JPH0998976A - Suturing instrument for medical use - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a suturing instrument for medical use capable of suturing easily and rapidly from sewing up of living structure with a suture to suture tacking without exchange of the suturing instrument. SOLUTION: A medical suturing instrument 1 that has an applicator 4 to tack the suture by ultrasonic using the suture tacking part, is provided with the applicator 4 and forceps 5 that is used to operate the suture or the suture needle parallel inside an insertion part 2, and is so arranged that the applicator 4 and the forceps can be inserted into the body at the same time.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical suturing device used for stitching tissues with a suture in endoscopic surgery.

[0002]

2. Description of the Related Art Conventionally, for example, a threaded needle is grasped by forceps and inserted into a body cavity, and another forceps is similarly inserted into the body cavity, and the threaded needles are handed over to each other. The tissue of the part to do was sewn together. At this time, when the suturing is finished, the thread may be fixed using a titanium clip or the like which is already known for the sake of simplicity.

Further, as a medical suturing device for stitching living tissue with a suture thread, for example, US Pat.
There is a suture device disclosed in the specification of 657,056. This suture machine uses ultrasonic waves to form a thread knot (thread stop) for easy fabrication. Further, as such a suture, US Pat.
No. 251, US Pat. No. 5,306,280, and Japanese Unexamined Patent Publication No. 6-7361 include suture clips.

This suture clip is made of a polymer material, and while the clip is heated to be softened,
By applying a compressive force to the clip and tightening the suture with the clip, the stitches are stopped and the suture is completed.

[0005]

However, the suturing work is generally performed using forceps, and at the end of the suturing, the forceps are removed from the body cavity to the outside of the body, and then a clip applicator for thread fastening is inserted into the body cavity. Then, the suture thread is stopped.
Since the work of inserting and removing the forceps and the clip applicator into the body cavity is performed for each suture, the work is very troublesome for the operator. Especially when performing multiple sutures, it is not possible to perform quick sutures, which increases the processing time,
It is a heavy burden on the patient.

[0006] The suture stop for connecting sutures with the ultrasonic suturing device disclosed in US Pat. No. 3,657,056 has two forceps inserted into the body cavity as a basic procedure. Is used for suturing work. At the end of suturing, either forceps is removed from the body, and then an ultrasonic suture instrument is inserted into the body cavity to fix the thread. Therefore, the above problem has not been solved.

The present invention has been made in view of the above circumstances, and an object thereof is to perform a medical suture in which a suturing operation and a thread fixing operation can be performed continuously and easily by using one medical suturing device. To provide a container.

[0008]

In order to achieve the above-mentioned object, the present invention provides a medical suturing device having a thread stopping means for ultrasonically stopping a suture with a thread stopping member. And a forceps for operating the suture thread or the suture needle are arranged so as to be simultaneously insertable into the body cavity.

According to the above construction, a suturing operation using a suture is performed by using a forceps with one medical suturing device, and when the suture is completed, the suture is tightened and fixed by a suture fixing member to perform a series of suturing operation and suture stopping. You can finish the work.

[0010]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings. 1 to 7 show the first embodiment, and FIG. 1 is a front view and a side view of a medical suturing device 1. FIG. 2 is an enlarged front view and side view of the distal end portion of the medical suturing device 1, and FIG. 3 is a longitudinal side view of the applicator.

As shown in FIG. 1, the medical suturing device 1 is composed of an elongated insertion portion 2 which is inserted into a body cavity and an operation portion 3 which is operated on the proximal side. An applicator 4 and forceps 5 are provided at the distal end of the insertion section 2, and the operation section 3 is composed of a forceps operation section 6 and an applicator operation section 7.

As shown in FIGS. 2 and 3, a thread stopper member 10 is housed in the distal end portion of the insertion portion 2, and the thread stopper member 1 is accommodated.
An applicator 4 for closing and fixing 0 and a forceps 5 for holding a suture needle or a suture thread are provided close to each other. The forceps 5 is composed of two forceps jaws 8 and 9, one forceps jaw 8 is fixed, and the other forceps jaw 9 is rotatable to be opened and closed.

