding from the tip of the bending portion into the loop of the bending portion, and the bending portion is forced into the sheath by pulling the bending portion into the sheath. Straighten into and remove the knot from the tip of the bend. And
In this way, the knot is tightened by pulling the free end of the thread after it has fallen off.

On the other hand, the German patent DE3413744C2 is
A spiral coil portion is provided at the tip of a long member. In this configuration, a knot is formed by passing a thread or a suture through the coil portion, and the coil member is rotated by rotating the elongated member to drop the knot from the tip of the coil portion. Then, the knot is tightened by pulling the free end of the thread after the thread is dropped in this way.

[0012]

However, US Pat. No. 5,
In both 281,236 and German Patent DE3413744C2, the knot forming direction (knotting direction) is inevitably determined in one direction depending on the bending direction of the closed loop or the winding direction of the coil portion, and therefore the first knot and the second knot The second knot is formed in the same direction. As described above, a knot in which the first knot and the second knot have the same direction is generally called a “female knot” and is easier to loosen than the aforementioned “male knot”, and is rarely used normally. .

Therefore, US Pat. No. 5,281,236 and German Patent DE 34, which can only form a "female knot"
When using the 13744C2 ligature, extra operations such as increasing the number of knots must be added to cover the looseness of the “female knot”.

Further, since the ligating tools of US Pat. No. 5,281,236 and German Patent DE3413744C2 do not have a gripping means for gripping a thread, only a ligating operation can be performed. Therefore, the number of times the ligature is inserted and removed from the abdominal cavity is increased, which is troublesome.

Further, in the case of German Patent DE3413744C2, it is difficult to pass the thread with the needle through the coil portion, and in order to drop the knot from the coil portion, the number of windings of the coil portion through which the thread with the needle passes is increased. Only the long member needs to be rotated, and the work is very troublesome.

The present invention has been made in view of the above circumstances, and its purpose is to provide a highly versatile ligature suitable for ligation and suturing, which can form a knot that does not loosen easily by a simple operation. To provide.

[0017]

In order to solve the above-mentioned problems, a ligature tool of the present invention is provided with a long tubular member that can be inserted into a living body and a distal end of the tubular member, and a part of a closed loop. And a knot forming member having a circular arc portion having a notched shape at the tip, and a knot forming member on which a suture can be set, and a gripping means that is rotatably and rotatably inserted into the tubular member and can grasp the suture at the tip. And a forceps member that can be inserted through the loop of the circular arc portion.

[0018]

The operation of the ligation tool having the above-mentioned structure is achieved by rotating the tubular member,
By rotating the knot forming member on which the suture is set, a pseudo loop is formed by the arc portion and the suture, and the knot is formed by inserting the forceps member holding the suture into the pseudo loop. You can tighten it.

If the arc portion of the knot forming member has a loop shape having one or more turns, the winding direction is determined, so that the second knot entangles in the same direction as the first knot. You can only make a "woman knot", but with the above configuration,
Since the arcuate portion of the knot forming member forms a single loop, the winding direction is not determined, and thus a “male knot” can be formed.

Further, a part of the loop is cut out in the arc portion of the knot forming member. Therefore, the knot formed in the arc portion of the knot forming member can be easily dropped from the portion lacking the loop. . Therefore, the ligation work can be efficiently performed. Further, since it has a gripping means for gripping the suture thread, the peeling work and the ligation work can be performed at one time with this single ligature tool.

[0021]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 29 show a first embodiment of the present invention. As shown in FIG. 1, a ligature tool 52 of the present embodiment includes a tubular thread hook 12 on which a suture thread (ligature thread) 3 is set, and a suture thread that is inserted into the thread hook tool 12 so as to be able to advance and retract. The forceps 10 has a grasping portion 23 for grasping 3 at its tip.

As shown in FIGS. 2 and 3, the thread hook 12
Is an outer pipe 14 having a handle portion 21 on the hand side.
And its inner side is detachably inserted into the outer pipe 14 and is rotatable with respect to the outer pipe 14.
3 and a tip portion main body 15 detachably attachable to the tip of the inner pipe 13. Once attached to the inner pipe 13, the tip portion main body 15 is non-rotatably fixed to the inner pipe 13. That is, the tip portion main body 15 rotates integrally with the inner pipe 13 in the attached state.

As shown in FIG. 3, the tip body 15 has a tubular knot forming member 1 having an arc portion 2 forming an arc loop at its tip, and a support member 1 for supporting the knot forming member 1 at the tip.
6. One end side of the suture thread 3 is inserted into the knot forming member 1, and the free end 3a of the suture thread 3 is led out from the end 36 of the arc portion 2 of the knot forming member 1.

The inner pipe 13 has removable pipes 17a and 17b having elasticity on both sides thereof. Further, the cam groove 1 forming a predetermined path is formed on the outer peripheral surface of the inner pipe 13.
9 are provided. The cam groove 19 includes a linear groove 19a,
It comprises a swirl groove 19b formed in the middle of this straight groove 19a. The swirl groove 19b is located inside the inner pipe 13 (that is, the knot forming member attached to the inner pipe 13) before the grip portion 23 of the forceps 10 pushed toward the tip side penetrates the arc portion 2 of the knot forming member 1 as described later. It is provided at a position where 1) is rotated 2/3 rotation to the right, preferably 1 rotation. In addition, the end of the cam groove 19 is a closed end portion 4.
5a, the base end side of the cam groove 19 is an open portion 45b that is open.

An annular thread fixing portion 18 for fixing the suture thread 3 is fitted on the outer peripheral surface of the inner pipe 13 between the terminal end portion 45a of the cam groove 19 and the removable pipe 17a. The outer pipe 14 includes an insertion portion 20 and a handle portion 21 connected to the base end portion of the insertion portion 20 via two parallel members 22 and 22. In this case, the two parallel members 2
A guide path 74 for guiding the proximal side of the forceps 10 in the longitudinal direction is formed between the Nos. 2 and 22.

