JPH09224946A - Suturing/ligating device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To firmly suture or Iigate living organs such as vessels and to miniaturize a suturing/ligating tool. SOLUTION: This suturing/ligating device, which is attached to living organs by deforming into a predetermined shape a suturing/ligating tool used in the suture, ligation, etc., of living organs, is formed into an approximately U shape comprising two approximately parallel legs 2 and a first end connecting the legs together. The device has an attaching means 2 for deforming and attaching the suturing/ligating tool 12 in which the two legs are formed approximately parallel to the first end, the opposite surfaces of the two legs of the suturing/ ligating tool being held in a close and appoximately parallel relation to each other by the attaching means 2, with at least portions of the first end sides of the two legs being not close to each other so that the suturing/ligating tool 12 is deformed in such a way as to create a space surrounded by the two legs and the first end.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention is mainly used in surgery and is used for suturing and ligating living tissues.
The present invention relates to a suturing / ligating device for attaching a ligature to a living tissue by deforming the ligature into a predetermined shape.

[0002]

2. Description of the Related Art Conventionally, suturing and ligation of a living tissue has been performed with a needle thread or a clip or staple made of metal or resin. Among these, metal clips and staples are USP 3,32 when ligating a blood vessel such as a blood vessel.
Clips having the shape of 6,216 were used, and staples having the shape of USP 3,643,851 were used when suturing the tissue, and each staple was attached to the living tissue by a dedicated applier. Also, along with current clips and staples, USP 4,325,376 and U
A continuous fire applier such as SP3,643,851 is generally used.

[0003]

In these conventional techniques, a clip for ligating a blood vessel such as a blood vessel is USP.
No. 4,325,376, it was attached by compressing and deforming the leg portion of the clip from the outer periphery by the jaws, but due to the method of deforming the clip that compresses the leg portion from the outer periphery, it is inevitable. The structure of the pliers had to be complicated.

Furthermore, since the structure of the applier is complicated, it is difficult to make the insertion diameter thin, especially when it is used in endoscopic surgery, and the diameter is generally 10 mm or more. Insertion diameter of the treatment tool is φ5
Although it is about mm, it is twice as thick, and the advantage of endoscopic surgery, which is minimally invasive, is impaired because a hole having that thickness is opened in the human body. In addition, since the deformation method is such that the jaws pinch, the jaws may directly grasp the vascular vessel and damage it when the clip is not loaded. Alternatively, the clip has a high probability of failure due to a complicated structure, and the clip may be clogged inside.

The complicated structure leads to an increase in cost, resulting in a surge in medical costs, and a problem of dust at the time of disposal due to the use of many resin and metal parts. The negative effects of the above cannot be ruled out, and since these are generally disposable products, their effects were large.

Further, in the case of USP 3,643,851, the structure is simpler than that of a clip, and even if the staple is not loaded, the operation thereof does not damage the tissue, but Due to the shape of the staple, the tissue could be sutured but the vessel could not be ligated.

Further, in the stapler such as USP 3,643,851, the holding member for holding the staple loaded in the attaching means is provided at the tip of the attaching means, but the holding member is the attaching means. Since it is exposed from the tip of the, it may come into contact with living tissue.

Further, in the stapler of USP 3,643,851 and the like, since there is no guide for holding the vessel, the stapled shape can be stapled together with the deformed form of the staple. The tube could not be stapled. Also, USP4
In the case of clip appliers such as 325 and 376, the jaw member that engages the clip with the vessel is not transparent, so that there is also a problem that the state of the vessel during the attaching operation is not clearly understood.

In the stapler like USP 3,463,851, when the staple is sandwiched between the holding member and the pusher for sandwiching and deforming the staple, the stapler is simply sandwiched. Since it is only there, the direction of the staple will change due to the disturbance.

Appliers as in the prior art have shown their worth especially in fields where it is difficult to suture and ligate with a needle thread, such as endoscopic surgery. In the prior art, a ratchet mechanism that distributes the operation stepwise is provided inside the operating means, but the mechanism is complicated and is likely to cause a cost increase and a failure.

Further, since the endoscope means generally has a circular cross section, it is necessary to arrange the pusher, which requires the largest width, at the center of the longitudinal axis of the pusher so as to reduce the diameter of the endoscope means. Was effective to do.

USP 3,326,216 and USP
4,844,066 or USP 4,325,376
In the case of a clip such as the one described above, the size of the clip is unnecessarily large because the base end portion of the clip has a substantially triangular shape in order to reduce the amount of force required for its deformation as described above. There is a problem that an unnecessarily large residue is left inside the living body, or many clips cannot be stored inside the applier.