The applicator 4 is provided with an accommodating portion 12 which is a recess for accommodating the thread stopping member 10 and an ultrasonic wave transmission pressing member 13 as a thread stopping means for closing the thread stopping member 10. The thread stopping member 10 is housed in the housing portion 12, and the thread stopping member 10 includes the jaw 11a and the jaw 1a.
1b and 1b can be closed. However, the thread stopping means is not limited to thread stopping by ultrasonic waves.

4 to 7 show the procedure and operation of suturing using the medical suturing device 1. FIG. 4 shows the distal end of the insertion portion 2 of the medical suturing device 1 inserted into the body cavity from outside the body through a treatment hole (not shown) provided in the abdominal wall and another treatment hole (not shown) provided in the abdominal wall. The distal end portion 14a of the needle holder 14 inserted into the body cavity from outside the body is shown.

First, one end of the incision 15 of the living tissue is pierced with the tip of the threaded needle 16 which is previously grasped by the tip 14a of the needle holder 14 outside the body and protruded from the surface of the other end of the incision 15. . As shown in FIG. 5, the forceps jaw 8 of the forceps 5 is operated by operating the forceps operating portion 6 with the tip of the threaded needle 16 protruding from the surface.
Hold with 9 and pull.

After that, the threaded needle 16 is changed over to the distal end portion 14a of the needle holder 14 and similarly sutured continuously. At the end of suturing, as shown in FIG. 6, the tip portion 14a of the needle holder 14
Hold the threaded needle 16 and apply tension,
The thread portion of the threaded needle 16 is arranged between the jaws 11a and 11b of the thread stopper member 10 housed in the applicator 4.

Then, the applicator operating section 7 is operated,
When the ultrasonic transmission pressing member 13 is moved forward, the thread stopping member 1
The zero jaws 11a and 11b are closed. When ultrasonic vibration is transmitted to the ultrasonic transmission pressing member 13 in this state, as shown in FIG. 7, the ultrasonic vibration is transmitted to the jaw 11 a and the jaw 1 a.
1a and 11b are welded. At this time, the thread portion of the needle thread 16 is also welded. As a result, the jaws 11a and 11b of the thread stopping member 10 cannot be opened again, so that the thread stopping is completed.

As described above, the applicator 4 as the thread stopping means and the forceps 5 are arranged so that they can be inserted into the body cavity at the same time, so that the forceps 5 is purposefully pulled out of the body at the end of the suturing operation. The thread suturing can be completed with one medical suturing device 1 without inserting the needle 4 into the body cavity, so that the treatment time is shortened and the operation time is shortened, so that the burden on the patient is reduced and the operability of the operator is reduced. The improved sewing simplifies the sewing operation. Further, since the thread is fixed by ultrasonic welding, the strength of the thread is increased and the reliability of the thread is improved.

According to this embodiment, the sheath of the applicator 4 and the forceps 5 are formed as a completely integrated body.
As shown in the modified example of (a), the sheath 4a of the applicator 4 and the sheath 5a of the forceps 5 may be arranged in parallel and close to each other.

Also, as shown in the modified example of FIG. 8B, the accommodating portion 12 which is a recess for accommodating the thread stopper member 10 of the applicator 4 is also provided at the opening edge of the accommodating portion 12.
By providing the pop-out preventing groove 12a for locking the thread stopping member 10 with the jaw 10a and preventing the thread stopping member 10 from popping out, the thread stopping member 10 can be reliably stored.

FIG. 9 shows a second embodiment, which is the same as the first embodiment except for the applicator 4 except for the constitution. The applicator 17 of this embodiment includes a pressing member 18 and a thread stopper member 19. The thread stopping member 19 includes a jaw 20a and a jaw 20b. A hook-shaped engaging portion 21a is integrally provided at the tip of one jaw 20a and an engaging portion 21a is provided at the tip of the other jaw 20b. A protruding piece-shaped engaging portion 21b that engages is provided.