The forceps 10, as shown in FIG.
It is used for endoscopic surgery, and mainly includes a grip portion 23 capable of gripping the suture thread 3, an insertion portion 24, and a handle portion 25. The forceps 10 is configured so that it can be freely disassembled and assembled. In the assembled state, the insertion portion 24 and the grip portion 23 do not rotate with respect to the handle 25.

As shown in FIG. 4B, the grip portion 24
Has a shape that is thinner toward the tip and bends to the left, and is formed in a shape suitable for peeling blood vessels and the like. Also, FIG.
(A), a pin 26 that engages with the cam groove 19 of the inner pipe 13 is provided on the outer surface of the insertion portion 24 in a protruding manner. Further, the handle portion 25 is provided with a handle lock mechanism 27 composed of a ratchet and an energizing pin 28.

In this structure, the grip portion 23 is opened and closed by opening and closing the handle portion 25, and the grip portion 23 can be held in a closed state by hanging the ratchet 27. Further, a high frequency current can be guided to the grip portion 23 through the energizing pin 28. It should be noted that parts other than the conductive part including the energizing pin 28 are electrically insulated. In addition, the insertion portion 24 of the forceps 10
The diameter reduction portion 44 is provided between the pin 26 and the grip portion 23 in the middle of the
Is provided.

The forceps 10 having such a structure is used for the thread hook 1
The second outer pipe 14 is inserted into the inner pipe 13 through the forceps insertion opening 29 (see FIG. 2). And
In this inserted state, the forceps 10 can be moved to a position projecting from the knot forming member 1 toward the distal end side by about 40 mm, for example, as shown in FIG. The protrusion length L is a length that does not hinder the knot forming member 1 when only the forceps 10 is used in a peeling operation or the like, and also serves as a standard for the length of the suture thread 3.

Since the inner pipe 13 is provided with the cam groove 19 as described above, the pin 2 of the forceps 10 is inserted into the cam groove 19 from the opening 45b located on the forceps insertion port 29 side.
After 6 is inserted, the forceps 10 and the inner pipe 13 operate integrally while being constrained by the engagement state of the pin 26 and the groove 19. That is, when the pin 26 of the forceps 10 is engaged with the straight groove 19a, the forceps 10 simply moves back and forth within the inner pipe 13, but when the pin 26 of the forceps 10 is engaged with the swivel groove 19b. The inner pipe 13 rotates as the forceps 10 moves back and forth.

In the present embodiment, the inner pipe 13 is provided with the cam groove 19 and the forceps 10 is provided with the pin 26.
The same operation can be realized even when a pin is provided so as to project inside the inner pipe 13 and a groove is provided on the outer peripheral surface of the insertion portion 24 of the forceps 10.

Next, each part of the ligature 52 will be described in more detail. As shown in FIG. 6, the knot forming member 1 constituting the tip portion main body 15 is made of a hollow and hard material, the inner diameter of which is larger than the thickness of the suture thread 3, and the suture thread 3 can be inserted therein. It is like this. Further, the knot forming member 1 extends in the axial direction of the support member 16 from the tip of the support member 16 and extends clockwise from the arc starting point portion 31 to the yarn discharging portion 32 and has a center O on the axis of the support member 16 in the clockwise direction. Forming 2. As can be seen, the yarn discharge portion 32 coincides with the end 36 of the arc portion 2. The knot forming member 1 may be formed of a flexible tube having a bending tendency.

Further, the circular arc is formed so that the forceps 10 can be inserted into the pseudo loop 4 (see FIG. 9 (b)) formed by the circular arc and the chord connecting the thread discharging portion 32 and the circular arc starting portion 31. The inner diameter and the central angle of the portion 2 are determined.
For example, in the present embodiment, the inner diameter of the arc portion 2 is the forceps 10
Slightly larger than the outer diameter of the arc, the central angle of the arc portion 2 is 270
It is a degree.

The suture thread 3 is guided in the knot forming member 1 from the thread releasing portion 32, and the supporting member 1 is led from the thread outlet 53.
6 is led out to the outside through the outer peripheral surface 34. Support member 1
6 is formed as a spiral-shaped portion 33 whose end portion is counterclockwise. Further, a cutout groove 35 having a central angle of about 90 degrees and a length of 40 mm is formed on the outer peripheral surface 34 of the support member 16 in the longitudinal direction. The length of the notch groove 35 is substantially equal to the forceps tip protrusion length L described above.

The knot forming member 1 has a circular arc end 36.
Are provided on the center line 30 of the cutout groove 35. The end surface of the support member 16 on the inner pipe 13 side is cut obliquely, and the end surface 37a is provided with a long hole 38 that can be fitted into the removable pipe 17a at the tip of the inner pipe 13.

As shown in FIGS. 7 and 8, the forceps 10 is
It is set so that the bending direction of the tip of the gripping portion 23 of the forceps 10 faces the position of about 90 degrees from the tip (end 36) of the arc portion 2 when passing through the arc portion 2. By setting in this way, even if the pseudo loop 4 does not have a sufficient size as shown in FIG. 9, the tip of the gripping portion 23 (the tip position of the gripping portion 23 is located at (b) of FIG. 9). It is possible to push out the suture thread 3 forming the pseudo loop 4 to the outside by means of the mark X), and it is possible to reliably pass the tip of the forceps 10 into the pseudo loop 4.

As shown in FIG. 10, the tip surface 37b of the inner pipe 13 is obliquely cut in the direction opposite to the cutting direction of the end surface 37a of the support member 16, and four tips extending radially from the tip surface 37b. A detachable pipe 17a having a slit 39a and having a spring property is extended in the axial direction. The inside diameter of the detachable pipe 17a is equal to the insertion portion 2 of the forceps 10.
The outer diameter is substantially the same as that of No. 4.

