WO2009113222A1 - Outil médical - Google Patents

Outil médical Download PDF

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Publication number
WO2009113222A1
WO2009113222A1 PCT/JP2008/073414 JP2008073414W WO2009113222A1 WO 2009113222 A1 WO2009113222 A1 WO 2009113222A1 JP 2008073414 W JP2008073414 W JP 2008073414W WO 2009113222 A1 WO2009113222 A1 WO 2009113222A1
Authority
WO
WIPO (PCT)
Prior art keywords
suture
puncture needle
rack
annular member
needle
Prior art date
Application number
PCT/JP2008/073414
Other languages
English (en)
Japanese (ja)
Inventor
昌貴 鮒田
尚樹 小林
一徳 笹渕
Original Assignee
Funada Masaki
Kobayashi Naoki
Sasabuchi Kazunori
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 Funada Masaki, Kobayashi Naoki, Sasabuchi Kazunori filed Critical Funada Masaki
Priority to DE112008003764.7T priority Critical patent/DE112008003764B4/de
Publication of WO2009113222A1 publication Critical patent/WO2009113222A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments 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, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3401—Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0485—Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00407—Ratchet means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06052—Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A61B2017/3407—Needle locating or guiding means using mechanical guide means including a base for support on the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A61B2017/3409—Needle locating or guiding means using mechanical guide means including needle or instrument drives