The operation of this embodiment is similar to that of the first embodiment, after the thread portion of the threaded needle 16 is arranged between the jaw 20a and the jaw 20b, the pressing member 18 is moved forward by the operation of the operating portion 3 to move the jaw. Pushing 20a closes jaws 20a and 20b. At this time, the engaging portion 21a and the engaging portion 21
The b is engaged and is not opened again, and the thread fastening is completed.

The effects of this embodiment are similar to those of the first embodiment, but since ultrasonic waves are not used, the structure of the medical suturing device is simplified, the weight is reduced, and the cost is reduced. be able to.

FIG. 10 shows a third embodiment, which is the same as the first embodiment except for the applicator 4 except for the configuration. In the applicator 22 of the present embodiment, a plurality of thread fixing members 10 are stored in the cartridge 23 in the same direction in a line. Further, in the cartridge 23, the thread stopper 10
There is provided a feeding means 25 such as a slide bar having a hooking claw for feeding the paper into the storage portion 24. Further, the ultrasonic wave transmission pressing member 2 for closing and fixing the thread stopping member 10 on a plane parallel to the plane where the cartridge 23 is provided.
6 are provided.

The operation of this embodiment is similar to that of the first embodiment, after the thread portion of the threaded needle 16 is placed inside the thread stopping member 10 at the end of the suturing, the thread stopping member 10 is moved by the ultrasonic transmission pressing member 26. By pressing and pushing ultrasonic waves in this state, the jaws 11a and 11b of the thread stopping member 10 are welded to perform thread stopping. After that, the thread stopping member 10 that has completed thread stopping
When the yarn is discharged, the yarn stopper member 10 stored in the cartridge 23 is loaded into the storage portion 24 by the feeding means 25, so that the yarn stopper can be continuously performed.

As an effect of this embodiment, when performing continuous suturing using a plurality of threaded needles 16, the needle holding device 14 holding the new threaded needle 16 is simply inserted into the body cavity, and the next suturing operation is performed. Can move to. Since a new thread stopper member 10 is loaded on the applicator 4 outside the body and suturing can be performed without reloading it inside the body cavity, the treatment time can be shortened and the operation time can be shortened, thereby reducing the burden on the patient. In addition, the operability of the operator is improved, so that the suturing work is simplified. Further, since the thread fixing member 10 is welded by using ultrasonic waves, the thread fixing strength is increased and the reliability is improved.

As a modification of this embodiment, the thread stopper member 19 of the second embodiment is used instead of the thread stopper member 10, and the ultrasonic transmission pressing member 26 is replaced by the pressing member of the second embodiment. 18 can also be used. The operation and effect of this modified example are the same except for the operation and effect of using the ultrasonic wave of the above configuration, but the medical suturing device of the modified example does not require an ultrasonic wave oscillating section, and the structure is simple and lightweight. It is possible to reduce the cost.

11 and 12 show a fourth embodiment, which is the same as the first embodiment except for the forceps 5 except for the structure. As shown in FIG. 11, the forceps 27 of this embodiment is provided at the tip of the insertion portion 2 of the medical suturing device 1 and has a tip shape similar to that of the needle holder 14 suitable for gripping the threaded needle 16. Are doing Further, as shown in FIG. 12, a bent pinch portion 2 suitable for pulling out the threaded needle 16 from the tissue.
A receiver-side forceps 28 having 8a is provided.

The action of this embodiment is that the forceps 27
The suture needle 16 can be grasped and inserted into the body cavity to start suturing, and at the end of suturing, the suture needle 28 for receiving the suture needle 28
The thread can be fixed without having to move the forceps to the forceps 27. Further, when another suturing work is started after the suturing work is completed, the medical suture instrument 1 of the present embodiment is pulled out of the body so that the forceps 27 can grasp the new needle 16 with a thread.
At this time, the applicator 4 is accommodated in the accommodating portion 12 and the thread stopper member 10 is provided.
Can be loaded.