The detachable pipe 17a has a thick wall on the tip side over a length of several millimeters, and has a step portion 41 on the outer surface of this portion. Detachable pipe 1
By inserting the detachable pipe 17a into the elongated hole 38 of the support member 16 in a state where 7a is bent inward in the radial direction (arrow direction in FIG. 10), the inner pipe 13 and the tip portion main body 15 are arranged coaxially. . And in this state, the detachable pipe 1
The bending of 7a returns and the tip side of the detachable pipe 17a is elongated hole 3
8 (see FIG. 6).
1)), the stepped portion 41 of the removable pipe 17a plays a role of preventing the inner pipe 13 and the tip portion main body 15 from being axially fixed. Further, in this fixed state, the inner pipe 13 and the obliquely cut surfaces 37a, 37b of the support member 16 are formed.
Since the two are abutted with each other without a gap, the rotation of the tip portion main body 15 with respect to the inner pipe 13 is also prevented.

Further, when the forceps 10 is inserted into the inner pipe 13 in this state, the forceps 10 is placed inside the removable pipe 17a because the outer diameter of the insertion portion 24 of the forceps 10 and the inner diameter of the removable pipe 17a are almost the same. Detachable pipe 17 when positioned
It is not possible to bend a. Therefore, the tip portion main body 15 does not come off from the inner pipe 13.

As shown in FIG. 12, a long groove 39b is also formed in the removable pipe 17b provided at the end of the inner pipe 13 on the handle 21 side. The detachable pipe 17b is formed such that its outer diameter is smaller than the outer diameter of the inner pipe 13, and has a step-shaped abutting portion 42. Further, a step portion 41b similar to the detachable pipe 17a on the tip body 15 side is formed at the tip of the detachable pipe 17b.

In this structure, the inner pipe 13 is inserted into the outer pipe 14 and the detachable pipe 17b is inserted.
When is fitted into the fixing hole 43 of the outer pipe 14, the inner pipe 13 is axially fixed by the abutting portion 42 and the step portion 41b of the detachable pipe 17b. However, the movement of the inner pipe 13 in the rotation direction is caused by the forceps 1 described above.
This is made possible by the engagement of the pin 26 on the 0 and the cam groove 19 of the inner pipe 13. In this case, the forceps 10 inserted into the inner pipe 13 prevents the inner pipe 13 from coming off from the outer pipe 14 as in the case of fixing the detachable pipe 17a.

Next, the annular thread fixing portion 18 (see FIG. 3) fitted to the outer circumference of the inner pipe 13 will be described in detail with reference to FIGS. 13 and 14. As shown, the thread fixing portion 18 cooperates with the leaf spring 47 to fix the suture thread 3. That is, a slit 46 is formed in the outer peripheral surface of the inner pipe 13 in the axial direction, and a leaf spring 47 having a width slightly narrower than the width of the slit 46 is fixed along the slit 46. The leaf spring 47 has its base end fixed to the spring fixing portion 49 and its tip folded back,
This folded back portion is a flat surface portion 48 that is substantially parallel to the axis of the inner pipe 13.

Further, a convex bending tendency protruding inward in the radial direction of the inner pipe 13 is given to a portion of the leaf spring 47 between the flat surface portion 48 and the spring fixing portion 49, and in a natural state, it is formed. The apex 50 projects radially inward of the inner pipe 13. Further, the annular thread fixing portion 18 fitted to the outer periphery of the inner pipe 13 is located outside the flat surface portion 48 of the leaf spring 47.

That is, in this structure, when the leaf spring 47 is forcibly pushed outward in the radial direction of the inner pipe 13, the suture thread 3 located between the flat surface portion 48 and the ring-shaped member 51.
Are clamped and fixed between them. Such a pushing-up operation of the leaf spring 47 is performed by the insertion portion 24 of the forceps 10. That is, the forceps 10 is placed inside the inner pipe 13.
, The leaf spring 47 is pushed up by the outer surface of the insertion portion 24 of the forceps 10, and the suture thread 3 is clamped and fixed between the flat surface portion 48 and the ring-shaped member 51 (state of FIG. 14). However, since the leaf spring 47 falls into the diameter reduction portion 44 of the forceps 10 when the length of the forceps 10 protruding from the knot forming member 1 is maximized, in this case (state of FIG. 13), The fixed state of the suture thread 3 is released,
The suture thread 3 can be pulled out freely.

The thread fixing portion 18 has an outer diameter slightly smaller than the inner diameter of the outer pipe 14, and is a guide for smoothly rotating the inner pipe 13 and the outer pipe 14 after assembling them. Also plays the role of.

Next, the method of using the ligature tool 52 will be described according to its procedure. First, a knot forming method using the ligature tool 52 of this embodiment will be conceptually described with reference to FIGS. 15 to 19.

As shown in FIG. 15, one pseudo loop 4 is formed by the arc portion 2 of the knot forming member 1 and the suture thread 3 arranged in the arc shape. In this case, the suture thread 3 is looped on the front side of the knot forming member 1. From this state,
By passing the free end 3a of the suture thread 3 into the pseudo loop 4 toward the front side, as shown in FIG.
a is formed. By removing the knot 6a from the knot forming member 1 and further tightening the knot 6a, the first knot 7 as shown in FIG. 19B is completed.

Thereafter, a knot having a entangled manner opposite to that of the first knot 7 is further formed so that a "male knot" having a high ligation strength is obtained.
(See (b) of FIG. 19) is completed, but in order to form this “male knot”, as shown in FIGS. 17 and 18, the free end 3 a of the suture thread 3 is set to the pseudo loop 4 as before. Must be inserted from different directions. That is, the suture thread 3 is looped on the other side of the knot forming member 1, and the free end 3a of the suture thread 3 is placed on the other side in the pseudo loop 4 formed by the arc portion 2 and the suture thread 3 arranged in the arc shape. The knot 6b is formed by passing the knot toward the second knot 8 (see (b) of FIG. 19).