Definitions

  • the present invention relates to a medical instrument used when a catheter is inserted into the abdominal viscera percutaneously.
  • a medical instrument used when a catheter is inserted into the abdominal viscera percutaneously.
  • it is used to fix the anterior abdominal wall and visceral wall to facilitate the insertion of a catheter during endoscopic gastrostomy for the purpose of supplementing nutrients and discharging body fluids. It is related with the medical device to be.
  • the inventor of the present invention provides a suture insertion puncture needle, a suture grasping puncture needle provided substantially in parallel with a predetermined distance from the suture insertion puncture needle, and the suture grasping puncture needle.
  • a medical instrument comprising a stylet that is slidably inserted therein, and a fixing member to which the proximal end of the suture insertion puncture needle and the suture grasping puncture needle are fixed.
  • the present inventor further disclosed an operation for sequentially feeding the sutures inserted into the suture insertion needle into the distal direction according to Japanese Patent Laid-Open No. 2007-319169, and suturing.
  • the stylet annular member housed inside the suture grasping needle can be protruded from or inserted into the tip.
  • the present invention has been made paying attention to the above-described problems of the prior art, and an operation for sequentially feeding the sutures inserted into the suture insertion needle into the distal direction, and a suture grasping
  • the operation of projecting or immersing the stylet annular member housed inside the puncture needle can be easily performed with one hand, and the annular member can be more easily and smoothly projected.
  • An object of the present invention is to provide a medical instrument that can reduce the momentum of immersing the annular member and can securely hold the annular member so that the treatment can be performed efficiently and safely.
  • a puncture needle for inserting a suture thread a puncture needle for gripping a suture thread provided approximately parallel to a predetermined distance from the puncture needle for inserting a suture thread, and sliding inside the puncture needle for gripping a suture thread
  • a medical device comprising: a stylet inserted so as to be able to be inserted; and a case main body on which the suture insertion puncture needle and the suture grasping puncture needle are supported.
  • the stylet has an annular member that is formed of an elastic material and can be stored inside the puncture needle for grasping a suture at its tip,
  • the suture thread is inserted so that the central axis of the suture insertion puncture needle or an extension line thereof penetrates the inside of the annular member. It is restored and extended in the direction of the puncture needle for A delivery mechanism that is provided on the side of the case body that supports the proximal end of the suture insertion puncture needle, and that sequentially feeds the sutures inserted from the proximal end of the suture insertion puncture needle in the distal direction.
  • the projecting mechanism is connected to the base end of the stylet so as to extend in the axial direction, and is rotatable in a state of meshing with the first rack disposed in the case body so as to be movable in the longitudinal direction.
  • An output gear supported on the shaft, an input gear coaxially connected to the output gear, and a gear movable in the longitudinal direction parallel to the first rack in the case body while meshing with the input gear.
  • a second rack that is connected to the base end of the second rack in a longitudinal direction, and an operation rod that protrudes from the base end of the case body and can protrude and retract, and has a diameter of the input gear.
  • the operating rod is urged by a spring member in a proximal direction in which the annular member is accommodated inside the suture grasping puncture needle, and the annular member is projected from the distal end of the suture grasping puncture needle.
  • a protruding locking means capable of constraining and releasing the operating rod at the position when the operating rod is pushed in the distal direction against the biasing force of the spring member. Instruments.
  • the present invention operates as follows. According to the medical instrument described in [1] above, when ligating between biological membranes that overlap vertically with the suture insertion needle and the suture grasping needle inserted into the living body,
  • the projecting mechanism causes the annular member at the distal end of the stylet accommodated inside the suture grasping puncture needle to project from the distal end of the suture grasping puncture needle. Then, the annular member extends in the direction of the suture insertion puncture needle so that the central axis of the suture insertion puncture needle or its extension line penetrates the inside of the annular member.
  • the delivery mechanism sequentially feeds the suture thread inserted from the proximal end of the suture insertion puncture needle in the distal direction, and projects the suture thread from the distal end of the suture insertion puncture needle so that the suture thread is the annular member. Pass inside. Thereafter, the stylet is pulled back and the annular member is housed inside the suture grasping needle. By this operation, the annular member is deformed so that the annular space is gradually narrowed, and the suture is gripped along with this, and the portion of the suture finally gripped by the annular member is sutured together with the annular member. It is housed inside the grasping puncture needle.
  • the operation of feeding out the suture that requires fine and careful operation and the operation of projecting or immersing the annular member from the tip can be reliably and easily performed by the delivery mechanism and the projecting mechanism, respectively.
  • the delivery mechanism and the projecting mechanism For example, when performing gastrostomy, it is possible for only one operator to perform gastric wall fixation and endoscopic operation, and only one operator, or two surgeons and assistants. The operation can be performed efficiently and safely.
  • the suture insertion puncture needle and the suture grasping puncture needle are each supported by the case body, and since the delivery mechanism and the protruding mechanism are housed in the case body, the device is easy to handle and convenient to carry. .
  • the second rack connected to the operating rod when the operating rod whose base end projects from the case body is pushed with a finger, the second rack connected to the operating rod also moves in the longitudinal direction, thereby meshing with the second rack.
  • the coaxial output gear As the existing input gear rotates, the coaxial output gear also rotates. Then, the first rack engaged with the output gear moves in the longitudinal direction, the stylet connected to the first rack is pushed out in the axial direction, and the annular member protrudes from the distal end of the suture grasping puncture needle. Can be made.
  • the annular member can be projected with a longer stroke than the pushing stroke of the operating rod.
  • the annular member can be protruded by a stroke twice the pushing stroke of the operating rod.
  • the operating rod is urged by the spring member toward the proximal direction in which the annular member is housed inside the suture grasping puncture needle. As described above, the operating rod is pushed against the urging force of the spring member. In this case, the operation rod is restrained at the position where the annular member protrudes from the distal end of the suture grasping puncture needle by the protruding lock means. When the restraint by the locking means at the time of protrusion is released, the operating rod returns to the original initial position by the biasing force of the spring member.
