US20030144673A1 - Medical ligating apparatus - Google Patents

Medical ligating apparatus Download PDF

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Publication number
US20030144673A1
US20030144673A1 US10/341,762 US34176203A US2003144673A1 US 20030144673 A1 US20030144673 A1 US 20030144673A1 US 34176203 A US34176203 A US 34176203A US 2003144673 A1 US2003144673 A1 US 2003144673A1
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United States
Prior art keywords
ligating
cutting
living tissues
distal end
tracting
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US10/341,762
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English (en)
Inventor
Yoshio Onuki
Satoshi Miyamoto
Koichi Kawashima
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Corp
Original Assignee
Olympus Optical Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Optical Co Ltd filed Critical Olympus Optical Co Ltd
Assigned to OLYMPUS OPTICAL CO., LTD. reassignment OLYMPUS OPTICAL CO., LTD. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: KAWASHIMA, KOICHI, MIYAMOTO, SATOSHI, ONUKI, YOSHIO
Publication of US20030144673A1 publication Critical patent/US20030144673A1/en
Assigned to OLYMPUS CORPORATION reassignment OLYMPUS CORPORATION CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: OLYMPUS OPTICAL CO., LTD.
Priority to US11/643,582 priority Critical patent/US8298249B2/en
Priority to US11/643,581 priority patent/US8298248B2/en
Priority to US12/324,986 priority patent/US8298250B2/en
Abandoned legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A61B2017/0488—Instruments for applying suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B2017/12018—Elastic band ligators

Definitions

  • the present invention relates to a medical ligating apparatus for ligating living tissues by inserting the apparatus into a body in a trans-endoscopic manner.
  • These medical ligating apparatuses are composed of: a sheath that can be inserted through an endoscope channel; a manipulating wire movably inserted through this sheath; a loop shaped ligating wire removably connected to a distal end of this manipulating wire; and a stopper provided at a proximal end of this ligating wire.
  • the ligating wire is formed of, for example, a synthetic resin such as nylon or polyolefin, or alternatively, stainless steel.
  • the stopper is formed of a thin tube consisting of an elastic element such as silicon rubber.
  • the stopper is a knot formed at a part of the ligating wire as disclosed in Jpn. Pat. Appln. KOKAI Publication No. 48-71090.
  • the scissors is inserted through the endoscope channel in order to isolate the ligating wire and manipulating wire connected with each other.
  • a manipulation for cutting the proximal end of the ligating wire by the scissors it is required to replace the medical ligating device with the scissors, and insert it into a body cavity in a trans-endoscopic manner.
  • an operation time is extended.
  • the proximal end of the ligating wire is cut, thereby isolating the ligating wire and manipulating wire connected with each other.
  • the ligating wire remains in the body cavity while this wire is extended from a ligating section. Therefore, for example, interference with another treatment device or endoscope may occur.
  • a medical ligating apparatus comprising: a medical ligating device consisting of a ligating member which consists of a flexible wire rod and ligates living tissues, and a fixing member which is movably provided at the ligating member and fixes the living tissues in a ligated state; and a manipulating device having a flexible sheath and a proximal manipulating section, wherein the manipulating device comprises cutting means for cutting the ligating member, the cutting means movably provided on the ligating member and can move back and forth.
  • the manipulating device comprises cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member, and the cutting means is advanced and retracted or rotated so that the ligating member can be cut at a proximal end of the fixing member.
  • the manipulating device comprises cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member, and the medical ligating device comprises a receiving member for receiving the cutting means, the receiving member being movably provided on the ligating member.
  • a medical ligating device a ligating member which includes a flexible wire rod and ligates living tissues; a fixing member which is movably provided on the ligating member that fixes the living tissues in a ligated state; and cutting means for cutting the ligating member, the cutting means being provided on the fixing member.
  • FIG. 1 is a structural view showing an entire medical ligating apparatus according to a first embodiment of the present invention, in which its distal end is cross-sectioned;
  • FIG. 2 is a longitudinal side cross section showing a distal end of the medical ligating apparatus according to the first embodiment
  • FIG. 3 is a longitudinal side cross section showing a distal end of the medical ligating apparatus according to the same embodiment
  • FIG. 4 is a longitudinal side cross section showing a distal end of the medical ligating apparatus according to the first embodiment
  • FIG. 5 is a perspective view showing a state in which a lesion is ligated by a ligating wire according to the first embodiment
  • FIG. 6 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a second embodiment of the present invention.
  • FIG. 7 shows the second embodiment and is a longitudinal, side cross-sectional view of the distal end of the medical ligating apparatus
  • FIG. 8 shows a third embodiment and is a longitudinal, side cross-sectional view of the distal end of the medical ligating apparatus
  • FIG. 9 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a fourth embodiment of the present invention.
  • FIG. 10 is a plan view showing a distal end of the medical ligating apparatus according to the fourth embodiment.