By the above work, the knot called "male knot" is completed. The suture thread 3 is inserted into the pseudo loop 4 by the forceps 10 that moves back and forth inside the inner pipe 13 and the distal end body 15. Also, the tip body 1
By rotating the knot forming member 1 fixed to the forceps 10 with respect to the forceps 10, the pseudo loop 4 is easily formed and the knot 6 (6a, 6b) is dropped from the knot forming member 1.

When the knot forming member 1 is a loop-shaped member having one or more turns, the winding direction is determined, so that the second knot 11 is entangled in the same direction as the first knot 7. Only "woman knot" can be made (see (a) of FIG. 19). Therefore, in order to make a “male knot”, the knot forming member 1 needs to have a shape (arc shape) in which a part of one loop is cut out, and the winding direction thereof is arbitrarily determined at the time of use. It is a condition to do so. With such a shape, the knot 6 formed in the circular arc portion 2 of the knot forming member 1 can be dropped from the lacking portion of the loop.

Next, the case of actually ligating a blood vessel using the ligature tool 52 of this embodiment will be described with reference to FIGS. First, as a preparation before use, prepare the tip portion main body 15 in which the suture thread 3 is preset,
A new tip body 15 is attached to the inner pipe 13 each time it is used. Of course, only the suture thread 3 may be set on the tip portion main body 15 each time it is used.

The suture thread 3 has a length of several tens of centimeters so that it can be ligated at a plurality of points. The suture thread 3 on the thread outlet 53 side of the knot forming member 1 is passed through the thread fixing portion 18 and the flat surface portion 48 of the leaf spring 47, and is inserted into the outer pipe 14 while being wound around the inner pipe 13. This allows suture 3
Is stored between the inner pipe 13 and the outer pipe 14, so that the suture thread 3 is not affected even when the ligature tool 52 is moved / rotated. When the forceps 10 is inserted into the inner pipe 13 from the forceps insertion port 29 in this state, the suture thread 3 is fixed as described above, and the preparation before use is completed.

Next, as shown in FIG. 20, the tubular tissue 54 such as a blood vessel is separated and exposed by the forceps 10. This time,
A high-frequency current is passed through the forceps 10 as needed. Once pulling the forceps 10 toward the front side of the knot forming member 1, while grasping the free end 3a of the suture thread 3 with the other forceps 55 (see FIG. 21), the knot forming member 1 is moved forward by moving the forceps 10 again. The pseudo loop 4 is formed by rotating (FIG. 22).
reference). At this time, the suture thread 3 is made to come to the front side of the knot forming member 1. Further, the forceps 10 is advanced, and in this state, the free end 3a of the suture thread 3 is grasped by the forceps grasping portion 23. If the length of the suture thread 3 is short, another forceps 55
The suture thread 3 may be pulled out to set the length (this operation may be performed before inserting the ligature tool 52 into the body).

Next, pass the suture thread 3 through the back side of the tissue 54,
Again, the free end 3a of the suture thread 3 is grasped by the forceps 10, the ratchet 27 is hung, and the forceps 1 is retained while maintaining this grasped state.
0 is drawn into the inner pipe 13 (see FIG. 23). At this time, the knot 6a is formed on the arc portion 2, but since the knot forming member 1 rotates, the knot 6a can be dropped through the arc portion end 36 (see FIG. 24).

Then, one end of the suture thread 3 is guided by the spiral end surface 33 of the support member 16 and one end of the suture thread 3 is cut out.
Guided to 5. Since the suture thread 3 is fixed by the thread fixing portion 18, the first knot 7 is completed by further pulling and tightening the knot 6a (see FIG. 25).

From this state, the forceps 10 is again advanced to pass the forceps 10 holding the suture thread 3 from the front side of the pseudo loop 4b (FIG. 26: the suture thread 3 forming the pseudo loop 4b at this time). Should be positioned on the other side of the knot forming member 1.), and the suture thread 3 is delivered to the other forceps 55 (see FIG. 27).

Thereafter, the forceps 10 are pulled in to rotate the knot forming member 1 to remove the knot 6b (see FIG. 28), and the second knot 8 is tightened with the other forceps 55 and the ligature tool 52 (FIG. 28). 29).

With the above, the "male knot" is completed, but the above-mentioned procedure is repeated as necessary to obtain the third knot and the fourth knot.
Nodules may be formed. When the ligation at one place is completed in this way, the suture thread 3 can be cut while leaving the ligation site (A in FIG. 29) to return to the initial state again, so that the ligature tool 52 remains in the body. The ligation can be repeated many times.

As described above, the ligature tool 5 of this embodiment
According to 2, "male knot" that is difficult to loosen by simple operation
Can be formed. Further, since it has a gripping means for gripping the thread, the peeling work and the ligation work can be performed at one time with only one ligature tool 52. further,
Since the knot forming member 1 has a shape (arc shape) in which a part of one loop is cut out, the knot 6 formed in the arc portion 2 of the knot forming member 1 can be easily detached from the lacked part of the loop. You can Therefore, the ligation work can be efficiently performed.

FIG. 30 shows a second embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment. The knot forming member 1 of the present embodiment is formed of a solid bar material and has an arc portion 2 and a straight portion 56. In addition, a hole 59 through which the suture thread 3 can be inserted is formed in the arcuate end 36 of the knot forming member 1, and the suture thread 3 is passed through the hole 59 and tied. A suture needle 57 is provided at the other end of the suture thread 3.
The suture thread 3 has almost the same length as the straight portion 56 of the knot forming member 1, and is long enough to ligate in the procedure of the first embodiment. In addition, at the end of the inner pipe 13,
Notch groove 35 and spiral end surface 33 as in the embodiment of
Is not formed.