That is, as shown in FIGS. 23 and 24, since the conventional suturing / ligating device 51 is left in the living body, it is not toxic to the living body, and Ti for securing the anti-artifact property of MRI is secured. Manufactured from titanium materials such as alloys. Generally, in order to ligate the vessel 50 having the diameter D, the length of the leg portion 52 needs to be about twice as long. Also, of course, the above 2
The distance L ₁ between the leg portions 52 of the book must be L ₁ ≧ D. Here, in the case of the prior art, the suture / ligature tool 51
In order to make it easy to deform, the base end portion 53 has a substantially triangular shape with an angle θ. Therefore, the total length is L ₂ + mco
It is sθ.

When the appliers are stored in a permuted state, as shown in FIG. 24, an unnecessary length of n is required for every two suturing / ligating tools 51, and the number of suturing / ligating tools 51 is reduced. As the number increases, the length increases, and as a result, the number of suture / ligature tools 51 that can be stored in the storage section decreases. In the advanced endoscopic surgery called the advanced procedure which is performed recently, more sutures / ligatures 51 are required than the 20 sutures / ligatures 51 stored in the conventional applier. However, it is rare that about 30 pieces are required.

However, as described above, the conventional technique can generally store only 20 pieces.
You will use the book applier. However, since appliers are generally disposable, the remaining 10 or more suturing / ligating tools 51 of the second applier are wasted.

The present invention has been made in view of the above circumstances, and the purpose thereof is that it is structurally simple, the insertion diameter can be made small, and the living tissue can be reliably sutured and ligated. It is to provide a suture / ligation device.

[0017]

In order to achieve the above-mentioned object, the present invention attaches to a biological tissue by deforming a suture / ligature tool for suturing / ligating the biological tissue into a predetermined shape. In the suturing and ligating device for use in the above, a substantially U-shaped body is formed having two legs in a substantially parallel state and a base end portion connecting the legs. It has a mounting means for deforming and mounting the suturing / ligating tool formed substantially perpendicular to the end, and the facing surfaces of the two legs of the suturing / ligating tool are close to each other by the mounting means. The two legs are in a substantially parallel state, and at least a part of the two legs has a portion where the two legs do not come close to each other, and is surrounded by the two legs and the base end. It is characterized in that it is deformed to have a space.

[0018]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings. 1 to 22 show the first embodiment. FIG. 1 shows an applier 1 for attaching a suture / ligature tool, which is a clip or staple, to living tissue, which will be described later. The applier 1 is a mounting means 2 for deforming the suture / ligature tool, and a trocar (not shown) for the mounting means 2. It is composed of an insertion portion 3 which is an endoscope means for inserting it into a living tissue via the above, and an operation means 4 for operating the attachment means 2. Further, the insertion portion 3 is rotatable with respect to the operation means 4, and a knob 5 for performing the rotation operation is provided at a joint portion with the operation means 4 on the proximal side of the insertion portion 3. .

As shown in FIG. 2, the insertion portion 3 is divided into a substantially transparent upper insertion member 6 and a lower insertion member 7 which are substantially transparent.
And is assembled by coating the outer tube 8 after combining them. The outer tube 8 is formed of a transparent heat-shrinkable tube so that the inside of the insertion portion 3 can be confirmed.

As shown in FIG. 1, the operating means 4 comprises a movable handle 9 and a fixed handle 10. By rotating the movable handle 9 with respect to the fixed handle 10, the operating means 4 can be operated. It can be carried out.

A lid 11 is attached to the upper portion of the fixed handle 10 of the operating means 4, as will be described later.
By opening and closing the lid 11, the insertion section 3 can be attached to and detached from the operating means 4, and the inside of the operating means 4 can be washed and sterilized.

Next, the structure of the mounting means 2 is shown in FIGS. The attachment means 2 has a guide member 13 at the tip that serves as a guide when the suture / ligature tool 12 is attached, and the suture / ligature tool 12 is loaded inside the guide member 13. The operation of loading the suture / ligature tool 12 and attaching it to the living tissue is performed by the pusher 14 as described later.

The guide member 13 is provided with a support pin 15 for supporting the suturing / ligating tool 12 when the suturing / ligating tool 12 is attached, whereby the suturing / ligating tool 12 is supported without falling off forward. . In the prior art, since the guide member 13 is not provided and the suture / ligature tool 12 cannot be securely held, two support pins 15 are provided at intervals, so that the distance between the leg portions 12a of the suture / ligature tool 12 is set to a leg. Although it was relatively wide with respect to the entire length of the portion 12a, the number of legs is 12 in the present embodiment, so the distance between the legs 12a can be made relatively small, which is very effective for ligating a blood vessel. The outer shape of the guide member 13 and the outer diameter of the insertion portion 3 can be reduced, which is effective in terms of minimally invasiveness.