  • the first rack is elastically returned to the initial position where the first rack returns by the biasing force of the spring member. It is advisable to provide a stopper that abuts against. Accordingly, it is possible to reliably position the annular member at the initial return position, and it is possible to prevent the puncture needle tip from being shaken due to an impact and the rack and the gear constituting the protruding mechanism from being disengaged.
  • FIG. 3 is a sectional view taken along line III-III in FIG. 1. It is a bottom view which shows the medical instrument which concerns on one embodiment of this invention.
  • FIG. 6 is a sectional view taken along line VI-VI in FIG. 2.
  • FIG. 5 is a sectional view taken along line VV in FIG. 2. It is explanatory drawing which shows the inside of the gear box of the medical instrument which concerns on one embodiment of this invention. It is sectional drawing which shows the state which accommodated the gear box of the medical instrument which concerns on one embodiment of this invention in the case main body.
  • FIG. 1 to 21 show an embodiment of the present invention.
  • the medical instrument 10 according to the present embodiment is used for fixing the anterior abdominal wall and the visceral wall, which is performed in order to facilitate insertion of a catheter during endoscopic gastrostomy.
  • 1 is a front view of the medical instrument 10
  • FIG. 2 is a plan view of the medical instrument 10
  • FIG. 3 is a cross-sectional view taken along line III-III in FIG. 4 is a bottom view of the medical device
  • FIG. 5 is a sectional view taken along line VI-VI in FIG. 2
  • FIG. 6 is a sectional view taken along line VV in FIG.
  • the medical instrument 10 includes a suture insertion puncture needle 20 and a suture grasping puncture needle 30 provided substantially parallel to the suture insertion puncture needle 20 at a predetermined distance.
  • the stylet 40 (see FIG. 6) slidably inserted into the suture grasping puncture needle 30, the suture insertion puncture needle 20 and the suture grasping puncture needle 30 are supported.
  • the case main body 11 is provided.
  • the case main body 11 forms a housing that unitizes the entire apparatus, and is specifically formed in a rectangular parallelepiped shape extending in the longitudinal direction.
  • FIG. 1 the upper surface side of the case main body 11 is a detachable lid 12, which is fixed to the case main body 11 with screws.
  • FIG. 3 is a partial cross-sectional view with the lid 12 removed.
  • the lid 12 of the case body 11 is made of a transparent synthetic resin, for example, a transparent material such as a vinyl chloride resin, a polyolefin such as polypropylene or polyethylene, or a polycarbonate, so that the inside can be seen through. In each figure, it is expressed for convenience as an opaque body whose inside cannot be seen through.
  • needles that support the proximal ends of the suture insertion needle 20 and the suture grasping needle 30 are provided at the distal end of the case body 11.
  • a base member 13 is provided.
  • the needle base member 13 is supported between the pair of support pieces 14 and 14 projecting from the tip of the case body 11 so as to be movable by a predetermined distance in the axial direction of the puncture needles 20 and 30. It is fixed at a desired position by screws 15 and nuts 16.
  • the locking teeth 14a, 14a,... are connected to the inner side surfaces of the pair of support pieces 14, 14 at a fine pitch, and the same locking teeth 13a, 13a,. Are engaged and engaged with each other.
  • the position of the needle base member 13 can be adjusted by the pitch interval of the respective locking teeth 13a, 14a, and is fixed by screws 15 and nuts 16 at predetermined positions.
  • Each pair of support pieces 14 and 14 is provided with a long groove 14b (FIG. 15A) into which a screw 15 is movably fitted.
  • the relative position can be adjusted.
  • the proximal end of the suture grasping puncture needle 30 is fixed in a state where the inside of the thin tubular needle communicates with the internal space of the needle base member 13 and opens. The same applies to the proximal end of the suture insertion needle 20.
  • the suture insertion puncture needle 20 and the suture grasping puncture needle 30 are supported by the needle base member 13 in parallel in a state of being separated from each other by a predetermined distance.
  • the suture insertion puncture needle 20 is a thin tubular needle into which the suture S (see FIG. 17) can be inserted.
  • the suture insertion needle 20 is formed of metal, for example, stainless steel, and has a blade surface for puncturing the skin at the tip. Have.
  • the distal end of the suture insertion puncture needle 20 has a blade surface cut along a plane that obliquely intersects the axis.
  • the inside of the suture insertion puncture needle 20 serves as a passage for guiding the suture in one direction from the proximal end to the distal end of the suture insertion puncture needle 20.
  • the suture insertion puncture needle 20 preferably has an outer diameter of about 21 G to 17 G, particularly preferably 20 to 18 G, and a length of about 70 mm to 120 mm, particularly about 80 to 100 mm. Those are preferred.
  • the suture inserted inside from the proximal end of the suture insertion puncture needle 20 is inserted.
  • a delivery mechanism 60 that sequentially feeds in the distal direction is provided. The delivery mechanism 60 is pressed from both sides into a guide hole 61 communicating with the proximal end of the suture insertion puncture needle 20 and the suture guided through the guide hole 61 into the suture insertion needle 20.
  • the guide hole 61 is formed in the case body 11 so as to extend in the axial direction of the suture insertion puncture needle 20.
  • the proximal end side of the guide hole 61 is formed in a tapered shape that gradually increases in diameter toward the outside, so that a suture can be easily inserted.
  • the distal end side of the guide hole 61 is connected to the inside of the suture insertion needle 20 through the hollow portion of the needle base member 13.
  • the auxiliary roller 62 and the yarn feed roller 63 are rotatably supported in a state where they are in contact with each other at a position on the proximal end side of the guide hole 61.
  • the operation roller 64 has a diameter that is approximately twice the diameter of the yarn feed roller 63, and is in contact (engaged) with the yarn feed roller 63 so as to be rotatable relative to each other.
  • the part is exposed to the outside through an opening provided in the side wall of the case body 11 and is pivotally supported so that it can be rotated from the outside.
  • the thread feed roller 63 is rotated, and the sutures sandwiched between the auxiliary roller 62 are sequentially directed toward the distal end of the suture insertion needle 20. It is configured to send out.
  • at least the outer peripheral portion of the yarn feed roller 63 is formed of an elastic material that elastically contacts the suture, for example, silicone rubber.
  • the yarn feeding roller 63 that actively feeds the suture thread but also the outer peripheral portion of the auxiliary roller 62 that forms a pair with the yarn feeding roller 63 may be formed of an elastic material.
  • the suture grasping puncture needle 30 is a thin tubular needle that is slidably inserted into the stylet 40 and is formed of metal, for example, stainless steel, and has a blade surface for puncturing the skin at the tip. ing.
  • the suture grasping puncture needle 30 may be the same as the suture insertion puncture needle 20 described above, or the same outer diameter. Further, in order to ensure that the annular member 42 of the stylet 40, which will be described later, extends in the direction of the suture insertion puncture needle 20, the blade surface at the tip of the suture grasping puncture needle 30 is shown in FIG. ), The opening is preferably made in the direction of the suture insertion puncture needle 20.