  • FIG. 11 is a sectional view taken along the line XI-XI of FIG. 9;
  • FIG. 12 is a sectional view taken along the line XII-XII of FIG. 9;
  • FIG. 13 is a sectional view taken along the line XIII-XIII of FIG. 9;
  • FIG. 14 is a longitudinal side cross section showing a distal end of the medical ligating apparatus in a state in which the ligating wire of the fourth embodiment is cut.
  • FIG. 15 is a longitudinal side cross section showing a distal end of a medical ligating apparatus showing a modified example of the first embodiment of the present invention
  • FIG. 16 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a fifth embodiment of the present invention.
  • FIG. 17 is an external view showing a distal end of a cutting sheath according to the fifth embodiment
  • FIG. 18A and FIG. 18B are perspective views showing a state during ligation according to the fifth embodiment
  • FIG. 19 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a sixth embodiment of the present invention.
  • FIG. 20 is an external view showing the apparatus in a direction indicated by the arrow XX in FIG. 19 according to the sixth embodiment.
  • FIG. 1 to FIG. 5 show a first embodiment of the present invention.
  • FIG. 1 is a structural view showing an entire medical ligating apparatus, in which its distal end is cross-sectioned.
  • FIG. 2 to FIG. 4 are longitudinal side cross sections of the distal end.
  • FIG. 5 is a perspective view showing a state in which a lesion is ligated by a ligating wire.
  • a medical ligating apparatus 1 is composed of: a medical ligating device 2 retained in a living body; and a manipulating device 3 for guiding the medical ligating device 2 into the living body, thereby carrying out ligating manipulation.
  • the manipulating device 3 is composed of: an insert section 4 having flexibility, the insert section being inserted into an endoscope channel; and a proximal manipulating section 5 .
  • the insert section 4 is composed of: an outer sheath 6 that consists of a flexible sheath; an inner sheath 7 that consists of a flexible sheath and is movably inserted into the outer sheath 6 in an axial direction; a cutting sheath 8 engaged with the outer of the inner sheath 7 , the cutting sheath being movably inserted in an axial direction; and a manipulating wire 9 that is retractable in an axial direction, the manipulating wire being inserted through the inner sheath 7 .
  • the outer sheath 6 is made of, for example, a plastic having flexibility such as polyethylene or PTFE, and is 2 mm to 5 mm in diameter.
  • the inner sheath 7 is made of, for example, a plastic having flexibility such as polyethylene or PTFE.
  • a metallic-meshed sheath may be inserted in a plastic sheath.
  • the manipulating wire 9 is formed of a metal twist wire such as stainless steel.
  • the proximal manipulating section 5 is composed of: a grip 10 fixed to a proximal end of the outer sheath 6 ; a slider 12 fixed to a proximal end of the manipulating wire 9 , the slider being retractable relative to a manipulating section main body 11 ; a cutting manipulating section 13 fixed to a proximal end of the cutting sheath 8 ; and a finger hook ring 14 .
  • the outer sheath 6 , manipulating wire 9 , and cutting sheath 8 can be moved relatively in the forward and backward direction by means of the grip 10 , slider 12 , and cutting manipulating section 13 .
  • annular cutting member 15 made of a metal such as stainless steel, the cutting member serving as cutting means.
  • a sharp cutting blade 16 is provided all around the distal end of the cutting member 15 .
  • a hook shaped engagement member 17 is securely fixed to the distal end of the manipulating wire 9 .
  • a loop shaped ligating wire 18 serving as a ligating member for ligating living tissues at the distal end portion of the device.
  • the ligating wire 18 is formed of a synthetic resin such as nylon or polyolefin, a metal thin wire such as stainless, a silk yarn, or biologically absorptive yarn, and is 0.2 mm to 1 mm in wire diameter.
  • the ligating wire 18 may be in any form of a single wire, twist wire, or knitted wire.
  • the proximal end side of the ligating wire 18 is folded, and a fold section 19 is formed. Both ends of the ligating wire 18 and the parallel two wires are fixed to an internal cavity of a connecting pipe 20 serving as a fixing parts by means of adhesive bonding or the like.
  • a tubular stopper 21 serving as a fixing member that is retractable on the wire is movably engaged.
  • the stopper 21 is made of, for example, a rubber such as silicon rubber or fluorine rubber or a variety of thermoplastic elastomers, or a knot of the ligating wire 18 .
  • the stopper 21 is advanced, whereby a loop section is reduced in diameter.
  • the stopper 21 is retracted, whereby the loop section is increased in diameter.
  • a receiving member 22 for receiving the cutting member 15 is provided at the ligating wire 18 at the proximal end of the stopper 21 .
  • the receiving member 22 is formed in a cylindrical shape, and is formed of a metal such as stainless or a plastic such as polypropylene, ABS, polyacetal, polycarbonate or the like.
  • An annular protrusion 23 is integrally provided at a substantially intermediate portion in an axial direction.
  • a converging section 24 is provided at the proximal end of the receiving member 22 .
