WO2016158452A1 - Knot formation device - Google Patents

Knot formation device Download PDF

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Publication number
WO2016158452A1
WO2016158452A1 PCT/JP2016/058487 JP2016058487W WO2016158452A1 WO 2016158452 A1 WO2016158452 A1 WO 2016158452A1 JP 2016058487 W JP2016058487 W JP 2016058487W WO 2016158452 A1 WO2016158452 A1 WO 2016158452A1
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WO
WIPO (PCT)
Prior art keywords
arm mechanism
member
loop
arm
position
Prior art date
Application number
PCT/JP2016/058487
Other languages
French (fr)
Japanese (ja)
Inventor
宏平 寺田
大輔 石井
尚久 木下
小林 将人
Original Assignee
ブラザー工業株式会社
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
Priority to JP2015074491A priority Critical patent/JP6380208B2/en
Priority to JP2015-074491 priority
Application filed by ブラザー工業株式会社 filed Critical ブラザー工業株式会社
Publication of WO2016158452A1 publication Critical patent/WO2016158452A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062Needle manipulators

Abstract

Provided is a knot formation device (10) having a first arm mechanism (14a) and a second arm mechanism (14b). Needles (50, 51) are respectively fixed to both ends of a string-shaped member (L). When an arm body (36a) of the first arm mechanism (14a) rotates about an axial line (C4) while holding the needle (50), and an arm body (36b) of the second arm mechanism (14b) rotates about an axial line (C5) while holding the needle (51), a loop (R) can be formed in the string-shaped member (L). Next, the two arm mechanisms (14a, 14b) are brought closer to one another, and the two arm mechanisms (14a, 14b) transfer their respective needles (50, 51) to the other (14b, 14a). The two arm mechanisms (14a, 14b) each separate from the other (14b, 14a), and then a moving member (78) pushes the string-shaped member (L). Thereupon, a section in which the string-shaped member (L) is fixed to the needle (50) can be passed through the loop (R), and a knot (M1) cam be formed in the string-shaped member (L). In this way, a knot (M1) can be automatically formed by a simple procedure.

Description

Knotting device

The present invention relates to knot forming device of the type forming a knot by passing the end of the ligature material e.g. threadlike members.

As a technique for fixing the object to be ligated material forms a loop to be ligated member for example the thread-like members, for example, described in Patent Document 1, a metal or twisted thread-like member using a thread anchor made of a synthetic resin together those, for example, those fitting the preformed irregularities filamentous member itself described in Patent Document 2. In Patent Document 3, a technique of welding the thread-like members to each other by heat or ultrasonic waves has been proposed. However, match twisted these thread members, is fitted, the thread-like members to fix by welding, bonding strength and tightening properties there has been a problem that it is insufficient as compared with the thread-like member to be ligated.

Therefore, various ligation method of fixing by forming a knot by ligating the threadlike members themselves known, aid to assist the formation of the knot, have been proposed. For example, needle holder described in Patent Document 4 and Patent Document 5, aid is it.

Patent Document 4 simply restrain the relative positional relationship by bundling two needle holder, it has been described to form a knot by performing the same operation as manual, in such techniques, substantially it is necessary to operate two needle holder, respectively. Further, Patent Document 5, suturing aid to form a knot by performing a predetermined procedure is described. In this case, it is necessary to use another one of forceps for delivery of thread-like members, it is impossible to form a knot only the suturing aid.

US Pat. No. 7416556 US Pat. No. 5207694 US Pat. No. 5417700 US Pat. No. 5336230 US Pat. No. 5480406

As in Patent Documents 4 and 5, apparatus for ligating the threadlike members, although various proposals have been made, only both are aids to help ligature thread members performed by the operator, the machine knot manner by the operation, but not to achieve a device for easily and reliably formed.

Cit 4, in any of the instrument references 5, is passing through the forceps on either side of the operation to humans which thread members where the time gripping the thread member, in order to determine the like or wound many times in either direction , the operation in response to incoming information, such as through the eyes of the operator who has made a decision to operate. Therefore, in order to form a knot using these, advance sufficiently Naru training it was also requires skilled manipulation in use. That is, references 4, any instrument references 5 also requires skill, a mechanical operation was achieved, hard to say that simply and reliably to form a knot device.

The present invention has been completed with the above view in mind and has an object, by a mechanical operation by simple operations, to provide a knot forming apparatus capable of forming a simple and reliable knots It lies in the fact.

And has as subject matter of the present invention for achieving the above object, (a) a base portion and, (b) provided on the base portion, the first arm mechanism and a second arm configured to be relatively movable a mechanism is provided in (c) said first arm mechanism, the first holding member for detachably holding the first position of the ligature member, provided in (d) of the second arm mechanism, wherein the ligating member a second holding member for holding a first position detachably in a third holding member for holding (e) provided on said first arm mechanism, detachably second position of the object to be ligature member, (f ) provided on said second arm mechanism, wherein the support and the fourth holding member for detachably holding the second position of the ligature material, the second position of (g) the object to be ligated body by the rotation operation, the wherein the ligating body 2 located between the second position and the first position of the ligature object intersects A loop forming means for forming a loop, (h) said first arm mechanism and the second arm mechanism mutually is separated, wherein the first position and the first holding member and the second position of the ligature material 4th in a state of holding by the holding member, wherein the first loop-forming operation for forming a loop of the ligature member by said loop forming means, and the arm close operation to close the first arm mechanism and the second arm mechanism to each other, the a first switching operation for switching to a state held by the first position and the second holding member and third holding member from the state holding the second position the first holding member fourth holding member of the ligating member, wherein the first position and the first arm spacing operation for spacing said first arm mechanism and the second arm mechanism to each other in a state held by the said second position the second holding member 3 holding member of the ligating member sequentially fruit It said first position forming a knot on the object ligating member is passed into the loop by, and an operation portion provided on the base portion is to contain.

According to the knotting device of the present invention, by operating the operating portion provided on said base portion, each other to separate the first arm mechanism and the second arm mechanism, wherein a first position of the ligating member second position from being held by the fourth holding member and the first holding member, wherein the first loop-forming operation for forming a loop of the ligature member by said loop forming means, said first arm mechanism and the second arm mechanism holding the arms close operation to close to each other, said the first position and the second holding member and third holding member from the state holding the said first holding member and the second position the fourth holding member of the ligating body cross a first switching operation for switching to a state, the first position and the second said position in a state of holding by the second holding member and third holding member first arm mechanism and the second arm mechanism of the ligation body spaced apart from each other in By executing the first arm spacing operation and sequentially to, the knot on the object ligating member said first position by passing the loop can be automatically formed.

Here, preferably, (i) said loop forming means is provided in the first arm mechanism and the second arm mechanism, (j) the operation portion are mutually the first arm mechanism and the second arm mechanism is spaced, the state in which the first position and the second position of the ligature member was held in the third holding member and the second holding member, the second to form a loop of the object to be ligated member by said loop forming means holding a loop forming operation, and the arm close operation to close the first arm mechanism and the second arm mechanism to each other, said the first position and the second position the second holding member and third holding member of the ligating member holding a second switching operation for switching to a state held by the first holding member and the fourth holding member from the state, the the first position and the second position the first holding member and the fourth holding member of the ligating body the first a in a state of Again passing the loop to the first position by sequentially executing a second arm spaced apart operation to separate the arm mechanism and the second arm mechanism to each other. Therefore, by loop forming means it is provided in both of the first arm mechanism and the second arm mechanism, wherein the first arm mechanism and the second arm mechanism is functionally symmetrical. Thus, the first loop-forming operation, the arm approaching operation, the first switching operation, and subsequently to form the first knot by sequentially executing the first arm spacing operation immediately, the first 2 loop forming operation, the arm approaching operation, the second switching operation, and by sequentially executing a second arm spaced apart operating, the said loop by again passing the first position the second knot following can be formed, it can be automatically form a multistage knot in a simple operation.

Also, preferably, (k) the knot, the first position of the ligature material, the position of the near side from a far side position than the first position of the to have a second position intersecting with said loop and those formed by relatively pass through the loop to, (l) the operation portion is for forming a plurality of times the knot, one knot of said plurality of knots in the loop forming means to form a loop wound around planned passage locus of the first position and the loop was last formed on the reverse. Thus, in a knot formed following the predetermined knot, said loop forming means, so to form a loop wound around planned passage locus of the first position and the loop was last formed on the opposite, knot the melt hardly square knot called knot can be automatically formed by a simple operation.

Also, preferably, (m) the knot, the first position of the ligature material, the position of the near side from a far side position than the first position of the to have a second position intersecting with said loop and those formed by relatively pass through the loop to, (n) the operation portion is for forming a plurality of times the knot, one knot of said plurality of knots in, the loop forming unit, the loop was last formed to form a loop wound around planned passage locus of the first position in the same direction. Thus, in a knot formed following the predetermined knot, said loop forming means, so to form a loop wound around planned passage locus of the loop between the first position the previously formed in the same direction, the knot the called knot and tighten easily On'namusubi can be automatically formed by a simple operation.

Also, preferably, the loop forming unit, one rotation forms the loop by its rotation. Thus, it referred to as single ligature from one round form loops, single ligature is formed which is the most basic knot.