  • the suture grasping puncture needle 30 is fixed in a state where the proximal end communicates with the needle base member 13 and opens.
  • the suture grasping puncture needle 30 may be anything as long as it can puncture the skin and insert the stylet 40. Specifically, the outer diameter and the length are the same as those of the suture insertion puncture needle 20. It is preferable to adopt the above.
  • the tip of the suture grasping puncture needle 30 facing the suture insertion puncture needle 20 is preferably chamfered so as not to break the thread.
  • the stylet 40 is slidably inserted into the suture grasping puncture needle 30, and has a rod-like member 41 having an outer diameter smaller than the inner diameter of the suture grasping puncture needle 30; It consists of an annular member 42 fixed to the tip of the rod-like member 41.
  • the annular member 42 is formed of an elastic material. When the annular member 42 protrudes from the distal end of the suture grasping puncture needle 30, the annular member 42 is restored to an annular shape as shown in FIGS. As shown in FIG. 17 (a), it is deformed so as to be substantially linear and can be accommodated inside the suture grasping puncture needle 30.
  • the center axis of the suture insertion puncture needle 20 or its extension line penetrates the inside of the annular member 42. It is formed to extend in the direction of puncture needle 20.
  • the annular member 42 is fixed to the tip of the rod-like member 41 at a certain angle, and when viewed from the side, the annular member 42 has a curved shape in which the tip part is a bottom part slightly from the center part. It is preferable. By forming in this way, the central axis of the suture insertion puncture needle 20 or its extension line penetrates the inside of the annular member 42 more reliably.
  • the distal end portion of the annular member 42 has a V-shape or a U-shape that is substantially centered on the distal end, and forms a suture grasping portion 42a with a reduced distance.
  • a metal for example, stainless steel
  • a synthetic resin for example, a polyolefin such as polypropylene or polyethylene, a fluorine resin such as PTFE or ETFE
  • a synthetic resin for example, a polyolefin such as polypropylene or polyethylene, a fluorine resin such as PTFE or ETFE
  • the stylet 40 housed in the suture grasping puncture needle 30 is provided on the side of the case body 11 that supports the proximal end of the suture grasping puncture needle 30.
  • a projecting mechanism 70 for projecting the annular member 42 from the distal end of the suture grasping puncture needle 30 is provided.
  • the protruding mechanism 70 includes a first rack 71 connected to the stylet 40, an output gear 73 that meshes with the first rack 71, an input gear 74 that is coaxial with the output gear 73, and a second gear that meshes with the input gear 74.
  • a rack 72 and an operation rod 76 connected to the second rack 72 are provided.
  • FIG. 7 is an explanatory view showing the inside of the gear box 70a forming the protruding mechanism 70
  • FIG. 8 is a cross-sectional view showing a state in which the gear box 70a is housed in the case main body 11.
  • 9 is a cross-sectional view seen from the front side showing a state in which the gear box 70a is housed in the case body 11
  • FIG. 10 is a bottom side view showing a state in which the gear box 70a is housed in the case body 11. It is sectional drawing seen from.
  • the first rack 71 is connected to the base end of the bar-like member 41 of the stylet 40 so as to extend in the axial direction. It is arranged to be movable in the longitudinal direction that coincides with the axial direction.
  • the output gear 73 is pivotally supported via a pivot 75 in a state of meshing with the first rack 71.
  • the second rack 72 is arranged so as to be movable in a longitudinal direction parallel to the first rack 71 in a state of meshing with the input gear 74 in the case body 11.
  • the input gear 74 is supported coaxially with the pivot shaft 75 of the output gear 73, and is integrally connected to the output gear 73 by the pivot shaft 75.
  • the diameter of the output gear 73 is set to a value larger than the diameter of the input gear 74.
  • the diameter of the output gear 73 is set to be twice the diameter of the input gear 74.
  • the first rack 71, the second rack 72, the output gear 73, the input gear 74, and the like are each housed in a gear box 70a and configured as a unit.
  • the operating rod 76 is connected to the base end of the second rack 72 so as to extend in the longitudinal direction.
  • the proximal end side of the operation rod 76 is arranged so as to protrude and project outside the gear box 70a and the case body 11.
  • An operation push button 77 is provided at the base end of the operation rod 76, and an elastically deformable locking claw 78 is provided on the operation rod 76 near the push button 77. It is provided so that it can appear and disappear in the radial direction from the outer peripheral surface.
  • a rod portion 72a extending in the longitudinal direction on the same axis extends at the tip of the second rack 72, and a coil-shaped spring member 80 is wound around the rod portion 72a.
  • the spring member 80 attaches the operating rod 76 in the proximal direction from which the push button 77 protrudes so that the annular member 42 returns to the proximal direction in which the suture member puncture needle 30 is housed. It is intended to help.
  • the urging force of the operating rod 76 by the spring member is directly urged through the portion of the rod portion 72a integral with the second rack 72. You may comprise so that it may urge directly with a member.
  • FIG. 11 shows a state in which the operating rod 76 is pushed, that is, although not shown in FIG. 11, the annular member 42 of the stylet 40 housed inside the suture grasping puncture needle 30 is inserted into the suture grasping puncture.
  • 3 is a cross-sectional view of the case main body 11 showing a state in which the needle 30 protrudes from the tip of the needle 30.
  • 12 shows a state in which the operating rod 76 protrudes outward, that is, although not shown in FIG. 12, the annular member 42 of the stylet 40 is housed inside the suture grasping needle 30. It is sectional drawing of the case main body 11 which shows the state which exists.
  • the protruding locking means includes the locking claw 78 provided in the middle of the operation rod 76 and a release button 79 for releasing the restrained state by the locking claw 78.
  • the locking claw 78 penetrates the middle of the operation rod 76. Pass through the insertion hole in a state of being recessed by the tip side taper. Then, when the locking claw 78 enters the case main body 11, it returns to its original protruding state, and the rear end side of the locking claw 78 is hooked on the inner edge of the insertion hole to be in a restrained state. To release the restraint, the release button 79 shown in FIG. 11 is pushed to temporarily dent the locking claw 78, and the engagement between the rear end of the locking claw 78 and the inner edge of the insertion hole of the case body 11 is released. It is configured to be able to.
  • FIG. 13 is a cross-sectional view showing the inside of the gear box 70a
  • FIG. 14 is a cross-sectional view showing the inside of the gear box 70a at another position.
  • the second rack 72 is moved in the proximal direction by the urging force of the spring member 80 when the restraint by the locking means at the time of release is released.
  • Return mitigation means is provided for reducing the return momentum by the sliding resistance brought into sliding contact with the second rack 72.