  • the converging section 24 is designed so as to be supported after being inserted into the distal end of the inner sheath 7 . Therefore, there is no step between an outer periphery face of the inner sheath 7 and an outer periphery face of the receiving member 22 so that the cutting sheath 8 can be advanced and retracted smoothly.
  • a pair of distal end holes 25 a , 25 b through which the ligating wire 18 can be inserted are punched at the distal end side more than the annular protrusion 23 of the receiving member 22 .
  • a pair of proximal end holes 26 a , 26 b through which the ligating wire 18 can be inserted are punched at the proximal end side more than the annular protrusion 23 .
  • the inner face at the distal end side of the distal end holes 25 a , 25 b and the inner face at the proximal end side of the proximal end holes 26 a , 26 b are formed on an incline face so that the ligating wire 18 can be easily inserted and withdrawn.
  • a side face at the proximal end side of the annular protrusion 23 is formed as an abutment face 27 of the cutting member 15 .
  • Each of the folded portions of the ligating wire 18 is led from a proximal opening of the receiving member 22 to the inner of the receiving member 22 .
  • these portions each are led from the proximal end holes 26 a , 26 b to the outer of the receiving member 22 .
  • these portions each are led from the distal end holes 25 a , 25 b to the inner of the receiving member 22 via the outer of the annular protrusion 23 .
  • these portions each are led from the distal opening to the outer.
  • the ligating wire 18 is pressed into an internal cavity of the stopper 21 in a bound state.
  • the full length of the receiving member 22 is about 5 mm to 10 mm.
  • the length of the remaining wire after cut is determined depending on a dimension L between its distal face of receiving member 22 and proximal end holes 26 a , 26 b each. Thus, the shorter L is desirable, and is set to about 2 mm to 5 mm.
  • an external diameter of the receiving member 22 is A
  • an external diameter of the annular protrusion 23 is B
  • an internal diameter of the cutting member 15 is C.
  • the proximal end holes 26 a , 26 b as shown in FIG. 15, may be spaced forwardly or backwardly, respectively.
  • the slider 12 is manipulated, whereby the manipulating wire 9 is advanced, and the engagement member 17 is protruded from distal openings of the outer sheath 6 and inner sheath 7 .
  • the fold section 19 at the proximal end of the ligating wire 18 is hooked on a hook section of the engagement member 17 .
  • the slider 12 is manipulated, thereby retracting the manipulating wire 9 and introducing the engagement member 17 into the inner of the inner sheath 7
  • the converging section 24 of the receiving member 22 is supported after being inserted into the distal opening of the inner sheath 7 .
  • the grip 10 is manipulated, thereby advancing the outer sheath 6
  • the ligating wire 18 is housed into the inner of the outer sheath 6 , and a loop section is reduced in diameter, as shown in FIG. 2.
  • the insert section 4 is inserted through the endoscope channel, and is inserted into a body cavity. Then, a distal end of the insert section 4 is guided to a target site in the body cavity. While a lesion 28 such as polyp is observed by means of an endoscope, when the grip 10 is manipulated, thereby retracting the outer sheath 6 , the ligating wire 18 is protruded from the distal opening of the outer sheath 6 . Then, the loop section of the ligating wire 18 is elastically restored, and is increased in diameter, as shown in FIG. 1.
  • the proximal end side of the ligating wire 18 is pulled by the manipulating wire 9 , and a tensile stress is applied.
  • the cutting blade 16 cuts well.
  • a time difference may occur without the two top and bottom ligating wires 18 being cut at the same time.
  • the two top and bottom ligating wires 18 are connected to each other by means of the connecting pipe 20 . Even if these wires are cut one by one, a tensile stress is maintained, and thus, the cutting performance is not degraded.
  • the proximal end side of the ligating wire 18 is cut, the inner sheath 7 and receiving member 22 are separated from each other. Then, the ligating device 2 and manipulating device 3 are completely separated from each other.
  • the insert section 4 is drawn from the endoscope channel, the receiving member 22 slips off from the cut proximal end of the ligating wire 18 . Therefore, as shown in FIG. 5, only the ligating wire 18 held in a tightly bound state by means of the stopper 21 is retained in the body, and a surgical operation for tightly binding the lesion 28 completes.
  • the receiving member 22 having slipped off from the ligating wire 18 is naturally discharged to the outer of the body via the digestive tract.
  • the medical ligating apparatus 1 a manipulation for tightly binding the lesion 28 by the ligating wires 18 and a manipulation of cutting and separating the ligating wires 18 can be carried out in series. Therefore, unlike the prior art, there is no need to replace the ligating apparatus with the scissors in the endoscope channel, and a surgical operation time can be reduced. Moreover, the ligating wire 18 can be cut at a portion close to the stopper 21 . Thus, the ligating wire 18 does not remain in the body cavity while being in an expanded state, and interference with another treatment device or an endoscope can be prevented.