As an effect of this embodiment, the time for changing over the needle 16 with a thread is shortened. Further, in order to load the threaded needle 16 and the thread stopping member 10, only the medical suturing device 1 needs to be removed from the body and inserted again into the body cavity, and the receiving side forceps 28 need not be removed to the outside of the body. Therefore, the treatment time is shortened, the burden on the patient is reduced, and the operability of the operator is improved.

13 and 14 show a fifth embodiment, which is the same as the first embodiment except for the applicator 4, except for the configuration. The applicator 29 of the present embodiment is located farther than the forceps 5 from a position (FIG. 13) inside the insertion part 2 on the hand operation side of the forceps 5 along an axis parallel to the long axis of the insertion part 2. 14 can be moved back and forth to a position (FIG. 14) in the direction, and the forceps 5 cannot move forward and backward.

In the operation of this embodiment, the applicator 9 can be housed in the insertion portion 2 and sutured during the suturing work, so that the applicator 29 does not interfere with the suturing work. Since the applicator 29 can be advanced further than the forceps 5 at the time of thread stopping, the thread can be stopped without interfering with the forceps 5.

Since the effect of this embodiment is that suturing and thread fastening can be performed smoothly, the suturing time is shortened and the treatment time is shortened. Therefore, the burden on the patient is reduced and the operability of the operator is improved.

15 and 16 show a modified example of this embodiment, in which the forceps 30 is located at a position distal to the applicator 4 along an axis parallel to the long axis of the insertion portion 2 (FIG. 15). Can move back and forth to a position (FIG. 16) inside the insertion section 2 on the hand operation side of the applicator 4, and the applicator 4 cannot move in the front-back direction. The operation of this modification is performed with the forceps 30 in the advanced state during suturing, so that the suturing operation can be performed without interfering with the applicator 4, and the forceps 30 can be retracted during suture fixing, so that the suture can be performed without interfering with the forceps 30. It can be stopped, and the same effect as the fifth embodiment can be obtained.

17 to 19 show a sixth embodiment,
Reference numeral 31 shows the medical suturing device of the present embodiment. An ultrasonic wave oscillating portion 33 to which an ultrasonic wave transmitting member 32 is attached is provided on the operation portion main body 31 a of the medical suturing device 31, and a handle 34 is attached to the lump ultrasonic wave oscillating portion 33. The sheath 35 and the sheath 36, which are provided as the outer tube of the ultrasonic transmission member 32, are elastically slidably attached to the handle 34 by a spring 37 in the axial direction of the sheath 36. It is configured to be movable along the sliding groove 39.

The case 38 located at the end of the sliding groove 39 on the insertion portion side is provided with a latch 40 which engages with the locking portion 34a of the handle 34. A spring 41 for abutting against the sheath 36 is provided inside the insertion portion side of the case 38.

A forceps 43 is provided at the tip of the insertion portion 42 of the medical suturing device 31, and a sheath 35 is provided.
An applicator 44 is provided at the tip of the. The applicator 44 is provided with a storage portion 45, and the thread storage member 10 similar to that of the first embodiment is provided in the storage portion 45.
Is loaded.

The operation of this embodiment is such that, when the handle 34 is advanced along the sliding groove 39 at the time of thread fastening, as shown in FIG. 18, the ultrasonic wave oscillating portion 33, the ultrasonic wave transmitting member 32, the sheath 35, and the sheath 35 are formed. Since 36 and the spring 37 advance, the applicator 44 at the tip of the insertion portion 42 advances.

Further, when the handle 34 is moved forward, the spring 37 contracts so that the ultrasonic wave oscillating portion 33 and the ultrasonic wave transmitting member 32 move forward relative to the sheath 35 and the sheath 36. At this time, the tip of the ultrasonic transmission member 32 presses the thread stopping member 10, and the thread stopping member 10 is closed as shown in FIG. 19 (a). At this time, the spring 37 contracts by the moving amount when the thread stopping member 10 is closed.