Generally, the outer diameter of the insertion portion 3 of the applier 1 for attaching the suture / ligature tool 12 to the living tissue is φ10 to 1
Although it is 2 mm, in the case of the present embodiment, it is sufficient to secure 7 mm, which is a width necessary to store the suturing / ligating tool 12 to be used, by the simple structure as described above. 6 and the lower insertion member 7 each have a thickness of 0.5 mm, and the insertion portion 3 has an outer diameter of 8 m.
has achieved m. In the prior art, the support pin 1
Although 5 is projected from the tip of the attachment means 2 and the risk of damaging the living tissue cannot be ignored, in the present embodiment, since it is stored inside the guide member 13, there is no risk of touching the living tissue. .

The guide member 13 has a support pin 15
Since the guide member 13 may be made at least partially transparent so that the suturing / ligating operation can be easily seen, since it is not necessary to have such strength except for the portion where is provided, it contributes to safe / reliable suturing / ligating. So I ’m going to use Applier 1
The safety of is improved.

With the support pin 15, the pusher 14 is used to deform the suture / ligature tool 12 into a predetermined shape when the suture / ligature tool 12 is attached to a living tissue.
The concave portion 16 is provided in the. After attaching the suture / ligature tool 12 to the living tissue, an ejector 17 for discharging from the applier 1 is attached to the lower part of the suture / ligature tool 12 inside the guide member 13.

The guide member 13 is fixed to the lower insertion member 7 constituting the insertion portion 3 by a pin 17a, a partition plate 18 is attached to the upper portion of the lower insertion member 7, and a suture / ligature tool is mounted thereon. Storage means 19 for storing 12
The upper insertion member 6 is provided with a holding spring 22 for holding the suture / ligature tool 12 downward. Further, the whole is further covered with the outer tube 8. Out of the members forming the insertion portion 3, the outer tube 8, the upper insertion member 6, and the lower insertion member 7 are transparently molded with a resin material as described above, and the attachment means 2 and the storage means 19 are The condition is visible.

The pusher 14 is provided with a hooking portion 20 which is a transfer means for sending out the suture / ligature tool 12 in the front row of the storage means 19. And storage means 19
A one-way clutch 21 is provided to prevent the suture / ligation device 12 from returning backward. The applier 1 stores a plurality of, for example, 20 suturing / ligating tools 12a to 12t from the front end to the rear end, and the suturing / ligating tool 12 stored in the initial state.
Is not particularly limited, and may be any number depending on the intended procedure.

Further, as will be described later, in the present embodiment, if the same number of suturing and ligating tools 12 are used as compared with the prior art, the entire length of the rows of the suturing and ligating tools 12 can be shortened. It is possible to store more suturing and ligating tools 12 in the storage means 19 than in the prior art.

Next, FIGS. 7 to 9 show the structure of the insertion portion 3 from the substantially middle portion to the proximal side. A plate-shaped buffer 23 for urging the row of the suturing / ligating tools 12 forward is engaged with the rear part of the suturing / ligating tool 12t at the rearmost part of the storage means 19, and the buffer 23 pushes the clip. It is biased forward by a spring 24. The rear portion of the clip pushing spring 24 is fixed to the proximal side of the insertion portion 3 by a spring holder 25. The buffer 23 is molded into a color tone such as a fluorescent color that is easy to see, and the buffer 23 moves forward each time the suture / ligature tool 12 is released, so that the remaining amount of the suture / ligature tool 12 can be known. ing.

Further, the number and type of the stored suture / ligature tools 12 may be displayed by arbitrarily setting the color tone. Alternatively, it may be displayed by arbitrarily setting the color tone of each component that constitutes the insertion portion 3. In such a case, for example, if the color of the guide member 13 is blue, the number of suturing / ligating tools is 20,
If it is red, it can be 10 and so on. Of course, 2
It is also possible to use more than one type of color and display them in combination. Generally, in the operating room, the assistant selects the equipment to be used according to the operator's instructions, but the assistant does not judge whether it is the intended equipment by reading the letters etc. written on the equipment, but the shape and color etc. This type of color identification is very effective in preventing incorrect equipment selection and improving the efficiency of the procedure, because it is determined by the elements that can be readily determined by appearance.

A ratchet arm 26 is attached to the pusher 14, and a ratchet mechanism 28 is formed by the ratchet teeth 27 attached to the lower insertion member 7. The ratchet mechanism 28 is sewn by returning the pusher 14 during operation. The clogging tool 12 is prevented from being clogged inside the attachment means 2. Further, in the conventional ratchet mechanism, it is common to use a dedicated thin blade-shaped component as the counterpart component that meshes with the ratchet teeth 27, but this is a costly component because it produces the necessary elastic force. there were. However, in the present embodiment, the ratchet arm 26 has a structure in which a round bar is bent, and since the elastic force is dealt with by increasing its effective length, it can be easily molded without cost. It is a part.