  • Such a simple structure is provided that the cutting means 15 having the cutting blade 16 oriented in the longitudinal direction of the manipulating device 3 is mounted at the distal end of the cutting sheath 8 , thus making it possible to reduce the manufacturing cost of the manipulating device and reduce the manipulating device in diameter. Further, even when the cutting performance of the cutting blade 16 is degraded due to repeated use of the manipulating device 3 , the cutting sheath 8 and cutting means 15 can be easily replaced by removing them from the manipulating device 3 .
  • FIG. 6 and FIG. 7 show a second embodiment of the present invention. Like elements in the first embodiment are designated by like reference numerals. A duplicate description is omitted here.
  • FIG. 6 and FIG. 7 are longitudinal side cross sections showing a distal end side of a medical ligating apparatus. An annular groove 30 into which the cutting blade 16 of the cutting member 15 is to be inserted is provided on the proximal side face of the annular protrusion 23 of the receiving member 22 according to the present embodiment.
  • FIG. 8 shows a third embodiment of the present invention. Like elements in the first embodiment are designated by like reference numerals. A duplicate description is omitted here.
  • FIG. 8 is a longitudinal side cross section showing a distal end side of a medical ligating apparatus.
  • the cutting member 31 of the present embodiment is provided at the inner of a sheath 7 a so as to be advanced and retracted by means of the cutting sheath 8 .
  • the cutting member 31 may be removable from the cutting sheath 8 so as to facilitate replacement.
  • a receiving member 32 is formed in a cylindrical shape that does not have an annular protrusion, and the distal end holes 25 a , 25 b and the proximal end holes 26 a , 26 b are provided.
  • An abutment face 34 of a cutting blade 33 of a cutting member 31 is provided on an internal wall of the receiving member 32 .
  • the cutting member 31 is provided at the inner of the sheath 7 a , whereby any protrusion is eliminated at the outer of the sheath 7 a , and the cutting blade is not exposed.
  • the outer sheath is eliminated, and thus, wiring can be directly provided to the endoscope channel.
  • the outer sheath is eliminated, whereby the insert section 4 of the medical ligating apparatus 1 is reduced in diameter, and wiring can be provided to a channel with its small internal diameter.
  • FIG. 9 to FIG. 14 show a fourth embodiment of the present invention.
  • Like elements in the first embodiment are designated by like reference numerals. A duplicate description is omitted here.
  • FIG. 9 is a longitudinal side cross section showing a distal end side of a medical ligating apparatus.
  • FIG. 10 is a plan view showing the same.
  • FIG. 11 is a cross section taken along the line XI-XI.
  • FIG. 12 is a sectional view taken along the line XII-XII.
  • FIG. 13 is a sectional view taken along the like XIII-XIII.
  • FIG. 14 is a longitudinal side cross section showing a distal end side of a medical ligating apparatus in a state in which a ligating wire is cut.
  • a fixing member 40 is provided at the proximal end side of the ligating wire 18 .
  • This fixing member 40 is preferably made of a plastic such as polypropylene, ABS, polyacetal, polycarbonate, or alternatively, a comparatively rigid material with excellent fluidity such as a liquid crystal polymer or polyphthal amide.
  • This member may be made of a metal such as stainless or aluminum, is about 1 mm to 3 mm in external diameter, and is about 5 mm to 10 mm in length.
  • the fixing member 40 is composed of a first member 41 and a second member 42 .
  • the first member 41 is formed in a cylindrical shape.
  • a large diameter section 43 is provided at a proximal end of the first member, and a press-in section 44 consisting of a short diameter section is provided at a distal end thereof.
  • An annular cutting member 45 is engagingly fitted to the outer periphery at the distal end side of the large diameter section 43 while its cutting blade 46 is oriented to the distal end side.
  • Wire guides 47 a , 47 b are provided at the top and bottom portions of the outer periphery of the proximal end side of the large diameter section 43 .
  • engagement claws 48 a , 48 b are provided at the right and left parts which are biased by 90 degrees in a peripheral direction relative to the wire guides 47 a , 47 b .
  • an internal cavity 49 is provided in an axial direction.
  • a protrusion 50 is provided at the substantially intermediate section in the axial direction of this internal cavity 49 . The height of this protrusion 50 is between 0.1 mm to 0.3 mm.
  • a columnar section 51 is provided at its distal end, and a cylindrical section 52 is provided integrally with the columnar section 51 at its proximal end.
  • an insert shaft 53 to be inserted into the internal cavity 49 of the first member 41 is protruded through the inner of the cylindrical section 52 .
  • a fixing internal cavity 54 into which a press-in section 44 of the first member 41 is to be pressed is provided at the columnar section 51 so as to surround the insert shaft 53 .
  • the length of the fixing internal cavity 54 is between 1 mm to 3 mm.
  • distal end holes 55 a , 55 b into the ligating wires 18 are inserted one by one are provided at the distal face of the second member 42 .
  • Side holes 56 a , 56 b are provided at the top and bottom parts at the outer periphery of the cylindrical section 52 of the second member 42 .
  • Slits 57 a , 57 b are provided in the neighborhood of these holes.