Also, preferably, the loop forming means 2 laps forming the loop by its rotation. Thus, termed double ligature from two laps formed loop, hardly double knot melt than simple single ligation to the next single ligation is formed.

Also, preferably, the loop forming unit, by its rotation, in the loop formed of first time is the loop formed two rounds around imaginary axis is an axis that intersects the projection plane of the loop, the second time in the loop-forming, the loop forming one round around the imaginary axis. Accordingly, referred knot is formed with surgical ligation the single ligation is formed in the following double ligature. The surgical ligation, lowermost knot loose while the force applied to the ligature object due to the large size of the knot of the lowermost double ligature is knotted in less than a single ligation and second stage Hateful.

Also, preferably, (o) said loop forming means, the distance between the loop forming portion having a larger radius than the distance to the second holding member from the rotation center, from the rotation center to the second holding member and a target ligation body passage portion having a smaller radius than, (p) the first position, to the object to be ligated body and the object to be ligated body passage portion forming a loop around the rotational center of said loop forming means It passed through the area enclosed between the second holding member and the first holding member. Thus, it is possible to easily realize a mechanism for passing the first position of the ligature member into the loop.

Also, preferably, (q) said loop forming means comprises a loop forming portion having a larger radius than the distance to the second holding member from the rotation center, along the axis of rotation than the loop forming section and a loop retaining portion having a larger radius than the loop forming portion be in a position far from the second arm mechanism, along the axis of rotation than the loop forming section than the loop forming section (r) said second side close to the arm mechanism has a radius of less than the loop forming portion. Thus, when the loop formation of the ligation body yarn addicted can form a stable loop into the groove made between the loop-forming means and the second arm, also replace the end of the ligature material , after which the loop is advantageous to deviate from the loop forming means naturally.

Also, preferably, (s) the loop-forming means, wherein are slidably supported along the longitudinal direction of the second position of the object ligation of the ligation material, (t) the operating unit , tighten the knot by pulling the pull position in the farther from the first position than the second position of the ligature member. This not only connecting the ligating member, a function of loosening the formed knot can have the device.

Also, preferably, the loop forming means along said second arm mechanism, the distance between the second holding member can be moved toward. Thus, such as when the ligating member is in communication with another object, when there are objects to be connected by the ligature member, in a state sandwiched the thickness of the object at the first arm mechanism and the second arm mechanism, can pass the ends of the ligature member, it is possible to make a state of holding the ligature material on both sides of the object.

Also, preferably, the loop forming unit, the distance between the second arm mechanism can be deformed along the direction approaching. Thus, such as when the ligating body is threaded through the hole in another object, when there are objects to be connected by the ligature member, a state in which sandwich the thickness of the object at the first arm mechanism and the second arm mechanism in, can be passed the ends of the ligature member, it is possible to make a state of holding the ligature material on both sides of the object.

Also, preferably, (u) said loop forming means, wherein the first support portion away from said second position of the ligating member to the first position, from said second position of said object to be ligated body wherein in the second support portion spaced tension position side supports a second position of the ligature member, (v) the operating unit, the first and the second support portion than the first support shaft along the arm mechanism or the second arm mechanism by pulling the pull position when the side closer to the base portion tighten the knot. Thus, by subtracting the pulling position of the object to be ligated body from the side of the base portion while pressing the vicinity of the tip of the first arm mechanism and the second arm mechanism to ligation object can tighten the knot tight.

Also, preferably, the operation unit, the tension position of the object ligation body, the operator is provided in a position that can be drawn directly. As a result, the operator can draw while feeling the tension of directly to the ligature body with fingers, as compared with the case to draw the ligature body via a lever or handle, tightening is too weak or too strong without it can tighten the knot of the ligation material with appropriate strength.