Next, FIG. 10 shows the proximal side of the insertion portion 3.
A knob 5 is provided at the rear end of the insertion portion 3 and is composed of vertically divided parts. A main spring 29 is provided inside the knob 5 and constantly urges the operating rod 30 connected to the pusher 14 toward the hand side. The main spring 29 can return the entire applier 1 including the attaching means 2 and the operating means 4 to the initial state after the series of clip attaching operations is completed.

The rear portion of the operating rod 30 has a spherical portion 32 that engages with an engaging groove 31 provided in the upper portion of the movable handle 9.
Is formed, and the operation rod 30 and the rear portion of the knob 5 are sealed by an O-ring 33. Generally, in endoscopic treatment, in order to secure a space to operate in the abdominal cavity or the like, the treatment is performed in a situation where the abdominal cavity called pneumoperitoneum is inflated with CO2 gas. The treatment tool such as the applier 1 used at that time needs to prevent the gas in the abdominal cavity from leaking to the outside, but the applier 1 is completely protected by the O-ring 33. Is sealed, or gas leakage is suppressed to a level that is practically acceptable.

Since the pusher 14 and the operation rod 30 connected thereto are provided at the center of the insertion axis in the longitudinal direction of the insertion portion 3 as described above, the insertion portion 3 is operated by operating the knob 5. Since it is located at the center of rotation when it is rotated with respect to the means 4, it is not necessary to use a special conversion means for connecting the pusher 14 and the operating rod 30 to cope with the rotation as in the prior art. Even if it is rotatable.

Next, the operating means 4 is shown in FIGS. As described above, the operating means 4 includes the movable handle 9, the fixed handle 10, and the lid 11 attached to the upper portion of the fixed handle 10. The knob 5 of the insertion portion 3 is rotatably attached to the fixed handle 10, and the spherical portion 32 of the operation rod 30 slides on a washer 34 inside an engagement groove 31 provided at the upper portion of the movable handle 9. It is engaged so that it can move and rotate freely.

The lid 11 is attached to the fixed handle 10 so as to be openable and closable by a hinge 35, and fixed when closed by a snap fit 36. When the lid 11 is opened, the knob 37 attached to the snap fit 36 is urged outward so that the snap fit 36 and the fixed handle 10 are disengaged and opened by the hinge 35. .

A space is opened inside the fixed handle 19 of the operating means 4 so that a cleaning liquid, sterilizing gas or high temperature steam, or a cleaning tool such as a cleaning brush can be inserted for cleaning and sterilization, and the upper portion thereof is the above-mentioned. By opening the lid 11 in this way, it is possible to reliably wash and sterilize, and the operating means 4 is a crown product that can be repeatedly used. Further, it goes without saying that each of the parts constituting the operating means 4 is made of a metal or resin having cleaning / sterilization resistance.

The spherical portion 32 of the operating rod 30 is engaged with the engaging groove 31 on the upper portion of the movable handle 9 so as to be rotatable and slidable, and the engaging groove 31 is open upward. Therefore, the spherical portion 32 is engaged by being inserted into the engaging groove 31 from the upper portion of the engaging groove 31, and can be removed by the reverse operation.

Therefore, by opening the lid 11 and removing the spherical portion 32 from the engaging groove 31 as described above,
The insert 3 can be removed from the operating means 4 and the insert 3 can be attached to the operating means 4 by the reverse procedure. As a result, the insertion section 3 can be attached to and detached from the operation means 4, so that, for example, the insertion sections 3 having different numbers of suture / ligature tools 12 stored inside the insertion section 3 are prepared. , Use the insertion part 3 that stores the suturing / ligating tool 12 in the number required for the intended procedure, or replace the inserting part 3 that has been used up with the suturing / ligating tool 12 with a new inserting part 3. be able to.

Further, it is possible to prepare the insertion portions 3 having different shapes of the suturing / ligating tool 12 and replace them according to the situation and use them. Generally, such a conventional applier 1 has a complicated shape such that the inside cannot be washed and sterilized. Further, since the insertion part 3 and the operation means 4 cannot be removed, the entire applier 1 becomes a disposable product. However, as in the present embodiment, the insertable portion 3 is detachable from the operating means 4, and the inside of the operating means 4 can be reliably washed and sterilized as described above. By becoming
Since the disposable part is only the insertion part 3 and the operating means 4 can be repeatedly used, the wasteful part is reduced, which not only saves costs, but also has effects of environmental conservation, energy saving, resource waste prevention, etc. To be

The movable handle 9 has a fulcrum screw 38.
It is rotatably attached to the fixed handle 10 by means of a nut 39 and the applier 1 is operated by closing the movable handle 9 from the initial state.