A needle holder 58 as forceps is inserted inside the inner pipe 13 so as to be able to move back and forth. Therefore, the suturing work can be performed. At the time of use, the tip portion main body 15 with the needle thread may be prepared in advance and replaced for each needle, or the suture thread 3 may be tied to the thread insertion hole 59 for each needle. . The material of the knot forming member 1 may be a super elastic alloy or a shape memory alloy. According to the above configuration, the same operational effect as that of the first embodiment can be obtained, and the suturing work can be performed.

FIG. 31 shows a third embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment. In the knot forming member 1 of the present embodiment, the surface forming the arc portion 2 has an angle α with respect to the axis of the support portion 16, and the center of the arc portion 2 is located closest to the tip end side. When forming the pseudo loops 4a and 4b, this α is determined to be an angle that makes it easy to set the positional relationship between the suture thread 3 and the knot forming member 1 correctly and easily, but the approximate range is 6
0 ° <α <120 °.

A thread outlet 53 is provided in the vicinity of the arc starting point portion 31, and the suture thread 3 is inserted from the thread discharging portion 32 and pulled out from the thread outlet 53. After that, a thread ball 60 larger than the thread outlet 53 is made on the drawn suture thread 3, and the knot forming member 1
Do not let go out.

According to the above construction, the same operational effect as that of the first embodiment can be obtained, and the positional relationship between the suture thread 3 and the knot forming member 1 can be easily set to a desired relationship. it can.

32 and 33 show a fourth embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment. In the present embodiment, the second forceps 61 is inserted inside the outer pipe 14 in parallel with the first forceps 10 so as to be movable back and forth. As shown, the second forceps 61
Are designed to pass through the outside of the arcuate portion 2 of the knot forming member 1. The grip portion of the forceps 61 is curved toward the forceps 10 side so that the suture thread 3 can be delivered between the forceps 10 and the forceps 61.

FIG. 33 shows a state in which the suture thread 3 is hung on the tubular tissue 54. As shown in the drawing, while the pseudo loop 4 is formed, the distal end 3a of the suture thread 3 is grasped by the forceps 61, passed through the back side of the tubular tissue 54, and the forceps 10 is advanced to fix the free end 3a of the suture thread 3. It is received by the forceps 10.

Subsequent work is performed in the same procedure as in the first embodiment. That is, after forming the second knot 6b, the free end 3a of the suture thread 3 is delivered to the forceps 61 and the second knot 8 is tightened to form a "male knot".

According to the above construction, the same operational effect as that of the first embodiment can be obtained, and the other forceps 55 can be obtained.
The ligation can be performed without the assistance of. 34 and 35 show a fifth embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment.

FIG. 34 shows the entire ligation tool of this embodiment. As illustrated, the knot forming member 1 is assembled directly to the inner pipe 13, and the straight portion 56 of the knot forming member 1 is connected to the second handle 62 on the proximal side. When the second handle 62 is moved back and forth, the knot forming member 1 advances and retracts in the inner pipe 13 (see FIG. 35). Therefore, the work of tightening the first knot 7 can be performed by pushing out the second handle 62.

The suture thread 3 is fixed by tying one end of the suture thread 3 to the thread insertion hole 59 provided at the arcuate end 36, as in the second embodiment. FIG. 36 shows a sixth embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment.

The knot forming member 1 of this embodiment is fixed to the inner pipe 13. Since the tip of the arc portion 2 is sharp, the arc portion 2 can be inserted into the living tissue 65 without resistance. Further, in order to prevent the suture thread 3 from being cut by the sharp tip portion 63, the thread discharge portion 32 is provided at the arc end 3
Does not match 6

The procedure of use is as follows. First, the sharp tip portion 63 is directly inserted into the tissue 65 to be sutured, and the thread discharge portion 32 is completely penetrated into the tissue 65 (see FIG. 36 (b)). The suture thread 3 in the vicinity of the thread discharge part 32 is grasped by the forceps 55, and the free end 3a of the suture thread 3 is pulled out from the tissue 65. Next, while holding the free end 3a of the suture thread 3 with the forceps 55, the circular arc portion 2
Are removed from the tissue 65. Hereafter, ligation can be performed by the same procedure as in the first embodiment.

FIG. 37 shows a seventh embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment. The knot forming member 1 is fixed to the inner pipe 13. Further, a thread fixing pipe 66 that can move forward and backward is provided between the inner pipe 13 and the outer pipe 14. An abutting member 68 is fixed to the inner pipe 13 so as to face the end surface of the thread fixing pipe 66. The suture thread 3 is sandwiched and fixed between the thread fixing pipe 66 and the butting member 68. A mesh-shaped groove is formed in the thread fixing surfaces of the thread fixing pipe 66 and the abutting member 68 so that the suture thread 3 does not slip. The yarn fixing pipe 66 is moved by the operating means on the hand side.

FIG. 38 shows an eighth embodiment of the present invention. It should be noted that, except for the points described below, it is the same as the first embodiment. The knot forming member 1 is not removable. At the tip of the inner pipe 13, a swivel unit body 71 that can swivel around the pin 70 is provided. Swivel body 71
The knot forming member 1 is fixed to the tip of the. Therefore, the angle formed by the surface of the arc portion 2 and the axis of the inner pipe 13 changes with the turning of the turning portion main body 71. The turning operation of the turning portion main body 71 is performed by the operation rod 69 extending from the hand. According to this embodiment, the pseudo loop 4
It becomes easy to make a correct positional relationship between the knot forming member 1 and the suture thread 3 when making a tie.

The configurations described above can provide various configurations shown in the following paragraphs. 1. A thread hook including an elongated pipe having a proximal end and a distal end, an arc-shaped member provided at the distal end of the pipe, and a suture thread arranged on the arc of the arc-shaped member. An elongated rod having a proximal end and a distal end, and a forceps member provided at the distal end of the rod with grasping means capable of grasping the free end of the suture, wherein the forceps member is the pipe. A ligature, wherein the forceps member is inserted into the interior of the body so as to be freely retractable and rotatably inserted, and the forceps member is inserted into a pseudo loop formed by the arc-shaped member and the suture thread.