Knot forming device in an embodiment of the present invention, the first arm mechanism and the second arm mechanisms is a front view showing a state in which the open. Knot forming apparatus of FIG. 1, the first arm mechanism and the second arm mechanisms is a front view showing a state in which the closed. It is an exploded perspective view of a knot forming apparatus of FIG. Figure 1 of the first arm mechanism knot forming apparatus shown in FIG. 3 is a perspective view showing a state that is is positioned in the open position. Figure 1 of the first arm mechanism knot forming apparatus shown in FIG. 3 is a perspective view showing a state that has been allowed to the closed position. A state where the first arm mechanism shown in FIGS. 4 and 5 are then positioned in the open position, releasing the front end side of the needle of the two needles, locked the needle located on the proximal side state the is a perspective view showing remove the guide cover. A state where the first arm mechanism shown in FIGS. 4 and 5 are then positioned in the open position, locking the front end side of the needle of the two needles, released the needle located on the proximal side state the is a perspective view showing remove the guide cover. Is a perspective view illustrating an enlarged structure of the first arm mechanism knot forming apparatus shown in FIGS. It shows a longitudinal section of the knot forming device in an open state in FIG. It shows a longitudinal section of the knot forming device in the closed state of FIG. The bottom surface of the knotting device in an open state in FIG. 1, that is, a diagram showing an end surface of the operation member. 45 degrees from the origin in FIG. 13 the operating member provided in the knot forming apparatus of FIG. 1, that is a view showing a state in which 270 degree rotation operation from Fig. And rotational operation angle of provided operating member knot forming device of FIG. 1, operated by the rotation operation of the operation member, the opening and closing operation of the first arm mechanism and the second arm mechanism, the arm body rotating operation, the needle lock and a chart for explaining the relationship between the release action. A schematic view for explaining the operations performed in the order shown in FIG. 13 by the rotating operation of the provided operating member knot forming device of FIG. 1, the arm separation state in which the first arm mechanism and the second arm mechanism is opened shows. A schematic view for explaining the operations performed in the order shown in FIG. 13 by the rotating operation of the provided operating member knot forming device of FIG. 1, the arm body provided on the first arm mechanism and the second arm mechanism that It shows the loop-forming state is rotated about longitudinal axis centerline. To illustrate the loop forming operation shown in FIG. 15 is a schematic view seen thread-like members from the distal end of the second arm mechanism. A schematic view for explaining the operations performed in the order shown in FIG. 13 by the rotating operation of the provided operating member knot forming device of FIG. 1 shows the arm approaching the closed state of the first arm mechanism and the second arm mechanism ing. It is a schematic view illustrating a switching operation for performing gripping replacement of the pair of needles in a state of closing the first arm mechanism and the second arm mechanism. The rotating operation of the provided operating member knot forming device of FIG. 1 a schematic view for explaining the operations performed in the order shown in FIG 13, the needle with the first arm mechanism and the second arm mechanism is closed after the passed arms approaching operation and the first switching operation, the first arm mechanism and the second arm mechanism indicates the arms separated state to be opened. The first arm mechanism after the first switching operation of FIG. 19 is a schematic view of the thread-like member from the tip. Filamentous member by a yarn removing operation is shown in FIG. 19 is a schematic diagram showing a state of being detached from the first arm mechanism and the second arm mechanism. Is a diagram for explaining a definition of a loop with that indicate a path projection is closed thread members L projected onto the projection plane S orthogonal to the virtual axis K. Figures 14 is a diagram showing a single ligation of the resulting threadlike member by knotting operation shown in FIG. 19. In the single ligature knot operations shown in FIG. 19 from FIG. 14 is a schematic diagram of the loop forming operation of Figure 15 corresponds to Figure 20 when rotated twice the arm body. It is a diagram illustrating a double ligation of the resulting threadlike members by the operation of FIG. 24. Is a view corresponding to Figure 21 when conducted twice single ligature knot forming operation shown in FIG. 19 from FIG. 14. Is a diagram illustrating a On'namusubi obtained threadlike members by On'namusubi forming operation of Figure 26. Figures 14 and an operation for performing single ligating knotting operation twice that shown in FIG. 19, when the second time in which the direction of passing the first position of the thread-like member in the loop opposite to the first time it is a view corresponding to FIG. 21. Is a diagram illustrating a square knot obtained threadlike members by square knot formation operation of FIG. 28. Double ligature obtained by knotting operation and a single ligature knot formation operation is a diagram showing a surgical ligating having a single ligature on the double ligature. Is a view corresponding to FIG. 11 showing an end face of another example of the operation member. Other knot forming device in an embodiment of the present invention, the first arm mechanism and the second arm mechanisms is a front view showing a state in which the open. Knot forming apparatus of FIG. 32, the first arm mechanism and the second arm mechanisms is a front view showing a closed. A exploded perspective view showing a knot forming device of FIG. 32. Figure 32 to the first arm mechanism knot forming apparatus shown in FIG. 34 is a perspective view showing a state that is is positioned in the open position. Of the first arm mechanism knot forming apparatus shown in FIGS. 32 through 34, is a perspective view showing a state that has been allowed to the closed position. A cross-sectional view illustrating a first cylindrical rotary mechanism provided in the distal end portion of the first arm mechanism shown in FIGS. 32 and 34, protrudes a cylindrical rotary member first arm mechanism is brought into position to the open position and is a sectional view showing an enlarged state. A cross-sectional view illustrating a first cylindrical rotary mechanism provided in the distal end portion of the first arm mechanism shown in FIGS. 32 and 34, the cylindrical rotary member first arm mechanism is brought into the closed position is pushed It was a state an enlarged sectional view showing the. A rotation mechanism and the needle locking mechanism of the cylindrical rotary member will be described as shown in FIGS. 37 and 38, is a diagram showing the back face of the cover. In FIG. 39, showing a state for rotating the cylindrical member. It is a diagram illustrating the configuration of the flange and the fixed lock plate of the bevel gear constituting the needle locking mechanism of Figure 39. A diagram illustrating the configuration of the flange of the bevel gear and the fixed lock plate constituting a needle locking mechanism of FIG. 39 is a diagram showing a state of switching the locked state of the two needles to each other. It shows a longitudinal section of the knot forming device in an open state in FIG. 32. It shows a longitudinal section of the knot forming device in the closed state of FIG. 32. The bottom surface of the knotting device in an open state in FIG. 32, that is, a diagram showing an end surface of the rotation operating member. The bottom surface of the knotting device in the closed state of FIG. 32, that is, a diagram showing an end surface of the rotation operating member. And rotational operation angle of the opening and closing operation member provided in a knot forming device of FIG. 32, operated by the rotational operation of the operation member, is a chart illustrating the relationship between the opening and closing operation of the first arm mechanism and the second arm mechanism . The first arm mechanism and the second arm mechanism by the rotation operation of the provided opening and closing operation member in a knot forming device of FIG. 32 is a schematic diagram showing an arm spaced the opened state. Loop formation state in which the first arm mechanism and the second arm mechanism cylindrical member provided in each of the rotational operation filamentous member is wound around the outer peripheral surface thereof is rotated in the rotating operation member provided on knot forming device of FIG. 32 it is a schematic view showing a. The arm approaching the closed state of the first arm mechanism and the second arm mechanism by the rotation operation of the provided opening and closing operation member in a knot forming device of FIG. 32 is a 示模 diagram. It is a schematic view illustrating a switching operation state in which the gripping replacement of the pair of needles in a state of closing the first arm mechanism and the second arm mechanism shown in FIG. 50. Shown in Figure 51, after the state the needle is passed in a state where the first arm mechanism and the second arm mechanism is closed, showing the arms separated state in which the first arm mechanism and the second arm mechanism is opened it is a schematic view. Thread members shown in FIG. 52 is a schematic diagram showing a state of being detached from the first arm mechanism and the second arm mechanism by the yarn removing operation. Other knot forming device in an embodiment of the present invention, the first arm mechanism and the second arm mechanisms is a front view showing a state in which the open. Knot forming apparatus of FIG. 54, the first arm mechanism and the second arm mechanisms is a front view showing a closed. It is an exploded perspective view of a knotting apparatus of FIG. 54. Of the first arm mechanism knot forming apparatus shown in FIG. 54 through FIG. 56 is a perspective view showing a state that is is positioned in the open position. Of the first arm mechanism knot forming apparatus shown in FIG. 54 through FIG. 56 is a perspective view showing a state that has been allowed to the closed position. Is a partial perspective view illustrating decomposing a needle holding mechanism provided at the distal end of the first arm mechanism shown in FIGS. 57 and 58. A perspective view illustrating a configuration of a main part of the needle holding mechanism provided at the tip of the first arm mechanism shown in FIG. 57 and FIG. 58 shows the unlock state of the needle. Is a cross-sectional view illustrating a configuration of a main part of the needle holding mechanism provided at the tip of the first arm mechanism shown in FIGS. 57 and 58. A perspective view illustrating a main structure of the first arm mechanism of the tip needle holding mechanism provided in section shown in FIGS. 57 and 58 show a needle locking state of. Is a bottom view of the knotting device in an open state in FIG. 54. It is a bottom view of the knotting device in the closed state of FIG. 55. It shows a longitudinal section of the knot forming device in an open state in FIG. 54. It shows a longitudinal section of the knot forming device in the closed state of FIG. 55. And rotational operation angle of provided operating member knot forming device of FIG. 54, operated by the rotation operation of the operation member is a chart illustrating the relationship between the opening and closing operation of the first arm mechanism and the second arm mechanism. The first arm mechanism and the second arm mechanism by the rotation operation of the provided opening and closing operation member in a knot forming device of FIG. 54 is a schematic view showing the arm separated state which is opened. The first arm mechanism and the outer peripheral surface thereof a first stitch holding mechanism and the second needle holding mechanism is rotated provided in the second respective arm mechanism by the rotation operation of the rotary operation member provided on knot forming device of FIG. 54 threadlike members is a schematic diagram showing a loop formation state wound around the. The arm approaching the closed state of the first arm mechanism and the second arm mechanism by the rotation operation of the provided opening and closing operation member in a knot forming device of FIG. 54 is a 示模 diagram. It is a schematic view illustrating a switching operation state in which the gripping replacement of the pair of needles in a state of closing the first arm mechanism and the second arm mechanism shown in FIG. 70. It is shown in Figure 71, after the needle has been passed in a state where the first arm mechanism and the second arm mechanism is closed, schematically the first arm mechanism and the second arm mechanism illustrating the arms apart the opened state it is a diagram. The thread-like member shown in FIG. 72 is a schematic diagram showing a state of being detached from the first arm mechanism and the second arm mechanism by the yarn removing operation. Other knot forming device in an embodiment of the present invention, the first arm mechanism and the second arm mechanisms is a front view showing a state in which the open. Knot forming apparatus of FIG. 71, the first arm mechanism and the second arm mechanisms is a front view showing a closed. It is an exploded perspective view of a knotting apparatus of FIG. 74. Of the first arm mechanism knot forming apparatus shown in FIG. 74 through FIG. 76 is a perspective view showing a state that is is positioned in the open position. Of the first arm mechanism knot forming apparatus shown in FIG. 74 through FIG. 76 is a perspective view showing a state that has been allowed to the closed position. Is an enlarged exploded perspective view showing the first needle disc holding mechanism provided at the distal end of the first arm mechanism shown in FIGS. 77 and 78. A portion of the first needle disc holding mechanism provided at the distal end of the first arm mechanism shown in FIGS. 77 and 78, a diagram showing the back face of the cover of the first arm mechanism, the front end side of the needle locked, and shows a state in which the needle on the proximal end side is unlocked. A portion of the first needle disc holding mechanism provided at the distal end of the first arm mechanism shown in FIGS. 77 and 78, a diagram showing the back face of the cover of the first arm mechanism, the front end side of the needle while being locked, the needle with a disk indicates the state where it is moved toward the proximal end. A portion of the first needle disc holding mechanism provided at the distal end of the first arm mechanism shown in FIG. 77 and FIG. 78 is a perspective view showing the back face of the cover of decomposition to the first arm mechanism. The bottom surface of the knotting device in an open state in FIG. 74, that is, a diagram showing an end surface of the operation member. The bottom surface of the knotting device in the closed state of FIG. 75, that is, a diagram showing an end surface of the operation member. It shows a longitudinal section of the knot forming device in the closed state of FIG. 74. It shows a longitudinal section of the knot forming device in the closed state of FIG. 75. And rotational operation angle of the provided opening and closing operation member in a knot forming device of FIG. 74, operated by the rotation operation of the opening and closing operation member, the relationship between the opening and closing operation of the first arm mechanism and the second arm mechanism is described Chart it is. The first arm mechanism and the second arm mechanism by the rotation operation of the provided opening and closing operation member in a knot forming device of FIG. 74 is a schematic view showing the arm separated state which is opened. With the first arm mechanism and the second arm mechanism is opened by the rotational operation of the provided opening and closing operation member in a knot forming device of FIG. 74, the needle with the disc is rotated by the operation of the rotation operating member the outer periphery thereof is a schematic diagram showing a loop formation state of thread-like members are wrapped around the surface. It is a schematic diagram showing the arm approaching the closed state of the first arm mechanism and the second arm mechanism by the rotation operation of the provided opening and closing operation member in a knot forming device of FIG. 74. It is a schematic view illustrating a switching operation state in which the gripping replacement of the pair of needles in a state of closing the first arm mechanism and the second arm mechanism shown in FIG. 90. It is shown in Figure 91, after the needle has been passed in a state where the first arm mechanism and the second arm mechanism is closed, schematically the first arm mechanism and the second arm mechanism illustrating the arms apart the opened state it is a diagram. From the state shown in FIG. 92 is a schematic diagram showing a state of being detached from the first arm mechanism and the second arm mechanism by the yarn removing operation without using the moving member. The knotting device according to another embodiment of the present invention is a schematic diagram showing. It illustrates a knot forming device having a needle with a disk having other shape with needle disc shown in Figure 74 below. It is a diagram for explaining a state to tighten the knot with a knot forming device comprising a needle with a disk shown in Figure 74 below.

It will be described in detail with reference to the drawings an embodiment of the present invention.