When the handle 34 is further advanced, the sheath 36 abuts on the spring 41 and contracts, and the handle 34
The engaging portion 34a of the above engages with the latch 40. At this time, as shown in FIG. 19B, a compressive force is applied to the thread fixing member 10, and the contraction amount when the spring 41 contracts is the spring 3.
It escapes as 7 contracts. Here, when ultrasonic waves are oscillated from the ultrasonic wave oscillating portion 33, the suture thread (not shown) disposed inside the thread stopping member 10 and the jaws 11a and 11b of the thread stopping member 10 are welded to each other. Latch 40 after welding
When the thread is released, the thread stopping member 10 is released from the storage portion 45, and the thread stopping is completed and the suturing can be finished.

As an effect of the present embodiment, the applicator 44 housed during suturing advances more than the forceps 43 during thread stopping, so that the thread can be stopped without interfering with the forceps 43, and the spring 41 acts on the thread stopping member 10. By applying a compressive force and engaging the latch 40, a constant compressive force is applied, and the ultrasonic waves can be efficiently transmitted to the thread stopping member 10, so that the thread stopping strength is increased and the reliability of the thread stopping is improved. .

Further, since the above-mentioned operation can be performed only by operating the handle 34, the operability is good, and since the thread fastening can be completed in a short time, the burden on the patient and the operator is reduced. FIG.
As shown in (a) and (b), the forceps 43 and the operation portion main body 31
Applicator 44 including ultrasonic wave oscillating portion 33, ultrasonic wave transmitting member 32, and thread stopping member 10 is not on the same straight line
If they are on the same straight line, ultrasonic waves can be transmitted more efficiently, so that highly reliable thread fastening can be performed.

As a modified example of this embodiment, in the case of a thread stopper that does not use ultrasonic waves, the ultrasonic wave oscillating portion 33 and the spring 41 are used.
The yarn latches 40 are not necessary, and the yarn fastening can be completed only by compressing the yarn fastening member 19 of the second embodiment shown in FIG. Further, instead of the applicator 44, the cartridge 2 that stores a plurality of thread stopping members 10 as in the third embodiment.
It may be an applicator 22 provided with 3. The effect is similarly good in operability, and since the thread can be fastened in a short time, the burden on the patient and the operator is reduced.

20 and 21 show the seventh embodiment, and the configuration of the medical suturing device 31 is basically the same as that of the sixth embodiment, and the same components are designated by the same reference numerals for description. Is omitted. The medical suturing device 31 of the present embodiment includes a forceps unit portion 46, a suture applicator unit portion 47, and a shell portion 48, and the forceps unit portion 46 is tightened as an assembling means provided at the base end portion thereof. It is configured to be attachable to and detachable from the shell portion 48 by the screw 49.

Therefore, by loosening the tightening screw 49, it is possible to disassemble and assemble the forceps unit 46, the thread applicator unit 47 and the shell 48 as shown in FIG. The stop applicator portion 47 can be used individually or independently.

As an effect of this embodiment, the forceps unit 46 and the thread applicator section 47 can be used alone without any new purchase, and the forceps unit 46 and the thread applicator section 47 can be used in combination. As a result, the cost of medical facilities such as hospitals can be reduced. In addition, decomposing at the time of cleaning improves the cleaning property.

FIG. 22 shows the eighth embodiment, and shows the medical suturing device 31 as viewed from the front. When the tightening screw 49 as the assembling means shown in the seventh embodiment is loosened,
Move the handle 34 from the standard position 50a to the leftward position 50a.
It is possible to rotate around the axis of the ultrasonic transmission member 32 at position b and rightward position 50c. Further, the thread stopper applicator portion 47 is rotated independently of the handle 34 to rotate the thread stopper applicator portion 47 to the inclined position 50.
It can be d.

According to the present embodiment, by rotating the handle 34, it is possible to grasp and operate with either the left or right hand regardless of the size of the operator's hand, and thus the operability is good. Further, by rotating the thread stopping applicator portion 47, it is possible to fix the thread at an optimum angle at which the suture thread can be easily fixed at the time of thread fixing.