2. The pipe is provided at its distal end with a long groove (width of which allows a knot to be successfully formed) through which the suture can be passed, and on the center line of the long groove, the arc-shaped member of the arc-shaped member is provided. The ligature according to item 1, wherein the terminal is located.

3. The ligature according to the first aspect, wherein the arcuate portion of the arcuate member and the end surface of the pipe are located with a distance of about 40 mm. 4. The ligature according to the third aspect, wherein the arc portion of the arc-shaped member and the pipe relatively move in the axial direction.

According to the configurations of the second to fourth items,
When pulling the forceps 10 into the pipe 9 and tightening the first knot 7, the suture thread 3 does not hit the end surface of the pipe 9. Therefore, both ends of the knot can be reliably pulled in the correct direction. Thereby, ligation with high strength can be performed.

5. The ligature tool according to any one of claims 1 to 4, wherein the pipe and the arc-shaped member rotate in accordance with the advance / retreat of the gripping means to form the pseudo loop.

6. The pipe has a groove on the inner surface, and when the gripping means is moved back and forth, a pin provided on the outer peripheral surface of the rod of the gripping means slides along the groove, and at that time, the pin is closer than the arc-shaped member. 6. The ligature tool according to claim 5, wherein the positional relationship between the pin and the groove is determined so that the pipe rotates on the proximal end side to form the pseudo loop.

According to the configurations of the fifth and sixth terms,
By moving the forceps 10 back and forth, pseudo loops 4a, 4
b is formed and the knots 6a and 6b are removed from the arc portion 2. That is, when forming a pseudo loop and when removing the knot from the arc-shaped member, it is necessary to rotate the arc-shaped member, but since the pipe rotates as the forceps move forward and backward, a rotation operation unit is provided. Eliminates the need, resulting in easier handling.

7. The ligating instrument according to claim 1, wherein the arc-shaped member is made of a hard hollow material, both ends of which are open, and the inner diameter thereof is larger than that of the suture thread. According to the configuration of the seventh item, by passing the suture thread 3 through the inside of the arc-shaped member 1, the suture thread can be easily arranged near the end of the arc portion.

8. The ligature according to the first aspect, wherein the arc-shaped member is made of a flexible tube, both ends of which are open, and the inner diameter of which is larger than that of the suture thread. According to the construction of the eighth item, by passing the suture thread 3 through the inside of the arc-shaped member 1, the suture thread can be easily arranged in the vicinity of the end of the arc portion. Further, since the arcuate portion 2 is linearized by pulling the suture 3, the rotating operation is not required even when the knot is dropped from the arcuate portion.

9. The ligature tool according to claim 1, wherein the arc-shaped member is a rod-shaped member, and a means for fixing the suture thread is provided at an end of the arc-shaped portion.
According to the configuration of the ninth item, the suture thread 3 is attached to the tip of the arc portion 2.
Since it can be attached, the same state as when the suture thread 3 is ejected from the thread discharge part 32 can be created. Therefore, the suture thread can be easily placed at the tip of the arcuate portion, and the suture thread does not need an extra length, so that there is no waste.

10. 10. The ligature according to claim 9, wherein the arc-shaped member is made of a shape memory alloy. According to the configuration of the tenth item, for example, the pseudo loops 4a and 4b
When making, the shape becomes an arc shape, and when the knots 6a and 6b are dropped from the arc portion 2 and tightened, the knots 6a and 6b are made straight, so that a desired shape can be made.

11. 10. The ligature according to claim 9, wherein the arc-shaped member is made of a superelastic alloy. This first
According to the configuration of the item 1, the arcuate member 1 bends when the knots 6a and 6b are tightened. ...... A considerable force is applied to the arc-shaped member when tightening the knot. If the strength of the arc-shaped member is insufficient, plastic deformation may occur, but this can be prevented by using a superelastic alloy.

12. When the tip of the grip of the grip is off the axis and the grip penetrates the arc-shaped member, the tip of the grip is about 90 degrees from the end of the arc-shaped member about the axis of the grip. The ligature according to any one of the first, fifth or sixth paragraphs, wherein the ligature is located in the direction of.

According to the structure of the twelfth item, the forceps 10 can be passed through the pseudo loops 4a and 4b which do not have a sufficient size. The same effect can be obtained even if the tip of the forceps can penetrate the pseudo loop that is not sufficiently large. It is conceivable that pseudo loops of various sizes are formed during actual use, but by doing so, the forceps can be reliably passed through the pseudo loop.

13. The ligature according to item 1, wherein the arc-shaped member is detachable from the pipe. According to the configuration of the thirteenth item, the arc-shaped member 1 can be replaced each time it is used. If an arc-shaped member to which a suture thread is attached is prepared in advance, it is only necessary to replace this with each use, and the labor of attaching the suture thread can be saved. Further, when it is necessary to replace the arc-shaped member due to deformation, it is sufficient to replace only this portion, which is economically advantageous.

14. Second having an axis parallel to the gripping means
Is located outside the pseudo loop, moves in the axial direction relative to the thread hooking device, protrudes and retracts from the pseudo loop, and the first gripping means and the suture thread are arranged before and after the pseudo loop. The ligation tool according to item 1, wherein a positional relationship for delivering the ligature is created.

According to the construction of the fourteenth item, the suture thread is delivered by the forceps 10 inside the pipe 9 and the second forceps. ...... The ligation work can be performed without the assistance of other forceps. Therefore, since the difficult two forceps are not coordinated, the operability is improved. Furthermore, since the number of holes to be opened in the body can be reduced, the invasion of the patient can be reduced.