1 to 3, knotting device 10 comprises a cylindrical longitudinal substrate 12, a pair of first arm mechanism 14a and the second arm mechanism 14b provided so as to be opened and closed at the tip of the longitudinal substrate 12 , at the proximal end of the longitudinal base 12 and the operating member 16 provided rotation operably about the axis line C1 of the longitudinal substrate 12, provided on the longitudinal base 12, the rotational operation force of the operation member 16 and a pair of first arm mechanism 14a and the second arm mechanism 14b is to transfer the first arm thereof a pair mechanism 14a and the second arm mechanism 14b to operate the operation force transmission mechanism 18. As shown in FIG. 3, the longitudinal substrate 12, partially cylindrical members 12a and 12b of a pair of semi-circular cross-section is formed in a cylindrical shape by being fixed in a combined state. In this embodiment, the longitudinal base 12 functions as a base unit, the operating member 16 functions as the operation unit. In FIGS. 1 to 11 are shown by omitting the threadlike members L which functions as the ligature member.

The distal end portion of the longitudinal substrate 12, a first arm mechanism 14a and the second arm mechanism 14b support holes 22a of the pair at a predetermined distance on the axis line C2 perpendicular to the cover face of axial center line C2 and it is formed with a pair of support holes 22b located on each of the parallel axial center line C3, the first arm mechanism 14a is supported rotatably around the axial line C2 by a pair of supporting holes 22a, is rotatably supported around the axis line C3 by the second arm mechanism 14b 1 pair of supporting holes 22b. A pair of first arm mechanism 14a and the second arm mechanism 14b, which is configured similarly to one another, described with reference to figures code a is attached to the end for the first arm mechanism 14a, a second arm mechanism description thereof will be given the same numeral designations which b is attached to the end for 14b.

As shown in FIGS. 2 and 5 show the closed position of the first arm mechanism 14a of FIG. 1 and FIG. 4 shows the open position, and the first arm mechanism 14a, a first arm mechanism 14a is a pair of support holes 22a integrally has a fit pair of protruded shaft 24a encased and the closing connecting arm 26a, it is rotatably supported around the axial center line C2 through the center of the pair of support holes 22 by the pair of supporting holes 22 ing. The first arm mechanism 14a includes an arm base 30a having a through hole 28a penetrating in a direction perpendicular to the axial center line C2 is formed, is connected to the mated universal joint 32a into the through hole 28a connected and a shaft 34a. Further, the first arm mechanism 14a includes arm body 36a, the guide cover 38a, the lock plate 40a, T-shaped bar support 42a, an elongated locking operation bar 46a. Arm body 36a is rotatably provided on the arm base 30a to rotate to and around the rotation axis C4 of the through hole 28a with the universal joint 32a around the axial center line C2. Guide cover 38a is fixed at a slight gap with respect to and opposing faces thereof so as to cover the entire facing surface of the second arm mechanism 14b side arm body 36a. Lock plate 40a is movably received in a longitudinal direction between the opposing face of the guide cover 38a and the arm body 36a. T-shaped bar support 42a is formed with modestly and offset to the second arm mechanism 14b side than the widthwise dimension of the arm body 36a to the proximal end side of the guide cover 38a. Locking bar 46a has the same longitudinal dimension and a width dimension of the arm body 36a, the bar support 42a in a state in which both ends in the longitudinal direction are exposed, longitudinal center on the inner side by the bar support 42a part is rotatably supported, and one end is engaged with the engaging recess 44a of the lock plate 40a. Or locking bar 46a has a protrusion (not shown) at one end thereof, the lock plate 40a of the projection is engaged with the engaging recesses 44a is in the distal end side position of the first arm mechanism 14a, the base end side It is be positioned in an inclined position that reflects whether the position. For example, as shown in FIG. 6, when the lock plate 40a is on the base end side position of the first arm mechanism 14a is and the other end is located at the distal end side one end to the proximal end of the locking bar 46a I am inclined posture that. Conversely, as shown in FIG. 7, if the lock plate 40a is in the distal end side position of the first arm mechanism 14a is and distal side located at the distal end side to the other side base end of the locking bar 46a It is an inclined posture that. T-shaped bar support 42a is the opposite ends of the locking bar 46a has alternatively abut the stopper function is caused, thereby, the lock plate 40a the distal end side position of the first arm mechanism 14a and it is alternatively be positioned between the two positions of the base end side position.

1 and 4 shows a state where the first arm mechanism 14a is opened, FIGS. 2 and 5 show a state where the first arm mechanism 14a is closed, FIG. 5, the pair of needles 50 and 51 It shows a state in which the distal end side of the needle 50 is released and the proximal side of the needle 51 is locked out of 7 the needle 51 opposite the needle 50 on the distal end side is locked to and proximal is released It shows the state. The pair of needles 50 and 51, an annular engaging groove 52 and 53 are formed on both ends, and a through hole 54 which threadlike members L is passed to function as a ligating member is formed in a central portion in the longitudinal direction It is. In the present embodiment, the through hole 54 in a state in which thread-like member L is passed to deform by applying an external force to crush the through-hole 54, thread-like member L by the so-called crimping process, but is fixed to the needle 50 and 51 , or form large knot from the through hole 54 in the thread-like members L, it may be fixed, such as by bonding the thread-like members to the needle 50 and 51. The ends of the needle 50 in this embodiment is formed by pointed in a tapered shape, although both ends of the needle 51 is formed flat, the needle 50 and 51 may be the same shape.

As shown in detail in FIG. 8 showing an enlarged arm body 36a of the exploded perspective view of FIG. 3, of the opposing surface of the arm body 36a, a predetermined distance arm from the position and the distal end of the tip portion of the arm body 36a 2 position of a position separated to the base 30a side, a pair of receiving holes 56a for receiving one end of the needle 50 and 51 are formed at positions corresponding to the pair of receiving holes 56a of the guide cover 38a is a pair of through holes 58a which can pass the needle 50, 51 are formed. Also, the position on the lock plate 40a corresponding respectively to the one and the other of the pair of receiving holes 56a and a pair of through holes 58a, the pair of engagement holes 57a and 59a are formed respectively. A pair of engagement holes 57a, the distal end side of the engaging hole 57a of 59a locks the engaging needle 50 into the engagement groove 52 of the needle 50 when the lock plate 40a is at the distal end position, the lock plate 40a is a hole shape to allow passage of the needle 50 when in a base end side position. That is, Zenpokoen the rectangular notches having a smaller width dimension than the diameter of the larger and the needle 50 than the groove bottom diameter of the engaging groove 52 of the circle and the needle 50 having a diameter larger than the diameter of the needle 50 are linked It has a shape. A pair of engagement holes 57a, engagement hole 59a of the base end side of the 59a, contrary, the needle 51 engages the engaging groove 52 of the needle 50 when the lock plate 40a is on the base end side position lock, there is a hole shape to allow passage of the needle 51 when the lock plate 40a is at the distal end side position.

The operating member 16 has a cylindrical shape, the inner peripheral surface thereof, the locking of the first arm mechanism 14a and the second arm mechanism 14b arm for opening and closing the opening and closing cam groove 60 and below the needle 50 and needle 51 and a needle lock cam groove 62 for operating the release is provided with a cylindrical grooved cam 64 formed in an annular shape. Although cylindrical grooved cam 64 is formed so the operating member 16 integrally, are shown separated on for convenience of illustration in FIG. Further, as shown in FIGS. 11 and 12, on the inner peripheral surface of the operating member 16, pinion 66a and 66b for rotating the arm body 36a and 36b are formed inner teeth 68a and 68b which respectively mesh . When the internal teeth 68a and the 68b rotates the operation member 16 in one direction up to the state not engaged again engaged through the engaged from a state not engaged with the pinion 66a and 66b, the pinion 66a and 66b is constructed exactly to one revolution. Since it is possible to form a loop be rotated one of the arm body 36b of the arm main body 36a and the second arm mechanism 14b of the first arm mechanism 14a, in this case, for example, as shown in FIG. 31, the operation the inner peripheral surface of the member 16, one of which is formed of the inner peripheral teeth 68a and 68b. With this configuration, when rotating the operation member 16 in one direction, operation of the arm body 36b of the arm main body 36a and the second arm mechanism 14b of the first arm mechanism 14a is only one of the one rotation It will be performed alternately.

3, FIG. 9 is a longitudinal sectional view of FIG. 1, and, as shown in FIG. 10 is a longitudinal sectional view of FIG. 2, the operation force transmission mechanism 18 transmits the rotational operation force for rotating the arm body 36a for, the pinion 66a and the universal joint 32a and the first rotation manipulation force transmission shaft 70a which is fixed at both ends, for transmitting the operation force for rotating the arm body 36b, a pinion 66b and the universal joint 32b is fixed at both ends a second rotational operating force transmitting shaft 70b was provided with. When the rotational operation of the predetermined angle of the operating member 16 is performed in the clockwise direction indicated by an arrow in FIG. 11, the arm body 36a has thereon by rotational operation force of the clockwise transmitted through the first rotation manipulation force transmission shaft 70a at the same time are rotated relative to the arm base 30a of the rotation axis C4 is a longitudinal clockwise, the arm body 36b is that the rotational operation force of the clockwise transmitted through the second rotation operation transmission shaft 70b it is rotated relative to the arm base 30b of the rotation axis C5 in the longitudinal direction clockwise. When the rotational operation of the predetermined angle of the operating member 16 is performed in the further leftward direction from the position shown in FIG. 12, the arm body 36a by the rotational operation force of the counterclockwise transmitted through the first rotation manipulation force transmission shaft 70a is at the same time are rotated relative to the arm base 30a around the left arm body 36b by the rotational operation force about the left which is transmitted via the second rotation operation transmission shaft 70b is to arm base 30b around the left It is rotated relative to Te. In this embodiment, the arm body 36a, 36b is functioning as a loop forming means for forming a loop by winding a thread-like member L.