  • the return mitigating means includes, on the back side of the second rack 72, a convex portion 84 that protrudes over a predetermined length with respect to the reference surface 83, and a resistance claw 81 that elastically slides on the convex portion 84.
  • the convex portion 84 is set to a length corresponding to a stroke from the position where the operating rod 76 is pushed back to the original protruding initial position.
  • the resistance claw 81 is provided on the inner wall surface of the gear box 70a so as to be elastically deformable in the protruding direction, and is disposed so as to elastically slide on the convex portion 84.
  • the gear box 70a housed in the case main body 11 has the second rack 72 in an initial position where the second rack 72 returns to the urging force of the spring member 80 when the restraint by the locking means is released.
  • an immersion lock means that can be restrained and released when the operation rod 76 is pushed.
  • the immersive locking means includes a concave groove 86 on the back side of the second rack 72, near the claw 85 projecting from the front end side of the reference surface 83, and a tapered surface of the claw 85. And a locking claw 82 that elastically fits into the groove 86.
  • the locking claw 82 overcomes the tapered surface of the claw 85 and elastically fits into the concave groove 86, so that the second rack 72 is placed at that position. Is restrained.
  • the push button 77 is pressed to push the operating rod 76 in the distal direction, the second rod 72 is released from being restrained by elastically deforming in a direction to get out of the groove 86 over the claw 85.
  • the case main body 11 has the first rack 71 at the initial position where the first rack 71 returns to the urging force of the spring member 80 when the restraint by the locking means when protruding is released.
  • a buffering stopper 87 with which one rack 71 abuts elastically is provided.
  • the stopper 87 is provided on the inner wall surface of the base end portion of the case main body 11 and is set so that the base end of the first rack 71 that has returned to the initial position just contacts.
  • the material of the stopper 87 may be a rubber sheet, for example.
  • the medical instrument 10 includes a flat plate member 90 through which a suture insertion puncture needle 20 and a suture grasping puncture needle 30 are slidably penetrated. Yes. Providing such a flat plate member 90 prevents the distance between the suture insertion needle 20 and the suture grasping needle 30 from changing at the time of puncturing, specifically, preventing the distance between the two from increasing. can do. Moreover, if it forms so that sliding is possible, the flat member 90 will not inhibit a puncture operation at the time of puncture.
  • the flat member 90 may be formed of a circular or polygonal plate material (not shown) in addition to a rectangular plate material whose bottom surface is a flat surface that does not irritate the skin. Further, tips of a pair of support rods 91, 91 extending substantially parallel to the suture insertion puncture needle 20 and the suture grasping puncture needle 30 are fixed to the flat plate member 90. The end side is slidably supported in the case body 11 and supported.
  • the front abdominal wall and the visceral wall for example, the front abdominal wall and the stomach body front wall are fixed by the medical instrument 10 according to the present embodiment.
  • One of the surgeons inserts an endoscope into the patient's stomach, supplies air sufficiently, fills the stomach with air, and causes the stomach body front wall to adhere to the front abdominal wall.
  • another surgeon or assistant disinfects the abdominal skin, confirms the position of the stomach by transmitted light from the endoscope, and performs local anesthesia on the abdominal wall of this site.
  • the annular member 42 of the stylet 40 is housed inside the suture grasping puncture needle 30, and inside the suture insertion puncture needle 20 from its tip, A medical instrument 10 inserted in a state where the end portion of the suture thread does not protrude is prepared, and the operator punctures the abdominal wall 100 as shown in FIG. From the front wall 110, the suture insertion needle 20 and the suture grasping needle 30 are projected into the stomach.
  • the surgeon uses the protruding mechanism 70 to attach the tip of the stylet 40 accommodated inside the suture grasping needle 30.
  • a certain annular member 42 is projected from the distal end of the suture grasping puncture needle 30. Then, the annular member 42 is restored, and the central axis of the suture insertion puncture needle 20 or its extension extends in the direction of the suture insertion puncture needle 20 so as to penetrate the inside of the annular member 42.
  • the operation of the projecting mechanism 70 is performed by pressing the push button 77 with a finger and pushing the operating rod 76 in the distal direction against the urging force of the spring member 80.
  • the rack 72 also moves in the distal direction, whereby the input gear 74 meshing with the second rack 72 rotates and the coaxial output gear 73 also rotates.
  • the first rack 71 engaged with the output gear 73 also moves in the distal direction, the stylet 40 connected to the first rack 71 is pushed out in the distal direction, and the annular member 42 punctures the suture thread. It protrudes from the tip of the needle 30.
  • the annular member 42 can be projected with a longer stroke than the pushing stroke of the operating rod 76.
  • the annular member 42 is projected by a stroke twice the pushing stroke of the operating rod 76. Can do.
  • the annular member 42 protrudes from the distal end of the suture grasping puncture needle 30, and the operating rod 76 is brought to the position by the locking means when protruding. Be bound. That is, when the operating rod 76 is pushed in the distal direction, the locking claw 78 in FIG. 12 passes through the insertion hole of the case body 11 through which the middle of the operating rod 76 penetrates while being recessed by the distal end side taper. When entering the main body 11, the original protruding state is restored, and the rear end side of the locking claw 78 is hooked on the inner edge of the insertion hole to be in a restrained state. Thereby, the annular member 42 is maintained in a state of extending in the direction of the suture insertion puncture needle 20 as it is.
  • the suture thread inserted into the case main body 11 passes through the guide hole 61 and is inserted into the inside from the proximal end of the suture thread insertion puncture needle 20.
  • the surgeon sequentially feeds the sutures further toward the distal end of the suture insertion puncture needle 20 by the delivery mechanism 60, protrudes from the distal end of the suture insertion puncture needle 20, and passes the suture through the annular member 42.
  • the operation of the delivery mechanism 60 may be performed by rotating the operation roller 64 in FIG. 3 so as to roll it in the direction in which the suture is delivered by a finger.
  • the thread feeding roller 63 rotates, and the suture thread sandwiched between the auxiliary roller 62 can be sequentially sent out toward the distal end of the suture insertion needle 20.
  • the feeding mechanism 60 using the roller it is possible to accurately feed an arbitrary amount as small as possible by adjusting the rotation of the operation roller 64 instead of sending the unit by a predetermined unit amount. be able to.
  • the suture is sent out in the same direction as the direction in which the operation roller 64 is rotated with a finger, the suture delivery operation can be performed intuitively and easily.
  • the auxiliary roller 62 that is paired with the yarn feeding roller 63 the suture can be fed more smoothly.
  • the outer peripheral portion of the yarn feed roller 63 is formed of an elastic material that elastically contacts the suture, it is possible to prevent the suture from being damaged.