FIG. 23A is a ninth embodiment and shows the operating portion 3 of the medical suturing device 1. A first handle 51 and a second handle 52 are rotatably engaged with the operation portion 3, and a first link 53 and a second handle 52 rotatably attached to the first handle 51. And a second link 54 that is rotatably attached to each other.

One end of a leaf spring 55 is fixed to the end of the second handle 52, and the other end is slidably elastically pressed against the inner surface of the first handle 51. Further, a handle lock 56 is detachably provided on the rotary mounting portions of the first and second handles 51, 52 so that the first and second handles 51, 52 can be locked.

Therefore, when the first handle 51 and the second handle 52 are gripped, the jaws of the forceps 5 are closed, and when the gripping force is loosened, the first handle 51 and the second handle 52 are gripped.
Is opened by the elastic force of the leaf spring 55, and the jaws of the forceps 5 are opened. When the handle lock 56 is inserted between the first handle 51 and the second handle 52 when the handle operation is completed, the first handle 51, the second handle 52, and the forceps 5 are inserted.
Joe can't open.

The effect of this embodiment is to set the handle lock 56 between the first handle 51 and the second handle 52 when the operation of the operating portion 3 is completed, so that the first handle 51 and the second handle 52 are Since the handle 52 is not opened and the jaws of the forceps 5 are also not opened, the thread stopping can be efficiently performed without interfering with the thread stopping operation.

FIG. 23B shows a tenth embodiment,
The forceps 57 in which the shape of the connection attachment part of the forceps 5 and the 2nd link 54 and the forceps 5 and a clip part differs is shown. A forceps attachment portion 59 is provided at the base end portion of the drive shaft 58 of the forceps 5, and the forceps attachment portion 59 is configured to be attachable to and detachable from the forceps receiving portion 60 provided on the second link 54. .

The drive shaft 58 connecting the forceps attachment portion 59 and the tip grip portion of the forceps 5 is made of a superelastic material, and the forceps 5 is inserted through the curved portion 62 of the sheath 61 as shown in FIG. 23 (a). It is a structure that can be removed. Therefore, the shape of the forceps tip gripping portion is different, and the forceps 57 suitable for gripping the needle also has the drive shaft 58 made of a superelastic material and can be inserted into the sheath 61 and attached to the forceps receiving portion 60. is there.

Therefore, the forceps 5 can be pulled out from the tip of the insertion portion after the forceps mounting portion 59 is removed from the forceps receiving portion 60. Further, forceps 57 having different forceps tip shapes are inserted into the sheath 61 from the tip of the insertion portion,
It can be attached to the forceps receiving portion 60 by further inserting it from the curved portion 62 to the operation portion side.

The effect of this embodiment is that even if the sheath 61 is curved, the forceps 5 and 57 can be opened and closed smoothly, and the forceps having a different shape of the tip of the forceps that the operator wants to use. The operability is improved because it can be used even if it is rearranged into 5,57. Further, at the time of cleaning, by removing the forceps 5 or the forceps 57 from the sheath 61, it becomes easier to clean and the cleaning property is improved.