  • engagement holes 58 a , 58 b to be engaged with the engagement claws 48 a , 48 b of the first member 41 are provided at the right and left parts which are biased by 90 degrees in a peripheral direction relative to the slits 57 a , 57 b .
  • an abutment face 59 of the cutting blade 46 is provided on an end face at the proximal end side of the columnar section 51 of the second member 42 , and an abutment section 60 , on which the press-in section 44 abuts, is provided in the vicinity of the distal end of the fixing internal cavity 54 .
  • a single-side clearance between an internal diameter of the fixing internal cavity 54 and an external diameter of the press-in section 44 is defined so as to be smaller than an external diameter of the ligating wire 18 .
  • the insert shaft 53 of the second member 42 is inserted into the internal cavity 49 of the first member 41 , and a distal face of the insert shaft 53 abuts against the protrusion 50 , whereby the insertion depth is restricted. Therefore, the cylindrical section 52 of the second member 42 is engaged with the outer of the cutting member 45 so as to cover the cutting blade 46 .
  • the ligating wire 18 is inserted from the distal end holes 55 a , 55 b into the inner of the second member 42 , and is led out to the outer through the side holes 56 a , 56 b . Further, the ligating wire 18 is guided by the slits 57 a , 57 b and wire guides 47 a , 47 b , and is led to the proximal end side of the fixing member 40 . Connection between the fold section 19 of the ligating wire 18 and both of the ends via the connecting pipe 20 is similar to that in the first embodiment.
  • the manipulating wire 9 is advanced, whereby the engagement member 17 is protruded from a distal opening of the sheath 7 a .
  • the fold section 19 at the proximal end of the ligating wire 18 is hooked on a hook section of the engagement member 17 .
  • the manipulating wire 9 is retracted, thereby introducing the engagement member 17 into the inner of the sheath 7 a , the converging section 24 of the fixing member 40 is supported after being inserted into the distal opening of the sheath 7 a .
  • the sheath 7 a including the ligating wire 18 is inserted through the endoscope channel, and is inserted into the body cavity.
  • the distal end of the sheath 7 a is guided to a target site in the body cavity. While the lesion 28 such as polyp is observed by means of the endoscope, when the sheath 7 a is advanced, the ligating wire 18 is protruded from the distal opening of the channel. Then, the loop section of the ligating wire 18 is elastically restored, and is increased in diameter, as shown in FIG. 9.
  • the distal face of the second member 42 of the fixing member 40 abuts against the lesion 28 , and the lesion 28 serves as a stopper.
  • the first member 41 is relatively advanced, and the second member 42 is retracted. Therefore, the insert shaft 53 of the second member 42 breaks the protrusion 50 , and is inserted into the internal cavity 49 of the first member 41 .
  • the press-in section 44 of the first member 41 is advanced in the direction of the fixing internal cavity 54 of the second member 42 .
  • the intermediate section of the ligating wire 18 is fixed to be pinched between an internal face of the fixing internal cavity 54 and an external face of the press-in section 44 .
  • the cutting blade 46 of the cutting member 45 provided at the first member 41 abuts against an abutment face 59 of the second member 42 . Therefore, when the intermediate section of the ligating wire 18 is cut, and a cut end is pinched and fixed between the internal face of the fixing internal cavity 54 and the external face of the press-in section 44 .
  • the sheath 7 a and the fixing member 40 are separated from each other by disconnection of the ligating wire 18 , and the ligating device 2 and manipulating device 3 are completely separated from each other.
  • the sheath 7 a is drawn from the endoscope channel, only the ligating wire 18 held in a tightly bound state by means of the fixing member 40 is retained in the body, and a surgical operation for tightly binding the lesion 28 completes.
  • the medical ligating apparatus 1 a manipulation for cutting and separating the ligating wires 18 at the same time when the lesion 28 is tightly bound by the ligating wire 18 can be carried out in series. Therefore, unlike the prior art, there is no need to replace the ligating apparatus with the scissors in the endoscope channel, and a surgical operation time can be reduced. Moreover, the cut end of the ligating wire 18 is housed at the inner of the fixing member 40 , and thus, interference with another treatment device or an endoscope can be prevented more effectively. In addition, the cutting member 45 is provided at the medical ligating device 2 itself. Thus, a new cutting blade is always used without repeated use of the cutting blade 46 . As a result, the ligating wire 18 can be cut reliably.
  • the cutting member 45 is provided at the inner of the fixing member 40 , whereby a protrusion is eliminated.
  • the outer sheath becomes unnecessary, and the wire can be directly inserted through the endoscope channel.
  • the outer sheath becomes unnecessary, whereby the insert section 4 of the medical ligating apparatus 1 can be reduced in diameter, and the wire can be inserted through a channel with its small internal diameter.
  • FIG. 16 to FIG. 18 show a fifth embodiment of the present invention.
  • FIG. 16 is a longitudinal side cross section showing a distal end of the apparatus.
  • FIG. 17 is an external view showing a distal end of a cutting sheath.