The operation force transmission mechanism 18 includes a first opening and closing force transmission links 72a and the second opening and closing force transmission link 72b. The first opening and closing operation force transfer link 72a, in order to transmit the opening and closing forces for opening and closing the first arm mechanism 14a in an open position and a closed position, the distal end portion is rotatably connected to open and close the connecting arm 26a, longitudinal has a proximal end a cam engaging portion 71a which engages the arm opening and closing cam groove 60 projects at right angles to the direction. The second opening and closing force transfer link 72b in order to transmit the opening and closing forces for opening and closing the second arm mechanism 14b in an open position and a closed position, the distal end portion is rotatably connected to open and close the connecting arm 26b, the longitudinal has a proximal end a cam engaging portion 71b that engages the arm opening and closing cam groove 60 projects at right angles to the direction.

Figure 4 shows a state where the first arm mechanism 14a has been rotated to the open position. The first arm mechanism 14a, by the first opening and closing force transfer link 72a moves, is pivoted to the open position. The first opening and closing operation force transfer link 72a is moved with the operation of the operating member 16. Specifically, when the operation member 16 is operated, the arm opening and closing cam groove 60 is rotated. It rotates the arm opening and closing cam groove 60, the first opening and closing force transfer link 72a is, when the cam curve of the arm opening and closing cam groove 60 to pass through a section will change to the distal end side of the longitudinal substrate 12, the first opening and closing operation force transfer link 72a is moved toward the distal end side of the longitudinal substrate 12. The first opening and closing operation force transfer link 72a is caused to be moved distally of the longitudinal substrate 12, the first arm mechanism 14a is in a state of being rotated to the open position.
Figure 5 shows a state where the first arm mechanism 14a has been rotated to the open position. The first arm mechanism 14a, by the first opening and closing force transfer link 72a moves, is rotated to the closed position. The first opening and closing operation force transfer link 72a is moved with the operation of the operating member 16. Specifically, when the operation member 16 is operated, the arm opening and closing cam groove 60 is rotated. It rotates the arm opening and closing cam groove 60, the first closing force transfer link 72a is, when the cam curve of the arm opening and closing cam groove 60 to pass through a section will change toward the proximal end of the longitudinal substrate 12, the first opening and closing operation force transfer link 72a is moved toward the proximal end of the longitudinal substrate 12. The first opening and closing operation force transfer link 72a is caused to be moved toward the proximal end side of the longitudinal substrate 12, the first arm mechanism 14a is in a state of being rotated to the open position.
Second opening and closing operating force transmitting link 72b of the second arm mechanism 14b, similarly to the first opening and closing force transfer link 72a of the first arm mechanism 14a, in connection with the operation of the operating member 16, the first opening and closing operation force transmitting synchronism with the link 72a is moved toward the proximal end side of the distal end side and the longitudinal base 12 of the longitudinal substrate 12. Thus, as shown in FIGS. 1 and 2, a pair of first arm mechanism 14a and the second arm mechanism 14b is opened and closed.

The operation force transmission mechanism 18, the first arm mechanism 14a and the second arm mechanism 14b prior to passing one receiving and the other needle 50 and 51 between the first arm mechanism 14a and the second arm mechanism 14b is to switch from one engagement state and a released state until then for the pair of needles 50 and 51 to the other when in the closed state, and a first push rod 76a and the second push rod 76 b. The first push rod 76a has a pair of locking bars 46a, 46b at one end to the contact with the T-shaped push-up portion 74a for rotating them at the distal end, projects at right angles to the longitudinal direction of the needle having a cam engaging portion 75a that engages with the lock cam groove 62 in the proximal portion. The second push rod 76b has a pair of locking bars 46a, 46b and the other end to the contact with the T-shaped push-up portion 74b for rotating them at the distal end, projects at right angles to the longitudinal direction having a cam engaging portion 75b that engages with needle lock cam groove 62 in the proximal portion. Needle lock cam groove 62, as shown in FIG. 13, when one of the first push rod 76a and the second push rod 76b is protruded to the distal side of the longitudinal base 12 and the other in the longitudinal base 12 as drawn into the proximal side, the cam curve is formed. 6, the first arm mechanism 14a, and the needle 50 is released by the lock plate 40a needle 51 indicates an engaged state by the lock plates 40a. At this time, the second arm mechanism 14b is not shown, conversely, the needle 50 is engaged and the needle 51 is released by the lock plate 40b by the lock plate 40b. 7, in the first arm mechanism 14a, the needle 50 is engaged and the needle 51 indicates a state of being opened by the lock plate 40a by the lock plate 40a. At this time, the second arm mechanism 14b is not shown, conversely, the needle 50 is opened and needle 51 is engaged by the lock plate 40b by the lock plate 40b.

Thus, for example, the first arm mechanism 14a and the second arm mechanism 14b in a state where the needle 51 of the base end side is by and distal end of the needle 50 held in the first arm mechanism 14a is held by the second arm mechanism 14b It is closed. Then, by the above operation, the other end of the same time the needle 50 Once the tip side of the needle 50 is from an engaged state and a released state by the lock plate 40b of the second arm mechanism 14b locks the first arm mechanism 14a It is from the released state into the engaged state by the plate 40a. One end of the base end side of the needle 51 is from the released state into the engaged state by the lock plate 40b of the second arm mechanism 14b and at the same time are engaged from the disengaged state by the lock plates 40a of the first arm mechanism 14a that. Thus, when the first arm mechanism 14a and the second arm mechanism 14b is opened, the needle 51 of the base end side is by and distal end of the needle 50 held in the second arm mechanism 14b is held by the first arm mechanism 14a the state. That is, between the first arm mechanism 14a and the second arm mechanism 14b, and the tip of the needle 50 and the proximal side of the side 51, is replaced.

In this embodiment, those of the front end side of the receiving hole 56a of the arm body 36a, and that of the front end side of the through hole 58a of the guide cover 38a, engagement hole of the lock plate 40a of the first arm mechanism 14a 57a is a portion formed functions as a first holding member for holding the needle 50 of the distal combine. Also, as the front end side of the receiving hole 56b of the arm body 36b, and those of the front end side of the through hole 58b of the guide cover 38b, the engagement hole 57b of the lock plate 40b of the second arm mechanism 14b is and forming portion is functioning as a second holding member for holding the needle 50 of the distal combine. Further, as the base end side of the receiving hole 56a of the arm body 36a, and that of the base end side of the through hole 58a of the guide cover 38a, engagement hole of the lock plate 40a of the first arm mechanism 14a 59a is a portion formed is functioning as a third holding member for holding the needle 51 proximal combination. Further, those of the base end side of the receiving hole 56b of the arm body 36b, and those of the base end side of the through hole 58b of the guide cover 38b, the engagement hole 59b of the lock plate 40b of the second arm mechanism 14b There the forming portion is functioning as a fourth holding member for holding the needle 51 proximal combination.

13, by a rotation of the operating member 16, the locking and release operation of the lock plate 40a and the lock plate 40b by the needle 50 and the needle 51 (however, the locking and release operation by the locking plate 40b is represented in FIG. 13 not but is an operation reverse to the operation of the lock plate 40a) and the rotational movement of the arm body 36b of the arm main body 36a and the second arm mechanism 14b of the first arm mechanism 14a, a first arm mechanism 14a and the second three operating the opening and closing operation of the arm mechanism 14b is a chart for explaining a state that is executed in a predetermined order for knot formation. The horizontal axis of the chart of Figure 13 shows the angle of rotating the operating member 16 clockwise as viewed from the direction of FIGS. 11 and 12. Figure 11 is approximately 135 degrees from the origin of the horizontal axis of the chart, FIG. 12 is about 45 degrees i.e. shown from FIG. 11 of the rotational position 270 degrees. 1 rotation operation of the operation member 16 may be manually operated or may be remotely to rotate the operating member 16 in a motor drive.

To release to move the thread member L to be described later to get around the first arm mechanism 14a and the second arm mechanism 14b, FIG. 3, FIG. 9, as shown in FIG. 10, the moving member 78, a cylindrical longitudinal groups It is housed in operably longitudinal substrate 12 protrudes from the tip of the timber 12. The moving member 78 is a part that is bent in an inverted U-shape as a whole from a single wire, a short line section 78b for connecting the tips of a pair of parallel long line section 78a to each other, one of the long line section 78a and an operation protrusion 78c protruding from the long hole 80 formed in the bent and partially cylindrical member 12a outwardly from the proximal end. The short line portion 78b of the moving member 78 protruding operation, is moved under ligating member L is in a direction away from the longitudinal base 12 along the longitudinal direction of the first arm mechanism 14a and the second arm mechanism 14b. Protruding operation of the movable member 78, to the operation protrusion 78c may be manually operated, pneumatic cylinder, or may be a remote control operating with an actuator such as an electric cylinder.