Next, the shape of the suturing / ligating tool 12 and the engagement with the pusher 14 are shown in FIGS. The suturing / ligating tool 12 of the present embodiment is formed of a titanium material such as a Ti alloy as described later. The suture / ligature tool 12 includes two leg portions 121 in a substantially parallel state and the leg portions 121.
Is formed in a substantially U-shape having a base end portion 122 for connecting.

A protrusion 40 having a substantially semicircular cross section is formed on the inner edge of the concave portion 16 of the pusher 14 in the longitudinal direction, and the base end 122 of the suture / ligature tool 12 is sewn. An engagement groove 41 is formed at a position that engages with the protrusion 40 when the ligature 12 is deformed. This prevents the suture / ligature tool 12 from falling off or changing its orientation due to disturbance when the suture / ligature tool 12 is released from the guide member 13 during deformation. In addition, such sutures, which are generally manufactured by press molding a wire rod,
Since it is easier to manufacture the ligature tool 12 having the same cross-sectional shape over the entire length of the material, in such a case, the suture / ligature tool 12 may be manufactured over the entire outer peripheral surface (outer circumference of the leg 121). The groove 41 may be formed.

The titanium material, which is the material of the suturing / ligating device 12, is known to be very hard and has a high specific strength, and has a very strong ability to be plastically deformed. Therefore, the suture and ligature tool 12 of the present embodiment is provided with a notch 42 in the leg portion 121 and the base end portion 122 in order to facilitate the deformation into a predetermined shape when deformed by the pusher 14. It is designed to bend from this part. Since it is sufficient that the portion of the cutout 42 bends easily with respect to the other portions, the Young's modulus can be improved by processing the material surface such as locally annealing only this portion instead of the cutout 42. It may be formed to be relatively larger than other portions so as to be easily bent, or to have a section modulus relatively smaller than that of other portions in the bending direction.

Next, the operation of the applier 1 will be described with reference to FIG.
It will be described with reference to FIGS. In FIG. 17, the suturing / ligating tool 12a is loaded on the guide member 13 and the movable handle 9 is operated up to the first stage. At this time, the movable handle 9 of the operating means 4 is at the position indicated by the solid line in FIG. In this state, the pusher 14 holds the suturing / ligating tool 12a with the support pin 15, and is held by the guide member 13 in the vertical direction. Further, of the suturing / ligating tool 12 inside the storage means 19, the suturing / ligating tool 12 b is opened in front of the partition plate 18 against the clip holding spring 22 by the hooking portion 20 provided on the pusher 14. It is moving to 43.

Suture / ligature tool 1 with permutation of suture / ligature tool 12
The suturing / ligating tool 12c next to 2b is moved to a position where the suturing / ligating tool 12d and the succeeding suturing / ligating tool 12 are urged by the buffer 23 to move over the one-way clutch 21. One-way clutch 2
Numeral 1 is formed of an elastic member such as a metal plate, and in combination with the shape thereof, the suturing / ligating tool 12 can be moved forward, but once it gets over the one-way clutch 21, it cannot return to the rear. There is.

FIG. 18 shows the next second operating stage. In this state, when the movable handle 9 is operated in the closing direction more than in the above state, the pusher 14 further advances, and the projection 40 of the concave portion 16 pushes the suturing / ligating tool 12a forward. As a result, the suturing / ligating tool 12a is attached to the support pin 1.
Since it is supported by 5, the portion pushed by the pusher 14 bends forward, is deformed into a predetermined shape by the notch 42, and the tips of the suture / ligature tool 12a come into contact with each other. Then, the suture / ligature tool 12a is released from the guide member 13, but as the deformation proceeds, the projection 40 of the pusher 14 and the engagement groove 41 of the suture / ligature tool 12a engage with each other as described above. It does not fall off from the mounting means 2 during the mounting operation.

At this time, the suture / ligature tool 12 inside the storage means 19 is moved forward by the hook 20 so that the clip pushing spring 24 is moved.
It moves further forward due to the urging of.

Further, as shown in FIGS. 19 to 21, as the movable handle 9 is closed, the pusher 14 advances, the suture / ligature tool 12a is gradually deformed, and the inside of the storage means 19 is sutured. The ligature tool 12 is also sent forward. Then, at the stage of FIG. 21, the movable handle 9
Reaches the completely closed position, the pusher 14 moves to the foremost position, and the suture / ligature tool 12a is changed to the final shape.

At this stage, the suturing / ligating tool 12b moves to the upper part of the opening 43 of the partition plate 18 and is loaded on the upper surface of the pusher 14 inside the opening 43 by the clip restraining spring 22. Then, the subsequent suture / ligature tool 1
2 then moves forward.

The final shape of the suturing / ligating tool 12 at this time is
The length of the portions of the two leg portions 121 that are substantially parallel and close to each other is about twice or more the length of the portion that surrounds the support pin 15, and thus the length of the final shape is unnecessarily increased. It is designed not to increase the length.