  • FIG. 18 is a perspective view showing a state during ligation. Only differences from the first to third embodiments will be described here.
  • an external diameter of the stopper 21 is substantially equal to that of the inner sheath 7 , and a distal face of the inner sheath 7 can abut against a proximal face of the stopper 21 .
  • a cutting sheath 8 is formed of a metallic meshed plastic (for example, polyethylene, PTFE, nylon or the like), or alternatively, a metallic multi-striped coil, and is excellent in rotation tracking properties.
  • a cutting member 65 is connected at a distal end of the cutting sheath 8 .
  • the cutting member 65 has a cutout 61 .
  • a cutting blade 66 is provided at the distal edge and side face edge of the cutout 61 .
  • a claw section 62 is provided at the distal end side of the cutout 61 .
  • the slider 12 is pulled toward the proximal side, and the lesion 28 is ligated. Then, the slider 12 is slightly pushed and advanced to the distal end side, and a portion of the ligating wire 18 at the proximal end side of the stopper 21 is exposed to the distal end side of the inner sheath 7 , as shown in FIG. 18A.
  • the cutting manipulating section 13 is manipulated, whereby the cutting sheath 8 is advanced to be protruded to the distal end side more than the inner sheath 7 .
  • the ligating wire 18 exposed as shown in FIG. 18B is hooked on a claw section 62 .
  • the cutting manipulating section 13 is pulled to the proximal side or is rotated in the direction shown in FIG. 18B, whereby a cutting blade 66 provided at a cutting member 65 cuts the ligating wire 18 at the proximal end side of the stopper 21 .
  • the present embodiment unlike the first to third embodiments, there is no need to provide a receiving member at the medical ligating device 2 , and the number of parts is reduced. Thus the manufacturing cost can be reduced.
  • the ligating wire 18 does not pass through the distal end holes 25 a , 25 b and proximal end holes 26 a , 26 b of the receiving member in a bent state, and extends straight between a proximal end of the stopper 21 and the engagement member 17 . This makes it possible to push and advance the stopper 21 to the distal end side with a gentle force when the lesion 28 is ligated.
  • FIG. 19 and FIG. 20 show a sixth embodiment of the present invention.
  • FIG. 19 is a longitudinal side cross section showing a distal end of the apparatus.
  • FIG. 20 is an external view of the apparatus in the direction indicated by the arrow XX in FIG. 19. Only differences from the first to third embodiments will be described here.
  • An annular cutting member 75 is provided at the proximal end side of the stopper 21 .
  • the cutting member 75 is formed of a metal member such as stainless.
  • a converging section 24 is provided at the proximal end side of the cutting member 75 , and is designed to enable engagement with a distal internal cavity of the sheath 7 a .
  • An external diameter of the converging section 24 is slightly larger than the distal internal diameter of the sheath 7 a . This external diameter is defined in a dimension such that the cutting member 75 , when engaged with the distal internal cavity of the sheath 7 a , does not slip off easily nor rotate relative to the sheath 7 a.
  • the sheath 7 a is formed of a metallic meshed plastic (for example, polyethylene, PTFE, or nylon and the like), or alternatively, a metallic multi-stripe coil, and is excellent in rotation tracking properties.
  • a metallic meshed plastic for example, polyethylene, PTFE, or nylon and the like
  • a metallic multi-stripe coil for example, a metallic multi-stripe coil
  • a distal end hole 71 and proximal end hole 72 through which two ligating wires 18 can be inserted are provided on a side face of the cutting member 75 . These holes communicate with an internal cavity of the cutting member 75 .
  • the ligating wire 18 After the ligating wire 18 has passed through the inner of the stopper 21 , the ligating wire enters a distal opening of the cutting member 75 . Then, the ligating wire 18 is exposed to the outer through the distal end hole 71 . Further, the ligating wire 18 extends to the engagement member 17 through the proximal end hole 72 , an internal cavity of the cutting member 75 , and an internal cavity of the sheath 7 a.
  • a distance L between the distal end of the cutting member 75 and the distal end hole 71 be short.
  • the distance L is set to about 2 mm to 5 mm.
  • a cutting blade 76 is provided at both edges of the distal end hole 71 .
  • the proximal end side of the sheath 7 a is rotated.
  • the cutting member 75 and the distal end of the sheath 7 a are engaged with each other so as not to easily rotate therebetween.
  • the cutting member 75 rotates in unison with the sheath 7 a.
  • the distal end side of the ligating wire 18 is fixed to be ligated around the lesion 28 .
  • the cutting blade 76 abuts against a portion of the ligating wire 18 which is passing through the distal end hole 71 , and cuts the portion of the wire.
  • the cutting member 75 is taken out of the body while it is fixed to the distal end of the sheath 7 a.
  • the cutting blade 76 may be provided at a distal edge of the distal end hole 71 .
  • the sheath 7 a is pulled to the proximal side, whereby the ligating wire 18 is cut by the cutting blade 76 .