  • the yarn feeding roller 63 that actively feeds the suture thread but also the outer peripheral portion of the auxiliary roller 62 that forms a pair with the yarn feeding roller 63 may be formed of an elastic material.
  • the diameter of the operation roller 64 is set larger than the diameter of the yarn feed roller 63, the suture can be sent out with a small operation amount of the operation roller 64.
  • the resistance claw 81 on the gear box 70 a side moves from the position where the operating rod 76 is pushed back to the original protruding initial position with respect to the convex portion 84 on the back side of the second rack 72. Slidably contact with each other.
  • the sliding resistance with which the resistance claw 81 slides into contact with the convex portion 84 of the second rack 72 the moment of return of the second rack 72 by the spring member 80 can be reduced, and the suture thread can be prevented from being broken. Can do.
  • the immersive locking means when the operating rod 76 returns to the original protruding initial position, the locking claw 82 jumps over the tapered surface of the claw 85 on the back side of the second rack 72 and repels the groove 86. Thus, the second rack 72 is restrained at this position. As a result, it is possible to prevent the annular member 42 that should have been stored from being inadvertently pulled out. Note that when the push button 77 is pressed to push the operating rod 76 in the distal direction, the locking claw 82 is elastically deformed in a direction to get over the claw 85 and disengage from the groove 86, thereby releasing the restraint of the second rack 72.
  • the first rack 71 is placed in the case body 11 at an initial position where the first rack 71 is returned by the urging force of the spring member 80 when the restraint by the locking means when protruding is released.
  • a stopper 87 is provided for elastic contact.
  • the medical instrument 10 is punctured again approximately parallel to a position separated by a predetermined distance, for example, about 20 to 30 mm, from the ligated portion by the suture, and the above-described operation is repeated, and the abdominal wall 100 and the stomach body using the suture.
  • the front wall 110 is fixed.
  • the medical instrument 10 used for puncture may be the one used for puncture as described above, or may be prepared separately.
  • a puncture comprising a metal needle 121 having a blade surface at the tip and a resin tube 122 that can be broken in the axial direction through which the metal needle 121 is inserted, as shown in FIG.
  • the instrument 120 is punctured.
  • the balloon catheter 123 is inserted into the tube 122 as shown in FIG.
  • the balloon is inflated with distilled water or the like, and the proximal end portion of the tube 122 is pulled outward in two directions.
  • the tube 122 is axially broken and removed from the patient.
  • the balloon catheter 123 is pulled to the proximal end side, the inflated balloon part is brought into close contact with the stomach body front wall 110, and further, an appropriate fixing tool is attached to the balloon catheter 123 exposed from the skin surface and sutured.
  • the balloon catheter 123 is fixed to the stomach body front wall 110. This completes the endoscopic gastrostomy.
  • an operation for feeding a suture that requires fine and careful operation, and an operation for projecting or immersing the annular member 42 are performed by a delivery mechanism 60 and a projecting mechanism 70, respectively. Because it can be performed reliably and easily, only one operator can perform gastric wall fixation and endoscopic operation when performing gastrostomy, and only one operator, or only the operator and assistant Two people can perform gastrostomy construction efficiently and safely.
  • the annular member 42 can be protruded easily and accurately by simply pressing the push button 77 with a finger. Further, according to the delivery mechanism 60, the suture can be fed out easily and accurately by an arbitrary amount only by turning the operation roller 64 with a finger.
  • the medical instrument 10 according to the present embodiment includes the flat plate member 90, the positional relationship between the suture insertion needle 20 and the suture grasping needle 30 changes during puncture, specifically, It is possible to prevent the distance between the puncture needles 20 and 30 from changing (for example, spreading).
  • the needle base member 13 that supports the proximal ends of the suture insertion puncture needle 20 and the suture grasping puncture needle 30 is provided at the distal end of the case body 11.
  • the needle base member 13 is provided so as to be movable by a predetermined distance in the axial direction of each puncture needle 20, 30 with respect to the tip of the case body 11, and the needle base member 13 is moved by a screw 15 and a nut 16 at a desired position. I was able to fix.
  • the relative position between the distal end of the suture grasping puncture needle 30 and the distal end of the annular member 42 of the stylet 40 accommodated in the suture grasping puncture needle 30 is determined as the needle base member 13. It can be adjusted as appropriate by moving or fixing.
  • the pair of support pieces 14, 14 that sandwich the needle base member 13 are provided with locking teeth 14 a, 14 a... At a fine pitch, and similarly, the locking teeth 13 a, Since 13a... Are continuously provided, a reliable and fine position can be achieved without being displaced.
  • the annular member 42 If accuracy does not occur due to tolerances and attachment processing errors of the annular member 42, the annular member 42 is deformed when it always protrudes from the distal end of the suture grasping puncture needle 30, or conversely within the suture grasping puncture needle 30 more than necessary. Thread breakage is induced when it is stored in, but as described above, the relative position between the annular member 42 and the suture grasping puncture needle 30 can be adjusted later so that accurate accuracy can be obtained. It becomes possible to mass-produce without.
  • the case main body 11 forms a housing that unitizes the entire apparatus, thereby further enhancing the convenience of handling and carrying as the apparatus. That is, the operator can easily operate the medical instrument 10 by holding it with one hand, and is easy to handle and carry as a device.
  • the case main body 11, in particular the lid 12, is formed of a transparent material so that the inside can be seen through, so that the internal operation status such as sending out the suture can be easily confirmed.
  • the extension line of the central axis of the suture insertion puncture needle 20 is configured to penetrate the inside of the annular member 42, but the inside of the suture grasping puncture needle 30 of the annular member 42 If it does not obstruct the projecting operation and the storing operation from the center, the central axis of the suture insertion puncture needle 20, in other words, the distal end portion of the suture insertion puncture needle 20 itself is an annular space formed by the annular member 42. You may comprise so that it may penetrate directly.
  • the operation of sequentially feeding the sutures inserted into the suture insertion needle into the distal direction and the annular of the stylet accommodated in the suture grasping needle By making it possible to easily perform the operation of projecting or immersing the member from the tip with one hand, only one operator can perform ligation and endoscopic operation. Furthermore, the annular member can be projected more easily and smoothly, the moment when the annular member is immersed can be reduced, the immersed annular member can be securely held, and the treatment can be performed efficiently and safely. Can do.