Next, the step moves to the stage shown in FIG. At this stage, the movable handle 9 finishes a series of operations, is completely moved to the released position by the main spring 29 at the rear end of the insertion portion 3, and the pusher 14 is also moved to the last position.

Then, the engagement between the suture / ligature tool 12a and the pusher 14 is released, and the suture / ligature tool 12a is moved to the outside of the guide member 13 by the elastic force of the ejector 15 provided inside the guide member 13. Is released. Generally, as shown in FIG. 23, when ligating the vascular vessel 50, one suture / ligature tool 12 is attached to the side to be cut and two suture / ligature tools 12 to the side to be left. Then, the suture / ligature tool 12 could not be released unless the applier 1 was removed from the vessel 50 each time the ligation operation was performed.
In the present embodiment, the guide members 13 can be ligated one after another simply by shifting the guide members 13 sideways in order, so there is no risk of losing the once held vessel 50.

The suturing / ligating tool 12b is the pusher 1
Since 4 moves to the rear of the opening 43, the elastic force of the clip holding spring 22 moves to the front of the pusher 14 to prepare for the next operation. Subsequent suture / ligature 1
The elastic force of the clip pushing spring 24 moves 2 to a position where the suture / ligature tool 12b comes into contact with the clip holding spring 22, and the applier 1 as a whole returns to the initial state.

By closing the movable handle 9 again from this state, the series of operations shown in FIGS. 17 to 22 is repeated, and the suturing / ligating device 12 is continuously fired. Then, when the last suturing / ligating tool 12t is released, the suturing / ligating tool 12 does not exist inside the storage means 19, but at this time, the buffer 23 moves to the foremost position as described above. It is confirmed that the suture / ligature tool 12 has been used up due to the color tone that is easily visible. In addition, even when the suture / ligature tool 12 is used up and further operation is performed, the suture / ligature tool 12 is still used by the applier 1.
Since there is no movable part for attaching the pusher 14 and the pusher 14 simply moves forward and backward, there is no risk of damaging the living tissue.

When the procedure is continued when the suturing / ligating tool 12 is used up, the lid 11 of the operating means 4 is opened and the insertion portion 3 is removed from the operating means 4 as described above, and a new insertion is made. The part 3 is incorporated into the operating means 4 to close the lid 11, and the applier 1 is newly sutured and ligated.
Equip 2.

Here, comparing the conventional suturing / ligating tool 51 shown in FIGS. 23 and 24 with the suturing / ligating tool 12 of the present embodiment, as described above, the suturing / ligating tool 51 is
In order to ligate the blood vessel 50 having the diameter D, the length of the leg portion 52 needs to be about twice as long, and the distance L ₁ between the two leg portions 52 is L.
_It must be ₁ ≥ D. Here, in the case of the conventional technique, the base end portion 53 has a substantially triangular shape with an angle θ in order to easily deform the suture / ligature tool 51. Therefore, the total length is L ₂ + mcos θ, which is longer than the case shown in the present embodiment by mcos θ.

When the appliers are stored in a permuted state, as shown in FIG. 24, an unnecessary length of n is required for every two suturing / ligating tools 51, and the number of suturing / ligating tools 51 is reduced. As the number increases, the length increases, and as a result, the number of suture / ligature tools 51 that can be stored in the storage section decreases. In the present embodiment, since there is no useless length n, for example, 20 pieces can secure a length of 19n, and therefore approximately four suturing / ligating tools 51 can be stored in a distance from the above. Conventional problems are solved.

Further, when the suture / ligature tool 51 is deformed into a predetermined shape, its total length is L ₂ + m in the prior art, but in this embodiment it is L ₂ + l / 2, so the subtraction m
The size of the substance remaining in the living body can be reduced by -1/2.

As described above, according to this embodiment, the applier 1 having the safe and simple mechanism, which is the object of the present invention, is described.
Can be used, or the size of the suturing / ligating tool 12 can be reduced to increase the number that can be stored inside the applier 1, or an unnecessarily large residue does not remain in the living body.
Further, the shape and structure of the applier 1, the suturing / ligating device 12 and the like are not particularly limited as long as the vascular vessel 50 can be ligated with the suturing / ligating device 12 and the like. It doesn't matter.

According to the above embodiment, the following structure can be obtained. (Supplementary Note 1) Suture for suturing / ligating living tissue
In a suturing / ligating device for attaching to a living tissue by deforming a ligature into a predetermined shape, it has two legs in a substantially parallel state and a base end portion connecting the legs, and is substantially U-shaped. The sewing machine has a mounting means which is formed in a mold and which deforms and mounts a suture / ligature tool in which the two leg portions are formed substantially perpendicular to the base end portion. The faces of the two legs of the ligature which face each other are close to each other and are in a substantially parallel state, and at least a part of the two legs has a portion where the two legs do not come close to each other. A suturing / ligating device characterized by being deformed so as to have a space surrounded by the two leg portions and the base end portion.