According to the above-described embodiment, the following structure can be obtained. (Supplementary Note 1) In a medical suturing device having a thread stopping means for ultrasonically stopping a suture with a thread stopping member, the suture stopping means and forceps for operating the suture or suture needle are a body cavity. A medical suturing device, which is arranged so that it can be inserted therein at the same time. (Supplementary Note 2) In a medical suturing device having suture stopping means for suturing suture with ultrasonic waves by suture stopping member, the suture stopping means and forceps for operating the suture or suture needle are combined. A medical suturing device, which is incorporated in an elongated insertion portion of a book. (Supplementary note 3) In a medical suturing device having suture stopping means for suturing a suture with ultrasonic waves by a suture stopping member, the suture stopping means and forceps for operating the suture or suture needle are parallel. A suture instrument for medical use, comprising a disposing / joining means for disposing and joining to each other. (Supplementary Note 4) At least one of the suture fixing means and the forceps is slidable in the axial direction.
The medical suturing device according to any one of 2 and 3. (Supplementary note 5) The suture stopping means performs suture fixing by welding the suture stopping member using ultrasonic waves.
The medical suturing device according to any one of 2 and 3. (Supplementary note 6) The medical suturing device according to any one of supplementary notes 1, 2, and 3, wherein the suture fix member has an engaging portion capable of fixing the suture thread by itself. (Supplementary Note 7) The suture for medical use, wherein the suture stopping means and the forceps for operating the suture thread or the needle both have an elongated insertion portion, and the insertion portions are arranged in parallel with each other and integrated. vessel. (Supplementary note 8) The medical suturing device according to supplementary note 7, wherein the outer diameter of the insertion portion is 10 mm to 12 mm. (Supplementary note 9) The medical suturing instrument according to supplementary note 7, wherein the suture fixing means and the forceps for operating the suture thread or the needle are configured to be disassembled and assembled, and can be used independently of each other. (Supplementary note 10) The medical suturing device according to supplementary note 7, wherein the suture stopping means and a forceps for operating the suture thread or the needle move relative to each other. (Supplementary note 11) The medical suturing device according to supplementary note 10, wherein the back-and-forth movement of the thread stopping means and the thread stopping operation of the thread stopping means are performed by one operating portion. (Supplementary Note 12) The medical suturing device according to Supplementary Note 7, wherein the operating portion of the suture stopping means can be rotated about an axis parallel to the forceps. (Supplementary note 13) The medical suturing device according to supplementary note 7, wherein the ultrasonic wave transmitting means is fixed until the thread fixing member is welded and thread fixing is completed. (Supplementary Note 14) A medical suturing device comprising a thread stopper and a forceps for operating a suture thread or a needle in one configuration.

As described above, when the thread fixing member is deformed by ultrasonic energy when the thread fixing member is fixed, the suturing operation can be performed more quickly,
Can be firmly fixed. When the applicator and the forceps as the thread stopping means can be disassembled and assembled, the applicator and the forceps can be used independently after disassembly.

Further, by adopting a structure in which the applicator and the forceps can be moved relative to each other, the applicator can be used while being separated from the forceps when suturing, and the applicator can be brought close to the forceps when fixing the thread fixing member. With such a configuration, the suture can be performed without interference between the forceps and the applicator at the time of suturing, and the needle thread can be accurately fixed at the time of fixing the thread stopping member.

[0060]

As described above, according to the present invention, when suturing a living tissue, the operations from suturing with a needle thread to thread stopping can be easily and quickly performed without replacing the suturing device, and sufficient suturing is possible. Since strong suturing work can be performed continuously and the suturing time can be shortened, there is an effect that the burden on the patient and the operator is reduced.

[Brief description of drawings]

FIG. 1 is a front view and a side view of a medical suturing device according to a first embodiment of the present invention.

FIG. 2 is an enlarged front view and side view of the distal end portion of the medical suturing device according to the embodiment.

FIG. 3 is a vertical sectional side view of the applicator according to the same embodiment.

FIG. 4 is an explanatory view of the suturing action of the same embodiment.

FIG. 5 is an explanatory view of the suturing action of the same embodiment.

FIG. 6 is an explanatory view of the suturing action of the same embodiment.

FIG. 7 is an explanatory view of the suturing action of the same embodiment.

FIG. 8 is an overall configuration diagram of a medical suturing device showing a modified example of the same embodiment, and a vertical sectional side view of a tip portion of an applicator.

FIG. 9 is a vertical cross-sectional side view of the tip of the applicator of the medical suturing device according to the second embodiment of the present invention.

FIG. 10 is a front view of a tip portion of an applicator according to a third embodiment of the present invention.

FIG. 11 is a front view of the distal end portion of the medical suturing device according to the fourth embodiment of the present invention.