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Abstract

La présente invention concerne un outil médical permettant à un opérateur et/ou à un assistant de réaliser une ligature dans un corps vivant de manière efficace et sûre. Dans un corps de boîtier, on a disposé les éléments suivants : un mécanisme de dévidage (60) destiné à fournir le fil de suture, qui a été inséré à l'intérieur depuis l'extrémité de base d'une aiguille de ponction pour insertion de fil de suture (20), séquentiellement en direction de l'extrémité avant ; et un mécanisme de saillie (70) permettant de mettre en saillie un élément annulaire (42) d'un stylet (40), qui a été logé dans une aiguille de ponction pour préhension de fil de suture (30), depuis l'extrémité avant de l'aiguille de ponction pour insertion de fil de suture (30). Le mécanisme de saillie (70) inclut une première crémaillère (71) raccordée au stylet (40), un pignon de sortie (73) entrant en prise avec la première crémaillère (71), un pignon d'entrée (74) coaxial au pignon de sortie (73), une seconde crémaillère (72) entrant en prise avec le pignon d'entrée (74), et une tige de manœuvre (76) raccordée à la seconde crémaillère (72). Le pignon de sortie (73) présente un diamètre fixé à une valeur supérieure à celle du diamètre du pignon d'entrée (74).
PCT/JP2008/073414 2008-03-12 2008-12-24 Outil médical WO2009113222A1 (fr)

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DE112008003764.7T DE112008003764B4 (de) 2008-03-12 2008-12-24 Medizinisches Instrument