(Supplementary Note 2) Approximately two leg portions in a substantially parallel state and a base end portion connecting the two leg portions for suturing and ligating a living tissue mainly used in a surgical operation. A suture / ligature tool, which is U-shaped and in which the two leg portions are formed substantially perpendicular to the base end portion, is such that the facing surfaces of the two leg portions are at least partially in contact with each other. A suturing / ligating device for attaching to a living tissue by deforming it into a predetermined shape as described above, and having an attaching means for attaching the suturing / ligating instrument to the biological tissue, wherein the attaching means is the suture / ligating instrument. By holding the suture / ligature tool between at least one holding means that holds the suture / ligature tool and the holding means, and pressing the proximal end portion of the suture / ligature tool, Approximately concave tip to transform into shape Suture-ligation apparatus consisting Jo pusher.

(Supplementary Note 3) Two leg portions in a substantially parallel state for suturing and ligating a living tissue mainly used in a surgical operation, and the two leg portions connecting the two leg portions. A suturing / ligating device for attaching a suturing / ligating device having a proximal end portion provided substantially vertically to a leg to a living tissue,
The attachment means for attaching the suture / ligature tool to living tissue has a holding means for holding the suture / ligature tool, and the suture / ligature is provided between the attachment means and the holding means.
By sandwiching the ligature tool and pressing the proximal end portion of the suture / ligature tool, the distal end portion for deforming the suture / ligature tool into a predetermined shape is a substantially concave pusher,
The suturing / ligating device, wherein one of the holding means is arranged at a position so as to engage with the center of the proximal end portion.

(Supplementary Note 4) In the supplementary notes 2 and 3, the suturing / ligating device stored inside the attaching means so that the holding member does not come into contact with the living tissue. (Supplementary Note 5) In Supplementary Notes 1 to 4, a suturing / ligating device having a guide member for engaging the suture / ligature tool with a target biological tissue when the attachment means is loaded with the suture / ligature tool. .

(Supplementary Note 6) In Supplementary Note 5, the guide member has two arms facing each other, and the two arms have a substantially U-shaped cross section having recesses on the surfaces facing each other. -A ligation device.

(Supplementary Note 7) In the supplementary notes 5 and 6, at least a part of the guide member is substantially transparent. (Supplementary Note 8) In Supplementary Notes 2 to 7, a protrusion for engaging with an engagement groove provided in at least a portion of the outer circumference of the suture / ligature tool is provided on at least a portion of the inside of the substantially concave shape of the pusher. Suture / ligation device used.

(Supplementary Note 9) In Supplementary Notes 1 to 8, the operating means, the endoscope means connected to the operating means, the distal end of the endoscope means, and the suture by operating the operating means. A suturing / ligating device having the attaching means for attaching the ligature to living tissue.

(Supplementary Note 10) In Supplementary Note 9, a ratchet mechanism for stepwise distributing the operation of the operating means is provided, and the ratchet mechanism has a cross section for engaging the ratchet teeth and the ratchet teeth. A suture and ligature device consisting of a single ratchet arm.

(Supplementary Note 11) The suture / ligation device according to Supplementary Note 10, wherein the ratchet arm has a substantially circular cross section. (Supplementary Note 12) The suture / ligation device according to Supplementary Notes 10 and 11, wherein the ratchet mechanism is provided inside the endoscope means.

(Supplementary Note 13) In the supplementary notes 9 to 12, the suture / ligation device for arranging the pusher for deforming the suture / ligature tool at the center of the longitudinal axis inside the endoscope means.

(Supplementary Note 14) In Supplementary Note 13, storage means for storing the suture / ligature tools in the longitudinal axial direction is stored above the pusher inside the endoscope means. By the transfer means provided in the pusher,
A suturing / ligating device that transfers the suture / ligature tool to a standby position, subsequently loads the attachment means from the standby position by the pusher, and deforms the attachment means by the holding means and the pusher into the predetermined shape.

According to Supplementary Notes 1 to 3, suturing and ligation can be reliably performed, and the structure of the suturing / ligating device is simplified.
The insertion diameter can be reduced, and the cost can be reduced. According to Supplementary Note 4, in addition to Supplementary Notes 1 to 3, since the holding member is stored inside the attaching unit, there is an advantage that there is no risk of damaging the living tissue by the attaching unit.

According to Supplementary Note 5, in addition to Supplementary Notes 1 to 4, there is an advantage that a target tissue can be reliably captured because there is a guide member for holding a living tissue, particularly a blood vessel. Appendix 6
According to this, in addition to Supplementary Note 5, since the suturing / ligating device can be held by the guide member, the vessel can be ligated more reliably.