15. 9. The ligature according to any one of items 7 and 8, characterized in that a fixing means for the suture is provided at a proximal end of the pipe. According to the construction of the fifteenth aspect, the suture thread 3 is released when the suture thread 3 is supplied and is fixed when the knot is tightened. If the suture is used as a fixing means, the knot can be tightened, and if the suture is released, the thread can be supplied.

16. The suture needle is attached to the tip of the suture thread, and the ligature tool according to the first aspect is characterized in that. 17． The ligature tool according to Item 16, wherein the forceps member is a needle holder.

According to the constitutions of the 16th and 17th items, it is possible to sew tissues together, and the application is expanded. 18. The ligature according to any one of items 7 and 8, wherein a thread insertion hole is provided in the vicinity of the arc starting point of the arc-shaped member.

According to the construction of Item 18, the suture thread 3 is inserted from the thread discharge portion 32 and pulled out from the thread insertion hole 59 near the arc starting point 31. Or vice versa. ...... The shorter the suture passage of the arc-shaped member, the easier it is to insert the suture. Therefore, by providing the thread outlet at the arc starting point, the suture thread can be inserted more easily.

19. 7. The ligature tool according to claim 6, wherein a plane formed by the arc portion of the arc-shaped member and an axis of the forceps member form an angle of 60 degrees to 120 degrees. According to the construction of Item 19, when the arcuate member 1 is rotated, the positional relationship between the suture thread 3 and the arcuate portion 2 is determined.
When performing male knotting by the method of the present invention, it is necessary to change the positional relationship between the suture thread and the arc-shaped member in the pseudo loop of the first knot and the pseudo loop of the second knot. By making an angle on the surface formed by the arc part or making it variable,
It is possible to easily make a correct positional relationship.

20. The ligature according to the first aspect, wherein a tip of an arc portion of the arc-shaped member is sharp. According to the structure of this twentieth item, it is possible to suture tissues together, and the application is expanded.

21. The ligation instrument according to claim 1, further comprising means for changing an angle formed by a plane formed by the arc portion of the arc-shaped member and an axis of the pipe.
According to the construction of the twenty-first paragraph, when the arcuate member 1 is rotated, the positional relationship between the suture thread 3 and the arcuate portion 2 is determined. ......
When the male knot is performed by the method of the present invention, the positional relationship between the suture thread and the arc-shaped member needs to be changed between the pseudo loop of the first knot and the pseudo loop of the second knot. By forming an angle on the surface formed by the arc portion or by making it variable, it is possible to easily form a correct positional relationship.

22. 22. The ligature according to any one of items 1 to 21, wherein there is an outer cylinder that covers the pipe, and only the rotational movement is possible with the pipe. According to the structure of this 22nd term, although it does not move in the axial direction with respect to the pipe 9, it can rotate. ...... When rotating the pipe with respect to the forceps, if some resistance is applied to the pipe, smooth rotation cannot be obtained. This problem can be solved by providing a rotatable outer cylinder that covers the pipe.

23. 23. The ligature tool according to any one of items 1 to 22, wherein the suture thread is housed between the pipe and the outer cylinder. According to the configuration of this Item 23, the suture thread 3 does not come into contact with anything other than the main ligature. Store long sutures. The suture may be pulled by a guide tube to the body tissue or body cavity during operation, but this can be prevented by storing it between the outer cylinder and the pipe. Further, since a long suture can be stored, it can be used for ligating at several places.

24. 24. The ligature tool according to any one of items 1 to 23, wherein fixing means for the suture thread is provided between the pipe and the outer cylinder. 25. 25. The ligature tool according to any one of items 1 to 24, wherein the thread fixing means fixes and releases the suture thread in accordance with the advance and retreat of the grasping means.

According to the configurations of the 24th and 25th items, the suture thread 3 is released when the suture thread 3 is supplied, and is fixed when the knot is tightened. If the suture is used as a fixing means, the knot can be tightened, and if the suture is released, the thread can be supplied. Furthermore, by releasing and fixing the forceps as they move forward and backward, the number of operating parts can be reduced,
The operation becomes easy.

26. The suture is released when the grasping means has a maximum protrusion length from the arc-shaped member,
The ligature according to any one of items 1 to 25, which is fixed at other positions.

According to the construction of Item 26, the suture thread 3 is released when the amount of protrusion of the forceps 10 from the arc-shaped member 1 is maximum, and is fixed at other positions. By making the maximum amount of protrusion of the forceps equal to the optimal length of the suture, it becomes easier to determine the length of the suture to be drawn out .............. If the suture is fixed, the knot can be tightened. The yarn can be supplied by releasing the. In addition, release
By fixing the forceps as the forceps move forward and backward, the number of operating parts can be reduced and the operation becomes easier.

27. A first step of peeling off tubular tissue with a forceps member of a ligature tool, and a suture thread set on the knot formation member by rotating the arc portion of the knot formation member of the ligature tool in one direction by advancing the forceps member. And a second step of forming a pseudo loop by the arc portion of the knot forming member and inserting the forceps member into the pseudo loop, and a third step of passing the free end of the suture thread forming the pseudo loop to the back side of the peeled tubular tissue And the fourth step of grasping the free end of the suture thread passed through the back side of the tubular tissue by the forceps member having the pseudo loop inserted therein, and the suture thread grasped by the forceps member by retracting the forceps member. The fifth step of forming the first knot by passing the free end of the knot into the pseudo loop, and further retracting the forceps member to rotate the arc portion of the knot forming member in the opposite direction. 6th step of dropping the knot from the arcuate portion, and 7th step of tightening the 1st knot to form the 1st knot by further retracting the forceps member as it is, and the suture with the forceps member. An eighth step of performing a second step while holding the second knot to form a second knot that is entangled in a direction opposite to the first knot;
A ninth step of delivering the free end of the suture to another forceps, a tenth step of retracting the forceps and rotating the arc portion of the knot forming member in the opposite direction to drop the second knot, An eleventh step of forming a male knot by forming a second knot by tightening the second knot.