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JP2008-062555 2008-03-12
JP2008062555A JP4814274B2 (ja) 2008-03-12 2008-03-12 医療用器具
JP2008062554A JP4814273B2 (ja) 2008-03-12 2008-03-12 医療用器具

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Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011075748A1 (fr) 2009-12-22 2011-06-23 Danisco Us Inc. Bioréacteur à membrane pour la production accrue d'isoprène gazeux
CN105286932A (zh) * 2015-09-21 2016-02-03 连云港亿帆医药技术有限公司 一种操作简单的缝合器
CN107456259A (zh) * 2017-08-14 2017-12-12 爱美客技术发展股份有限公司 一种固体植入物的推注装置
US10463363B2 (en) 2014-04-08 2019-11-05 Quantum Medical Innovations Llc Suture passer
CN115645012A (zh) * 2022-12-26 2023-01-31 真健康（北京）医疗科技有限公司 用于机器人穿刺手术的自动穿刺装置

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* Cited by examiner, † Cited by third party
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JP5738039B2 (ja) * 2011-03-31 2015-06-17 日本コヴィディエン株式会社 医療用縫合具
JP5743828B2 (ja) * 2011-07-06 2015-07-01 日本コヴィディエン株式会社 医療用縫合具
JP5863313B2 (ja) * 2011-07-28 2016-02-16 日本コヴィディエン株式会社 医療用縫合具
JP5832216B2 (ja) * 2011-09-28 2015-12-16 日本コヴィディエン株式会社 医療用縫合具
JP5946335B2 (ja) * 2012-06-18 2016-07-06 日本コヴィディエン株式会社 医療用縫合具
JP5963559B2 (ja) * 2012-06-18 2016-08-03 日本コヴィディエン株式会社 医療用縫合具
JP6124527B2 (ja) * 2012-07-27 2017-05-10 日本コヴィディエン株式会社 医療用縫合具
JP6053369B2 (ja) * 2012-07-27 2016-12-27 日本コヴィディエン株式会社 医療用縫合具
CN106725673B (zh) * 2017-03-16 2023-02-14 中国人民解放军联勤保障部队第九00医院 内镜缝合器
KR102142367B1 (ko) * 2018-12-28 2020-08-07 한스바이오메드 주식회사 혈관 천자부위 폐색 장치
CN112244952B (zh) * 2020-09-28 2021-07-06 南通大学附属医院 一种安全防护型胸部肿瘤穿刺装置及工作方法

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2006025934A (ja) * 2004-07-13 2006-02-02 Jms Co Ltd 生体用縫合具
WO2007129431A1 (fr) * 2006-04-07 2007-11-15 Sumitomo Bakelite Co., Ltd. DISPOSITIF MéDICAL ET PROCédé DE FIXATION D'UN ORGANE INTERNE
JP2007319169A (ja) * 2006-05-30 2007-12-13 Masataka Funada 医療用器具
JP2007319593A (ja) * 2006-06-05 2007-12-13 Nippon Sherwood Medical Industries Ltd 医療用縫合具

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0624533B2 (ja) * 1990-12-29 1994-04-06 昌貴 鮒田 医療用器具
JP2003265406A (ja) * 2002-03-19 2003-09-24 Olympus Optical Co Ltd 内視鏡処置具進退装置
JP4716821B2 (ja) * 2005-08-24 2011-07-06 オリンパスメディカルシステムズ株式会社 内視鏡システム、並びに、内視鏡用処置具及び内視鏡
JP4894402B2 (ja) * 2006-08-09 2012-03-14 マックス株式会社 外科用ステープルリムーバ

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2006025934A (ja) * 2004-07-13 2006-02-02 Jms Co Ltd 生体用縫合具
WO2007129431A1 (fr) * 2006-04-07 2007-11-15 Sumitomo Bakelite Co., Ltd. DISPOSITIF MéDICAL ET PROCédé DE FIXATION D'UN ORGANE INTERNE
JP2007319169A (ja) * 2006-05-30 2007-12-13 Masataka Funada 医療用器具
JP2007319593A (ja) * 2006-06-05 2007-12-13 Nippon Sherwood Medical Industries Ltd 医療用縫合具

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011075748A1 (fr) 2009-12-22 2011-06-23 Danisco Us Inc. Bioréacteur à membrane pour la production accrue d'isoprène gazeux
US10463363B2 (en) 2014-04-08 2019-11-05 Quantum Medical Innovations Llc Suture passer
CN105286932A (zh) * 2015-09-21 2016-02-03 连云港亿帆医药技术有限公司 一种操作简单的缝合器
CN107456259A (zh) * 2017-08-14 2017-12-12 爱美客技术发展股份有限公司 一种固体植入物的推注装置
CN107456259B (zh) * 2017-08-14 2023-07-21 爱美客技术发展股份有限公司 一种固体植入物的推注装置
CN115645012A (zh) * 2022-12-26 2023-01-31 真健康（北京）医疗科技有限公司 用于机器人穿刺手术的自动穿刺装置

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JP4814273B2 (ja) 2011-11-16
WO2009113221A1 (fr) 2009-09-17
JP2009213763A (ja) 2009-09-24
JP2009213764A (ja) 2009-09-24

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