  • the sheath 7 a and converging section 24 must be set so as not to be disengaged from each other in the range of a force required to cut the ligating wire 18 .
  • the cutting member 75 is provided in place of the receiving members according to the first to third embodiments.
  • the cutting sheath 8 becomes unnecessary, the number of parts is reduced, and the manufacturing cost can be reduced.
  • the medical ligating device is not retained in the body in such a state that another member remains at the proximal end side of the fixing member. Thus, interference with another treatment device or an endoscope can be prevented more efficiently immediately after the ligating device has been retained.
  • a manipulation for tightly binding a lesion by a ligating member and a manipulation for cutting the ligating member can be carried out in series.
  • the ligating member can be cut at a portion close to the fixing member.
  • the cut end of the ligating member does not remain in the body cavity while it is extended, and interference with another treatment device or an endoscope can be prevented.
  • the cutting blade extends in the longitudinal direction of the manipulating device.
  • the manipulating device can be reduced in diameter.
  • means for cutting the ligating member is formed with a simple structure. Thus, the manufacturing cost can be reduced.
  • the ligating device is not limited to a loop-shaped one.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Reproductive Health (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
US10/341,762 2002-01-16 2003-01-14 Medical ligating apparatus Abandoned US20030144673A1 (en)

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US11/643,582 US8298249B2 (en) 2002-01-16 2006-12-21 Medical ligating apparatus
US11/643,581 US8298248B2 (en) 2002-01-16 2006-12-21 Medical ligating apparatus
US12/324,986 US8298250B2 (en) 2002-01-16 2008-11-28 Medical ligating apparatus

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US11/643,581 Expired - Fee Related US8298248B2 (en) 2002-01-16 2006-12-21 Medical ligating apparatus
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US12/324,986 Expired - Fee Related US8298250B2 (en) 2002-01-16 2008-11-28 Medical ligating apparatus

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US20100049213A1 (en) * 2007-10-19 2010-02-25 Guided Delivery Systems Inc. Devices and methods for termination
US20100094314A1 (en) * 2008-10-10 2010-04-15 Hernlund Jonathan D Tether tensioning devices and related methods
US20100121349A1 (en) * 2008-10-10 2010-05-13 Meier Stephen C Termination devices and related methods
US20110106107A1 (en) * 2009-10-30 2011-05-05 Wilson-Cook Medical Inc. Apparatus and methods for maintaining a force upon tissue using a loop member
US20120022558A1 (en) * 2008-10-20 2012-01-26 Mayo Foundation For Medical Education And Research Tissue ligation devices and methods
US8105355B2 (en) 2006-05-18 2012-01-31 C.R. Bard, Inc. Suture lock fastening device
WO2012158737A1 (en) * 2011-05-18 2012-11-22 St. Jude Medical Puerto Rico Llc Suture locking device and methods
US8469975B2 (en) * 2005-06-20 2013-06-25 Nobles Medical Technologies, Inc. Method and apparatus for applying a knot to a suture
US9131938B2 (en) 2007-03-29 2015-09-15 Nobles Medical Technologies, Inc. Suturing devices and methods for closing a patent foramen ovale
US9326764B2 (en) 2008-05-09 2016-05-03 Nobles Medical Technologies Inc. Suturing devices and methods for suturing an anatomic valve
US9398907B2 (en) 1999-07-02 2016-07-26 Quickpass, Inc. Suturing device
US20160317274A1 (en) * 2013-12-30 2016-11-03 Lifetech Scientific (Shenzhen) Co., Ltd. Implant Conveying Device and Implanted Medical Instrument
US9649106B2 (en) 2011-04-15 2017-05-16 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic valve
US9706988B2 (en) 2012-05-11 2017-07-18 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic structure
US20170273705A1 (en) * 2016-03-28 2017-09-28 Mona Zallum Skin tag remover
EP3292823A4 (en) * 2015-04-30 2019-02-27 Cai, Xiujun TOTAL LAPAROSCOPIC TWO-STAGE SURGICAL METHOD FOR RESECTING THE SIDE OF A LIVER OF A PATIENT OVER A METHOD OF LIBERATING TAPE
US10512458B2 (en) 2013-12-06 2019-12-24 Med-Venture Investments, Llc Suturing methods and apparatuses
US10687801B2 (en) 2016-04-11 2020-06-23 Nobles Medical Technologies Ii, Inc. Suture spools for tissue suturing device
US10828022B2 (en) 2013-07-02 2020-11-10 Med-Venture Investments, Llc Suturing devices and methods for suturing an anatomic structure
CN112603446A (zh) * 2020-12-21 2021-04-06 河南驼人医疗器械集团有限公司 一种肛肠套扎器
US20210153869A1 (en) * 2019-11-27 2021-05-27 Boston Scientific Scimed, Inc. Devices, systems, and methods for securing tissue