FIG. 12 is an explanatory view of the suturing action of the same embodiment.

FIG. 13 is a front view of the distal end portion of the medical suturing device according to a fifth embodiment of the present invention.

FIG. 14 is a front view of the distal end portion of the medical suturing device according to the same embodiment.

FIG. 15 is a front view of the distal end portion of the medical suturing device showing a modified example of the same embodiment.

FIG. 16 is a front view of the distal end portion of the medical suturing device showing a modified example of the same embodiment.

FIG. 17 is a vertical cross-sectional side view of the operating portion of the medical suturing device according to the sixth embodiment of the present invention.

FIG. 18 is an operation explanatory view of the same embodiment.

FIG. 19 is an operation explanatory view of the same embodiment.

FIG. 20 is a vertical sectional side view of a medical suturing device according to a seventh embodiment of the present invention.

FIG. 21 is an exploded side view of the medical suturing device according to the same embodiment.

FIG. 22 is a front view of the distal end portion of the medical suturing device according to an eighth embodiment of the present invention.

FIG. 23 is a vertical sectional side view and a side view of a distal end portion of an operating portion of a medical suturing device according to ninth and tenth embodiments of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Medical suturing device 2 ... Insertion part 3 ... Operation part 4 ... Applicator 5 ... Forceps 10 ... Thread stop member

[Procedure amendment]

[Submission date] December 8, 1995

[Procedure Amendment 1]

[Document name to be amended] Statement

[Correction target item name] 0020

[Correction method] Change

[Correction contents]

Also, as shown in the modified example of FIG. 8B, the accommodating portion 12 which is a recess for accommodating the thread stopper member 10 of the applicator 4 is also provided at the opening edge of the accommodating portion 12.
By providing the pop-out preventing groove 12a for locking the thread fixing member 10 by locking it with the jaw 11a , the thread fixing member 10 can be reliably stored.

[Procedure amendment 2]

[Document name to be amended] Statement

[Correction target item name] 0022

[Correction method] Change

[Correction contents]

The operation of this embodiment is similar to that of the first embodiment, after the thread portion of the threaded needle 16 is arranged between the jaw 20a and the jaw 20b, the applicator operating portion 7 is operated to move the pressing member 18 forward. , The jaw 20a and the jaw 20b are closed by pushing the jaw 20a. At this time, the engaging portion 21a
And the engaging portion 21b are engaged with each other and cannot be opened again, and the thread fastening is completed.

[Procedure 3]

[Document name to be amended] Statement

[Name of item to be corrected] 0032

[Correction method] Change

[Correction contents]

In the operation of this embodiment, since the applicator 29 can be housed in the insertion portion 2 and sutured during the suturing operation, the applicator 29 does not interfere with the suturing operation. Since the applicator 29 can be advanced further than the forceps 5 at the time of thread stopping, the thread can be stopped without interfering with the forceps 5.

[Procedure amendment 4]

[Document name to be amended] Statement

[Correction target item name] 0035

[Correction method] Change

[Correction contents]

17 to 19 show a sixth embodiment,
Reference numeral 31 shows the medical suturing device of the present embodiment. The operation portion main body 31a of the medical suturing device 31 ultrasonic generator 33 attached to ultrasound transmission member 32 is provided, the ultrasonic generator 33 of this has handle 34 is attached. The sheath 35 and the sheath 36, which are provided as the outer tube of the ultrasonic transmission member 32, are elastically slidably attached to the handle 34 by a spring 37 in the axial direction of the sheath 36. It is configured to be movable along the sliding groove 39.

[Procedure Amendment 5]

[Document name to be amended] Drawing

[Correction target item name] Fig. 23

[Correction method] Change

[Correction contents]

FIG. 23

Claims (1)

[Claims] 1. In a medical suturing device having a thread stopping means for ultrasonically stopping a suture thread by a thread stopping member, the suture stopping means and forceps for operating the suture thread or suture needle are provided. A medical suturing device, which is arranged so that it can be simultaneously inserted into a body cavity.