[0106]

As described above, in the ligature of the present invention, since the arcuate portion of the knot forming member forms a single loop, the winding direction is not determined, thus forming a "male knot". can do.

Further, a part of the loop is cut out in the arc portion of the knot forming member. Therefore, the knot formed in the arc portion of the knot forming member can be easily dropped from the portion lacking the loop. . Therefore, the ligation work can be efficiently performed. Further, since it has a gripping means for gripping the suture thread, the peeling work and the ligation work can be performed at one time with this single ligature tool.

[Brief description of drawings]

FIG. 1 is an overall view of a ligature according to a first embodiment of the present invention.

FIG. 2 is an overall view of a thread hooking tool that constitutes the ligation tool of FIG.

FIG. 3 is an exploded view of the thread hooking device of FIG.

FIG. 4 is an overall view of forceps constituting the ligation tool of FIG.

FIG. 5 is a view showing a state in which forceps are projected from an arc portion of the thread hooking device.

FIG. 6 is a diagram showing in detail a tip end main body of the thread hooking device of FIG. 2;

FIG. 7 (a) is a front view showing a state before the forceps have passed through the circular arc portion of the thread hook, and FIG. 7 (b) is a side sectional view in the state of (a).

8A is a front view showing a state in which forceps are passing through an arc portion of a thread hook, and FIG. 8B is a side sectional view in the state of FIG. 8A.

FIG. 9A is a front view showing a state immediately before the distal end portion of the forceps is inserted into the pseudo loop, and FIG. 9B is a view showing the pseudo loop formed by the circular arc portion and the suture thread.

10 is an enlarged view of a tip portion of an inner pipe that constitutes the thread hooking device of FIG.

FIG. 11 is a sectional view of the tip side in a state where the tip body and the inner pipe are connected.

FIG. 12 is a sectional view of a proximal end side in a state where an outer pipe and an inner pipe are connected to each other.

FIG. 13 is a cross-sectional view around the thread fixing portion in the thread fixing released state of the thread hooking tool of FIG. 2;

FIG. 14 is a cross-sectional view around the thread fixing portion in the thread fixing state of the thread hooking tool of FIG.

FIG. 15 is a diagram showing a first stage of forming a first nodule.

FIG. 16 is a diagram showing a second stage of forming the first knot.

FIG. 17 is a diagram showing a first stage of forming a second nodule.

FIG. 18 shows a second stage of forming a second nodule.

19A is a diagram showing a female knot, and FIG. 19B is a diagram showing a male knot.

FIG. 20 is a diagram showing a state in which tubular tissue is peeled off with forceps.

FIG. 21 is a diagram showing a state in which the free end portion of the suture is held by another forceps.

22 is a diagram showing how a pseudo loop is formed from the state of FIG. 21. FIG.

FIG. 23 is a diagram showing a state in which a suture is passed through tissue and the free end of the suture is grasped by forceps.

FIG. 24 is a view showing a state in which a free end portion of a suture grasped by forceps is inserted into a pseudo loop to form a first knot.

FIG. 25 is a diagram showing a state in which the first knot is formed by dropping the first knot from the knot forming member.

FIG. 26 is a view showing a state in which the free end portion of the suture thread is further inserted into the pseudo loop while being held by the forceps from the state of FIG. 25.

FIG. 27 is a diagram showing how to form a second knot.

FIG. 28 is a view showing a state in which the second knot is formed by dropping the second knot from the knot forming member.

FIG. 29 is a view showing a state in which the first knot and the second knot are tightened to form a male knot.

FIG. 30 is a view of the distal end portion of the ligation tool showing the second embodiment of the present invention.

FIG. 31 is a view of the distal end portion of the ligation tool showing the third embodiment of the present invention.

FIG. 32 is a view of the distal end portion of the ligature showing the fourth embodiment of the present invention.

FIG. 33 is a view showing a state in which a suture is wound around the back of the tubular tissue using the ligation tool of FIG. 32.

FIG. 34 is an overall view of a ligating tool showing a fifth embodiment of the present invention.

FIG. 35 is a view showing an operation mode of the ligation tool of FIG. 34.

FIG. 36 (a) is a view of the distal end portion of the ligation tool showing the sixth embodiment of the present invention, and FIG. 36 (b) is the ligation tool of FIG. It is a figure which shows the state which was done.

FIG. 37 is a view of the distal end portion of the ligation tool showing the seventh embodiment of the present invention.

FIG. 38 is a view of the distal end portion of the ligation tool showing the eighth embodiment of the present invention.

[Explanation of symbols]

1 ... Knot forming member, 2 ... Arc part, 3 ... Suture thread, 10 ...
Forceps (forceps member), 13 ... Inner pipe (tubular member), 1
4 ... Outer pipe, 23 ... Gripping part, 52 ... Ligation tool.

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[Procedure amendment]

[Submission date] November 29, 1995

[Procedure Amendment 1]

[Document name to be amended] Statement

[Name of item to be corrected] 0015

[Correction method] Change

[Correction content]

Further, in the case of German Patent DE3413744C2, it is difficult to pass the thread with the needle through the coil portion, and in order to drop the knot from the coil portion, the number of windings of the coil portion through which the thread with the needle passes is reduced. Only the long member needs to be rotated, and the work is very troublesome.

Claims (1)

[Claims] 1. A long tubular member that can be inserted into a living body, and an arc portion that is provided at the tip of the tubular member and has a shape in which a part of a closed loop is cut out, and has a suture set therein. A possible knot forming member, a forceps member that is inserted into the tubular member rotatably and rotatably, and has a gripping means that can hold a suture at the tip, and that can be inserted into the loop of the arc portion. A ligature, characterized by being provided.