Further, as shown in FIGS. 3, 9, 10, the base end side of the longitudinal substrate 12, a tubular receiving member 82 is disposed. Receiving member 82 rotatably supports the first rotation manipulation force transmission shaft 70a and the second rotational operating force transmission shaft 70b. Also, receiving member 82, the first opening and closing force transmission links 72a and the second opening and closing force them with the first opening and closing force transmission links 72a and the second opening and closing force transfer link 72b to movably support in the longitudinal direction guiding in the longitudinal direction by using a cam-engaging portion 71a and the cam engaging portion 71b of the pair of guide holes 82a provided in the base end of the transfer link 72b. Also, receiving member 82, provided on the base end of the first push rod 76a and the second push rod their first push rod 76a with 76b to be movably supported in the longitudinal direction and the second push rod 76b cam guiding in the longitudinal direction with the engaging portion 75a and the cam engaging portion 75b a pair of guide holes 82b.

In knot forming device 10 configured as described above, when rotating the operation member 16, as shown in FIG. 13, the locking of the first arm mechanism 14a and the second arm mechanism 14b the opening and closing operation, the needle 50 and the needle 51 and release operation, and the rotation operation of the arm body 36a and the arm body 36b is performed. Thereafter, thread-like member L by the movement member 78 when removed from the first arm mechanism 14a and the second arm mechanism 14b, the loop of thread members L knot M1 is formed is automatically formed. The operation of the knotting apparatus 10 of the present embodiment will be specifically described below.

Knot formed by the thread-like member L is the thread-like members L surrounding the ligation symmetrical equivalent to knot as close to the annular filamentous member L, the first arm mechanism 14a, a second arm mechanism 14b, the longitudinal group so that ligation symmetrical product in a closed path consisting of wood 12 is enclosed. A threadlike members L of FIG. 14, the path of the annular combined and the broken line D becomes closed path here. For example, if the thread-like members L to the suture of the living tissue T is applied, the state in which lock the needle 50 on the distal end side by the lock plate 40b of the second arm mechanism 14b, the first arm mechanism 14a and the second arm mechanism close and 14b, is penetrated by the needle 50 of the distal suture portion sandwiched biological tissue T between the tip portion of the distal end portion of the first arm mechanism 14a and the second arm mechanism 14b, the first arm mechanism 14a opening the by the lock plate 40a in a state of locking the needle 50 on the distal end side and the first arm mechanism 14a and the second arm mechanism 14b, partly threadlike members L of the living tissue T, the first arm mechanism 14a, the second arm mechanism 14b, a state enclosed in a closed path consisting of longitudinal base 12. Predetermined position or first arm mechanism 14a and a predetermined position, i.e. the base end side which is passed through the second position of the thread-like member L was locked by first locking the tip side of the needle 50 is passed through the position plate 40a of the thread-like member L in the state immediately after the needle 51 is opened and the second arm mechanism 14b that is locked by the lock plate 40b, the operating member 16 is in the operating position in the vicinity of 45 degrees. Figure 14 shows this state schematically.

Next, the operating member 16 to around 135 degrees in the operation sequence, the arm body 36b of the arm body 36a and the second arm mechanism 14b of the first arm mechanism 14a is, the first arm mechanism 14a and the second arm mechanism 14b the closing surface that is rotated once in the same rotational direction longitudinal rotation axis C4, about C5 parallel and the first arm mechanism 14a and the second arm mechanism 14b, a loop is formed around the arm body 36b. The loop here, threadlike members L is one rotation around an axis, in the state where the enclosing over 360 degrees, refers to a portion surrounding it. It other words, mapping threadlike members L is not self-intersect when projected filamentous member L in a plane perpendicular to an axis, the axis is present in the annular closed portion including the intersection of the mapping when the original since substantial portion of the annular portion of the mapping is a loop. To make a knot in general, through the loop formed in the thread-like member, the ends of the thread must pass. The "pass" in this case, the end portion of the loop and the thread along the axis to define a loop passing relative movement, nothing but the relative positional relationship in the axial direction are interchanged. Since the loop is as defined in relation to the axis of the loop, for example in the Front View in FIG. 15 is a loop of thread-like members that looks just inverted letter S, the direction of the rotation axis C5 as shown in FIG. 16 See the closed but occurs that such has become ring from, if in the direction along the axis "pass" described above is performed, to be the knot going Mieyo how the other direction, the shaft in the opposite if "pass" above is performed in a direction along the can not knots also seems to be a loop as viewed from the other direction. 15, the schematic diagram of FIG. 16 and FIG. 17 shows a state after the loop in the sense described above is formed by the first loop forming operation.
When FIG. 16 (a) and FIG. 16 (b) the biological tissue T is positioned on the front of FIG respect knot forming apparatus 10, FIG 16 (d) and FIG. 16 (c) biological tissue T knot at a time when one forming device 10 is positioned on the far side of the figure is a view seen from the proximal end in each direction of the rotation axis C4, C5. Thus, it can as any case where the relative positional relationship between the thread-like member L and the knotting device 10 whether the loop can be, or may be different. In this embodiment, the case where the loop body tissue T is located on the near side of FIG respect knot forming device 10 around the arm body 36b, as shown in FIG. 16 (a) and FIG. 16 (b) is formed explain, but even if the loop body tissue T is located on the far side of FIG respect knot forming device 10 around the arm body 36a as shown in FIG. 16 (d) Fig. 16 (c) is formed, knot like is formed in the following description by the overall symmetry. Both of the arm body 36a and 36b in this embodiment is rotated in the same direction, it is devised so that the loop in either around at least the arm body 36a and 36b are formed. Also, depending on the orientation of the thread-like member L, and is also possible to simultaneously form the loop shown in FIG. 16 (b) and FIG. 16 (d).
Subsequently, the first arm close operation for operating the operation member 16 to near 135 degrees, and the first arm mechanism 14a and the second arm mechanism 14b is closed. Although the posture of the threadlike members L at the time of the state of FIG. 15 is a loop according to the above definitions are also conceivable if not completed, in which case also the first arm mechanism 14a as the second arm mechanism 14b is closed loop is completed according to the above definition in the middle of the process. Schematic diagram of Figure 17 shows a state where the first arm close operation is complete.

Then, the first switching operation for operating the operation member 16 to the vicinity of 180 degrees, the other end of the one end is and needle 50 releases the lock plate 40a of the first arm mechanism 14a of the needle 50 is the lock plate of the second arm mechanism 14b 40b at the same time being locked by the other end of the needle 51, one end of the second arm mechanism 14b is released by the lock plate 40b of and the needle 51 is locked by the lock plate 40a of the first arm mechanism 14a. Figure 17 shows a state before the first switching operation, FIG. 18 shows a state after the first switching operation. 17 and 18, a state where the needle 50 and the needle 51 is locked is indicated by hatching of the first arm mechanism 14a and the second arm mechanism 14b. When the operating member 16 is operated to near 225 degrees, and the first arm mechanism 14a and the second arm mechanism 14b is opened. The schematic diagram of FIG. 19 and FIG. 20 illustrates this first arm spacing operation. In this state, the first thread-like member L is not looped R is formed consisting of the thread-like member L by being wound around the singlet to the second arm mechanism 14b, the tip side of the needle 50 and the proximal side of the needle 51 passing between the arm mechanism 14a and the second arm mechanism 14b is completed. In this case, the thread-like members L, the first arm mechanism 14a, a second arm mechanism 14b, closed path consisting of longitudinal base 12, it is already knot topological sense at this point. When it may be the same shape continuously deform the object, before and after the shape modification is topologically that it is identical. If the object filamentous closed annularly, thread deformed so as to pass through the thread, or equivalently discontinuous deformation such as once cut as close again ring by traverse the yarn deforming the ring the without, it can be said that the shape, such as may be modified only in a continuous deformation (referred to Reidemeister move) is topologically the same. Generally the yarn closed annular free of knots, topology is different than a closed thread containing knots. That means that topologically is already knot, threadlike members L, the first arm mechanism 14a, a second arm mechanism 14b, and closed path consisting of longitudinal base 12, only by a continuous deformation, closed path threadlike members means that only a portion consisting of L in a state in which form the deformation can as knot shape exists.

21, after the first arm spacing operation, the thread-like members L indicates the state of being removed from at least a first arm mechanism 14a of the first arm mechanism 14a and the second arm mechanism 14b. Threadlike members L, when a series of operations with the operation projecting first arm spacing operation, or a first arm spacing operation and the moving member 78 in the arrow direction is performed, out of the first arm mechanism 14a and the second arm mechanism 14b . Thread members L when the first arm spacing operation and the operation for projecting the moving member 78 in the arrow direction is performed by continuous deformation while keeping the identity of the topology of the closed path, in the schematic diagram of FIG. 21 as shown, a state in which the knot M1 is formed only in the so-called single ligature thread members L.
Threadlike members L from the at least a second arm mechanism 14b, by moving the longitudinal substrate 12, it may remove the threadlike members L. In operation performed later by the first arm mechanism 14a and the second arm mechanism 14b, if there is no trouble, threadlike members L may not necessarily be removed from the first arm mechanism 14a. Threadlike members L is, after the state shown in FIG. 21, by operating tightening the thread members L, single ligation M1 in FIG. 23 is obtained. That is, a single ligation M1 by the filament member L Such single ligating forming operation is automatically formed.