According to Supplementary Note 7, in addition to Supplementary Notes 5 and 6, at least a part of the guide member is transparent, so that the situation can be confirmed when attaching the suturing / ligating device to the living tissue, which is safer. -A reliable operation is possible. According to Supplementary Note 8, in addition to Supplementary Notes 2 to 7, since the suture / ligature tool engages with the pusher, the orientation of the suture / ligature tool during mounting does not change due to disturbance.

According to Supplementary Note 9, in addition to Supplementary Notes 1 to 8, the suturing / ligating device can be used in endoscopic treatment such as endoscopic surgery. According to Appendixes 10 and 11, Appendix 9
In addition, the ratchet mechanism required for the suture / ligation device can be easily realized.

According to Supplementary Note 12, in addition to Supplementary Notes 10 and 11, the internal structure of the operating means can be simplified, and
Since the endoscope means can be a mechanism independent of the operating means, even when the both are disassembled, the attachment means can be prevented from malfunctioning due to clogging or the like even by itself.

According to Supplementary Note 13, in addition to Supplementary Notes 9 to 12,
By disposing the pusher, which is the widest component, on the central axis of the endoscope means, the diameter of the endoscope means can be made as small as possible. According to Supplementary Note 14, in addition to Supplementary Note 13, by arranging each component more effectively, it is possible to simplify the mechanism for performing the operation of attaching the series of suture / ligature tools to the biological tissue. Furthermore, the diameter of the endoscope means can be reduced.

[0079]

As described above, according to the present invention, it is possible to reliably sew and ligate a biological tissue, the structure of the suturing and ligating device is simplified, and the insertion diameter can be reduced.
Further, there is an effect that the cost can be reduced.

[Brief description of drawings]

FIG. 1 is an overall side view of an applier showing a first embodiment of the present invention.

FIG. 2 is a vertical cross-sectional plan view and a vertical cross-sectional side view of the attachment means of the same embodiment.

FIG. 3 is a front view as seen from the direction of arrow X in FIG.

FIG. 4 is a cross-sectional view taken along the line AA ′ of FIG.

5 is a cross-sectional view taken along the line BB ′ of FIG.

6 is a cross-sectional view taken along the line CC ′ of FIG.

FIG. 7 is a vertical cross-sectional side view showing the storage means of the applier of the same embodiment.

FIG. 8 is a vertical cross-sectional side view showing the ratchet mechanism of the applier of the same embodiment.

9 is a cross-sectional view taken along the line EE ′ of FIG.

FIG. 10 is a vertical cross-sectional plan view and a vertical cross-sectional side view of the insertion portion of the same embodiment on the side of an operation unit.

FIG. 11 is a vertical cross-sectional side view showing the operating means of the applier of the same embodiment.

12 is a cross-sectional view taken along the line II ′ of FIG.

13 is a cross-sectional view taken along the line JJ ′ of FIG.

14 is a cross-sectional view taken along the line KK 'of FIG.

FIG. 15 is a perspective view of the pusher and the suture / ligature tool of the same embodiment.

FIG. 16 is a perspective view of the suture / ligature tool of the embodiment.

FIG. 17 is a vertical sectional side view showing the operation of the applier of the embodiment.

FIG. 18 is a vertical sectional side view showing the operation of the applier of the embodiment.

FIG. 19 is a vertical cross-sectional side view showing the operation of the applier of the embodiment.

FIG. 20 is a vertical cross-sectional side view showing the operation of the applier of the same embodiment.

FIG. 21 is a vertical cross-sectional side view showing the operation of the applier of the embodiment.

FIG. 22 is a vertical sectional side view showing the operation of the applier of the embodiment.

FIG. 23 is an explanatory view of a conventional suture / ligature tool.

FIG. 24 is an explanatory view of a conventional suture / ligature tool.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Applier 2 ... Attachment means 3 ... Insertion part 4 ... Operation means 12 ... Suture / ligature tool 121 ... Leg part 122 ... Base end part

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Toshihiko Suzuta 2-43-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Minor Tsuruta 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Hiroyuki Nagamizu 2-43-2, Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Yoshikiyo Shibata 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Shinichi Nishigaki 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Yoshinao Daimei 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Industry Co., Ltd.

Claims (1)

[Claims] 1. A suturing / ligating device for attaching living tissue to living tissue by deforming a suturing / ligating tool for suturing / ligating living tissue into a predetermined shape. Portion and a base end portion connecting the leg portion to each other are formed in a substantially U shape, and the two leg portions are formed substantially perpendicular to the base end portion. And attaching means for deforming and attaching the two legs of the suture / ligature tool to each other so that the surfaces facing each other are close to each other and are in a substantially parallel state. At least partly has a portion where the two legs do not come close to each other, and is deformed so as to have a space surrounded by the two legs and the base end portion. .