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US11395658B2 (en) 2014-07-11 2022-07-26 Cardio Medical Solutions, Inc. Device and method for assisting end-to-side anastomosis
US11672524B2 (en) 2019-07-15 2023-06-13 Ancora Heart, Inc. Devices and methods for tether cutting
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KR20240069235A (ko) 2022-11-11 2024-05-20 주식회사 다운컴퍼니 디지털 에이전시 기반의 그로스 해킹 테스팅 플랫폼
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US12402871B2 (en) 2007-03-29 2025-09-02 Scarab Technology Services, Llc Device for applying a knot to a suture
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US9326764B2 (en) 2008-05-09 2016-05-03 Nobles Medical Technologies Inc. Suturing devices and methods for suturing an anatomic valve
US11166712B2 (en) 2008-05-09 2021-11-09 Scarab Technology Services, Llc Suturing devices and methods for suturing an anatomic valve
US10285687B2 (en) 2008-05-09 2019-05-14 Nobles Medical Technologies Inc. Suturing devices and methods for suturing an anatomic valve
US8795298B2 (en) 2008-10-10 2014-08-05 Guided Delivery Systems Inc. Tether tensioning devices and related methods
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US20100094314A1 (en) * 2008-10-10 2010-04-15 Hernlund Jonathan D Tether tensioning devices and related methods
US20100121349A1 (en) * 2008-10-10 2010-05-13 Meier Stephen C Termination devices and related methods
US20120022558A1 (en) * 2008-10-20 2012-01-26 Mayo Foundation For Medical Education And Research Tissue ligation devices and methods
US8961543B2 (en) * 2008-10-20 2015-02-24 Mayo Foundation For Medical Education And Research Tissue ligation devices and methods
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US11337723B2 (en) 2009-10-30 2022-05-24 Cook Medical Technologies Llc Apparatus and methods for maintaining a force upon tissue using a loop member
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US10842525B2 (en) 2009-10-30 2020-11-24 Cook Medical Technologies Llc Apparatus and methods for maintaining a force upon tissue using a loop member
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US9649106B2 (en) 2011-04-15 2017-05-16 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic valve
US10624629B2 (en) 2011-04-15 2020-04-21 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic valve
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US9681866B2 (en) 2011-05-18 2017-06-20 St. Jude Medical Puerto Rico Llc Suture locking device and methods
US10420545B2 (en) 2012-05-11 2019-09-24 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic structure
US11051802B2 (en) 2012-05-11 2021-07-06 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic structure
US9706988B2 (en) 2012-05-11 2017-07-18 Heartstitch, Inc. Suturing devices and methods for suturing an anatomic structure
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US10188497B2 (en) * 2013-12-30 2019-01-29 Lifetech Scientific (Shenzhen) Co. Ltd. Implant conveying device and implanted medical instrument
US20160317274A1 (en) * 2013-12-30 2016-11-03 Lifetech Scientific (Shenzhen) Co., Ltd. Implant Conveying Device and Implanted Medical Instrument
US11395658B2 (en) 2014-07-11 2022-07-26 Cardio Medical Solutions, Inc. Device and method for assisting end-to-side anastomosis
EP3292823A4 (en) * 2015-04-30 2019-02-27 Cai, Xiujun TOTAL LAPAROSCOPIC TWO-STAGE SURGICAL METHOD FOR RESECTING THE SIDE OF A LIVER OF A PATIENT OVER A METHOD OF LIBERATING TAPE
US20170273705A1 (en) * 2016-03-28 2017-09-28 Mona Zallum Skin tag remover
US10687801B2 (en) 2016-04-11 2020-06-23 Nobles Medical Technologies Ii, Inc. Suture spools for tissue suturing device
US11957331B2 (en) 2017-06-19 2024-04-16 Heartstitch, Inc. Suturing systems and methods for suturing body tissue
US11839370B2 (en) 2017-06-19 2023-12-12 Heartstitch, Inc. Suturing devices and methods for suturing an opening in the apex of the heart
US11202624B2 (en) 2017-08-18 2021-12-21 Nobles Medical Technologies Ii, Inc. Apparatus for applying a knot to a suture
US11701121B2 (en) * 2019-01-11 2023-07-18 United States Endoscopy Group, Inc. Cinch ligating assembly
US11672524B2 (en) 2019-07-15 2023-06-13 Ancora Heart, Inc. Devices and methods for tether cutting
US12114860B2 (en) * 2019-11-27 2024-10-15 Boston Scientific Scimed, Inc. Devices, systems, and methods for securing tissue
US20210153869A1 (en) * 2019-11-27 2021-05-27 Boston Scientific Scimed, Inc. Devices, systems, and methods for securing tissue
CN112603446A (zh) * 2020-12-21 2021-04-06 河南驼人医疗器械集团有限公司 一种肛肠套扎器

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US8298249B2 (en) 2012-10-30
US20090105730A1 (en) 2009-04-23
US20070106309A1 (en) 2007-05-10
US8298248B2 (en) 2012-10-30
JP2003204966A (ja) 2003-07-22
US8298250B2 (en) 2012-10-30
US20070106308A1 (en) 2007-05-10

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