As described above, in order to form a knot, through the loop formed in the thread-like members L, but must pass through the end portion of the thread, the knot is one among the loop passing direction considered two ways forming a while the other can not form a knot. This is when the other direction is because the loop is eliminated disappears in a loop before passing through the loop. Describing it in detail with reference to FIG. 22. In Figure 22, when making a path projection of thread-like members L projected onto the projection plane S orthogonal to the virtual axis K is closed to define the loop, the entity of the thread-like members L to be projected as the intersection of its closed path , 2 position of the thread-like member L, that is a crossing composed of the first intersection a and the farther the second intersection B of the closer to the first position is a first end of the thread-like member L. The first position is a first end of the thread-like member L for passing a loop, passing in the direction of the arrow direction, i.e. virtual axis K direction from the second intersection B side with respect to the loop to the first intersection A side It can knot by. For example in the FIG. 21, by the delivery of the first arm mechanism 14a and the needle 50 and needle 51 following the closing of the second arm mechanism 14b in a state where the loop is formed around the arm body 36b, the thread-like members L the first threaded portion on the needle 50 is the position of the first from the second intersection B side of the first side farther than the position of the two positions of the thread-like member L corresponding to intersections of the loop near side because it is allowed to relatively pass through the loop to 1 intersections a side, knot M1 is formed into a loop.

Here, the operation process to around 135 degrees operating member 16, when the arm body 36b of the arm body 36a and the second arm mechanism 14b of the first arm mechanism 14a is rotated about its longitudinal axis, 2 rotated to the number of teeth of the internal teeth 68a for performing an operation, it is also possible to use the operating member 16 with 68b. Alternatively, if the structure of rotating the arm body 36a and the arm body 36b with the second operating member independently of the operating member 16 used in the opening and closing of the first arm mechanism 14a and the second arm mechanism 14b , it can be rotated twice the angle by the second operating member when rotated once an arm body 36a and the arm body 36b. In this case, the thread-like member L is is wound in loop double is formed in the second arm mechanism 14b. Then passes the needle 50 and the needle 51 from this state, when removing the thread members L performs a projecting operation of the moving member 78 from the first arm mechanism 14a and the second arm mechanism 14b, as shown in the schematic diagram of FIG. 24 , loop knot M2 so-called double ligature is formed is formed. Then, the double ligature M2 in FIG. 25 by manipulating tightening thread-like member L is obtained. That is, according to the knotting device 10 of the present embodiment, such a double ligature forming operations by a double ligature M2 is automatically formed.

When repeated twice a single ligature forming operation comprising a projecting operation of the operation and the moving member 78 to around 225 degrees of the operating member 16, a loop knot M3 is formed of a so-called On'namusubi shown in the schematic diagram of FIG. 26 while being formed, by tightening the thread-like members L, On'namusubi M3 of Figure 27 is obtained. That is, according to the knotting device 10 of the present embodiment, by repeating twice the single ligature forming operations described above, On'namusubi M3 is automatically formed.

Further, when the single ligating forming operation of the two is performed, first with respect to the rotation direction of the arm body 36a and the arm body 36b in the single ligation formation, at the time of the second single-ligated forming the arm body 36a and the arm by the rotation direction of the main body 36b in the opposite, with loop knot M4 so-called square knot is formed shown in the schematic diagram of FIG. 28 is formed, by tightening the thread-like members L, square knot M4 in FIG. 29 is obtained It is. That is, according to the knotting device 10 of the present embodiment, by performing the single ligature formed two operations, square knot M4 is automatically formed. In the present embodiment, and is configured to be able to rotate the arm body 36a and the arm body 36b in opposite directions by a reverse rotation direction of the operating member 16.

Further, after forming a double ligature M2 by the double ligature forming operation, by subsequently forming a single ligating M1 by performing the single ligating forming operation, the two in the first stage as shown in FIG. 30 surgical ligation M5 with single ligation M1 heavy ligation M2,2 stage is formed. Such surgical ligation M5 can also be automatically formed by using a knotting device 10 of the present embodiment. After forming the knot, the case of forming a performs an operation of subsequently make another knot called multistage ligation plurality of knots are combined as described above, with the formation of the knot of the first stage is completed in the present embodiment has a second arm mechanism 14b holding the needle 50, in a state where the first arm mechanism 14a holds the needle 51. Therefore before replacing operation of the needle 50 and 51 again, it is possible to form a knot of the two-stage by performing the same work by returning the device to the initial state, in the present embodiment the first arm mechanism 14a When since the second arm mechanism 14b is configured to functionally symmetrical, it is possible to perform immediate second stage of formation of the knot from the state in which the formation of knots in the first stage has been completed. In this case, the procedure of forming the knot of the first stage first arm mechanism 14a and the second arm mechanism 14b, and use these components in reverse. In the above description of the present specification may be read as interchanged subscripts a and b.

Incidentally, FIG. 15, the loop-forming operation shown in FIG. 16, has an arm body 36b of the arm body 36a and the second arm mechanism 14b of the first arm mechanism 14a is rotated in the same rotational direction about its longitudinal axis It was, but only the arm body 36b of the second arm mechanism 14b the needle 51 of the base end side is fixed or may be rotated 1,

According to the knotting device 10 of the present embodiment, the longitudinal substrate by (base) 12 operating member provided on the base end portion of the (operation unit) 16 operation, the first arm mechanism 14a and the second arm mechanism 14b mutually is separated, said second intersection position of the thread-like members L, which passed through the first intersection and the needle 51 of the thread-like members L, which passed through the needle 50 and the first holding member as shown in FIG. 15 first while kept at 4 holding member, the first arm as shown in the arm body (loop forming means) 36a, a first loop-forming operation to form a loop of thread members L by 36b, 17 as shown in FIG. 15 an arm close operation to close the mechanism 14a and the second arm mechanism 14b to each other, from the state held by the first position and the second position and the first holding member fourth holding member thread members L, as shown in FIG. 18 the second holding member State holding the first switching operation for switching to a state held by the third holding member, by the first position and the second holding member and the second position the third support member of the thread-like member L as shown in FIG. 19 in by sequentially executing a first arm spacing operation for spacing said first arm mechanism 14a and the second arm mechanism 14b together, the knot M the first position is passed through a loop R filamentous member L, automatic it can be formed. Also, both before and after the formation of the knot M, because the ends of the thread-like member L is held at a position away from the separate first arm mechanism 14a and the second arm mechanism 14b, hardly threadlike members L entangled, subsequent tightening or cutting becomes easy.

Further, according to the knotting device 10 of the present embodiment, the arm body (loop forming means) 36a, 36b is provided in the first arm mechanism 14a and the second arm mechanism 14b, the operation member (operation unit) 16, Following the first knot forming operation, the first arm mechanism 14a and the second arm mechanism 14b mutually moved away, in the third holding member of the first position and the second position and the second holding member of the thread-like member L in the holding state, the arm body (loop forming means) 36a, a second loop forming operation for forming a loop of thread members L by 36b, the arm close operation to close the first arm mechanism 14a and the second arm mechanism 14b to each other When, to the state held by the first position and the first holding member and the fourth holding member from the state holding the said second position the second holding member and third holding member thread members L A second switching operation for changing Ri, mutually spaced first position and the first arm mechanism 14a and the second arm mechanism 14b in a state where the second position is held by the first holding member and the fourth holding member thread members L again passing the loop into the first position by performing a second arm spaced operation of sequentially. By arm body (loop forming means) 36a, 36b are provided on both of the first arm mechanism 14a and the second arm mechanism 14b, the first arm mechanism 14a and the second arm mechanism 14b is functionally symmetrical. Thus, the first loop forming operation, the arm approaching operation, the first switching operation, and subsequently to form the first knot by sequentially executing the first arm spacing operation immediately, the second loop forming operation, arm approaching operation, the second switching operation, and by sequentially executing a second arm spaced operation, the first position of the thread-like member L in a loop again passed through a can form a second knot of the next , it is possible to automatically form a multistage knot in a simple operation.

Further, according to this embodiment, it is possible to wind the thread-like members L to the first arm mechanism 14a and the second arm mechanism 14b itself during loop formation, a good space efficiency, compact automatic ligation capable knotting device can get. Also, both before and after the knot formation, since the both ends of the thread-like member L are held apart in separate first arm mechanism and the second arm mechanism, difficult threadlike members L entangled, thereby facilitating subsequent tightening and cutting . Furthermore, by a first arm mechanism 14a and the second arm mechanism 14b of the tip of the knotting apparatus 10 is opened and closed, symmetric product e.g. biological tissue T is sandwiched by and their first arm mechanism 14a and the second arm mechanism 14b it is possible to form the knot around. The second second arm body 36b even after rotation of the loop-forming operation by the a first position and a second position operating the first arm mechanism 14a second arm mechanism 14b as a holder in accordance with the operation of the operating member 16 It can be exchanged between.

Next, another embodiment of the present invention. In the following description, the portions common to the embodiments are not described with the same reference numerals.

Figure 32 is a front view showing a state where the first arm mechanism 102a and the second arm mechanism 102b knot forming apparatus 100 according to another embodiment of the present invention is opened, FIG. 33, the first knot forming apparatus 100 it is a front view showing a state where the arm mechanism 102a and the second arm mechanisms 102b is closed, FIG 34 is a exploded perspective view showing the knotting apparatus 100. Knot forming device 100 of this embodiment, and the needle 50 and functions as a loop forming means based on the rotational operation force transmitted respectively through the first rotation manipulation force transmission shaft 70a and the second rotational operating force transmitting shaft 70b a pair of first cylindrical rotary mechanism 104a and the second cylindrical rotary mechanism 104b that functions as a needle locking mechanism for detachably holding the 51, are provided at the front end of the first arm mechanism 102a and the second arm mechanism 102b points, the operation force transmission mechanism 18 is first push rod 76a, that it does not include the second push rod 76 b, and, as the operation member, the rotation operably paired handling provided on the base end portion of the longitudinal substrate 12 in that the member 106 and the rotation operating member 108 is provided, but are different compared to the knot forming apparatus 10 of FIG. 1, other similar It is configured.

Knot forming apparatus 100 includes a cylindrical longitudinal substrate 12, a pair of first arm mechanism 102a and the second arm mechanism 102b, a pair of opening and closing member 106 and the rotation operating member 108, the operation force transmission mechanism 18. A pair of first arm mechanism 102a and the second arm mechanism 102b is openably provided, respectively so as to be rotatable about axial line C2 and axial center line C3 in parallel with each other at the tip portion of the longitudinal substrate 12 is supported by ing. Paired handling member 106 and the rotary operation member 108 is at the proximal end of the longitudinal substrate 12 provided rotatably operated about the axis line C1 of the longitudinal substrate 12, and another disposed relatively rotatably there. Operating force transmitting mechanism 18 is provided in the longitudinal base 12, opening and closing force first rotation manipulation member 108 of the pair and the arm mechanism 102a and the second arm mechanism 102b of the opening and closing member 106, a first cylindrical rotating the pair transmission to mechanisms 104a and the second rotation mechanism 104b. In this embodiment, a pair of opening and closing member 106 and the rotation operating member 108 functions as the operation unit.

Since the first arm mechanism 102a and the second arm mechanism 102b is constructed similarly to each other, it will be described first arm mechanism 102a. The first arm mechanism 102a includes an arm body 114a, a cover 118a, a first cylindrical rotating mechanism 104a, the rotary drive shaft 122a, and includes.
Arm body 114a is a universal joint 32a rotatable with open connecting arm 26a is positioned sandwiched a projecting shaft 24a projecting to one which is fixed to and outwardly to a pair of parallel plates 110a and the pair of parallel plates 110a having respective having a proximal end and a member 112a receives the joint through holes 28a are formed to accept. An arm body 114a, the cover 118a is a circular opening 116a is formed in the distal end portion, and is fixed to the arm body 114a so as to cover the opposing face of the arm body 114a. Rotary drive shaft 122a is provided between the arm body 114a and a cover 118a, it is rotatably supported around the longitudinal direction parallel to the rotation axis C4 of the central axis or first arm mechanism 102a of the through hole 28a, Universal the proximal end joint 32a is connected, the pinion 120a is fixed to the distal end.

The first cylindrical rotary mechanism 104a, as also shown in FIGS. 35 and 36, provided at the tip portion of the arm body 114a and a cover 118a of the first arm mechanism 102a. Figure 37 is a longitudinal sectional view illustrating the structure of the first cylindrical rotary mechanism 104a. The first cylindrical rotary mechanism 104a includes a cylindrical member 128a, the bevel gear member 132a, the guide plate 136a. Cylindrical members 128a, the first arm mechanism 102a and the second arm mechanism 102b by a cylindrical bearing 124a has a central shaft portion 126a which is fitted in projecting from a cylindrical bearing 124a which inwardly from the arm body 114a is rotatably supported about the rotation axis C6 orthogonal to parallel and rotational axis C4 to cover face is mounted with a partially protruding through the circular opening 116a formed in the tip portion of the cover 118a. Bevel gear member 132a is rotatably supported by the outer peripheral surface of the distal end portion of the cylindrical bearing 124a, a plate-shaped locking flange 130a projecting to the outer periphery. The guide plate 136a is sandwiched between the arm body 114a and a cover 118a, and a guide plate 136a to form the annular slot 134a between the outer peripheral edge of the locking flange 130a is located inside. By bevel gear member 132a is engaged with a pinion 120a provided on the shaft end of the rotary drive shaft 122a, the cylindrical members 128a and the bevel gear member 132a is adapted to be rotated about the rotational axis C6.

The cylindrical member 128a is urged in the projecting direction by a spring 138a interposed between the cylindrical member 128a and the bevel gear member 132a. Thus, in a state where the first arm mechanism 102a and the second arm mechanism 102b is closed, by being pushed against the urging force of the spring 138a as shown in FIG. 38, the cylindrical body tissue T having a predetermined thickness member 128a and is capable be sandwiched between the cylindrical member 128b.

39 and 40 are views as seen from the arm body 114a side respectively showing a locked state was and needle 51 releases the needle 50 between the locking flange 130a and the guide plate 136a, FIG. 39 is first Figure, Figure 40 viewed cylindrical rotary mechanism 104a from the arm body 114a side illustrates removing the cylindrical member 128a, the rotary drive shaft 122a and the cover 118a from Figure 39. Further, FIG. 41 is a view corresponding to FIG. 40 showing a state in which the locking and the needle 51 of the needle 50 has been released with the locking flange 130a and the guide plate 136a. Further, FIG. 42, in a state where the needle 50 locks the released and the needle 51 between the locking flange 130a and the guide plate 136a, which is a view corresponding to FIG. 39 showing a state of rotating the cylindrical member 128a.

Radial dimension of the annular slot 134a formed between the inner periphery of the outer peripheral edge and the guide plate 136a of the lock flange 130a is smaller than the outer diameter of the needle 50 and the needle 51, the groove bottom diameter of the engaging groove 52 It is also set large. Further, the 2 position on the straight line perpendicular to the axis of rotation C6 streets and rotation axis C4 of the inner periphery of the guide plate 136a is a large radius of curvature of the arcuate shape than the radius of curvature of the outer diameter of the needle 50 and needle 51 outer arc-shaped notches 139a and 140a having is formed on a position opposite to the rotation axis C6. The lock on the flange 130a spaced two positions 180 degrees circumferential direction of the outer peripheral edge of has a diameter larger radius of curvature than the radius of curvature of the needle 50 and the needle 51, the outer arc-shaped notches 139a and 140a than the groove bottom diameter of the engaging groove 52 of the needle 50 and the needle 51 between the inner arc-shaped notches 142a and 144a to permit passage of needle 50 and needle 51 between an inner periphery of the guide plate 136a of the large and an inner rectangular notches 146a and 148a than the outer diameter of the needle 50 forms a small gap is formed by connecting a semi Zenpokoen shape. Then, the two positions spaced 180 degrees circumferentially of the outer peripheral surface of the cylindrical member 128a is needle receiving groove 150a and 152a rotational axis C6 parallel semicircular cross section for receiving the needle 50 and the needle 51 , it is formed.

Thus, in FIG. 39, the cylindrical member 128a needle receiving grooves 150a needle 50 received in of missing between the outer arc-shaped notch 139a and the inner arcuate cutout 142a is allowed, and, the cylindrical member 128a needle receiving grooves 152a needles received in 51 shows a state in which omission between the outer arc-shaped notch 140a and the inner rectangular notch 148a is prevented. From this state, when the locking flange 130a and the bevel gear member 132a counterclockwise is rotated, it pushed the needle 51, which is missing prevented also cylindrical member 128a is rotated as shown in FIG. 40, the cylindrical member 128a threadlike members L is wound around the outer peripheral surface of the loop of thread members L are formed. When the amount of rotation of the cylindrical member 128a reaches the relative 360 ​​degrees relative to the other of the cylindrical member 128b, it is stopped rotating. Figure 41 shows this state. In this state, similarly to FIG. 39, the needle 50 is missing between the outer arc-shaped notch 139a and the inner arcuate cutout 142a is allowed, and the needle 51-out outer arc-shaped notch 140a and the inner rectangular cut missing between the notch 148a is blocked. During this state, the lock flanges 130a and bevel gear member 132a clockwise is caused by a predetermined angle opposite rotation, as shown in FIG. 42, the needle 50 and the outer arc-shaped notch 139a and the inner rectangular cutout 146a in loss is prevented, and the needle 51 is missing between the outer arc-shaped notch 140a and the inner arcuate cutout 144a is prevented. That is, in either rotated in either direction Finally, switches the lock state of the needle 50 and needle 51.

In this embodiment, the first cylindrical rotary mechanism 104a, and a portion inside arcuate notches 142a and inner rectangular notch 146a of the locking flange 130a formed in the bevel gear member 132a is formed, of the guide plate 136a the combination of an outer arc-shaped notch 139a is formed parts, functions as a first holding member for holding the needle 50. In the second cylindrical rotary mechanism 104b, and a portion inside arcuate notches 142b and the inner square notch 146b of the locking flange 130b formed on the bevel gear member 132b is formed,-out outer arc-shaped notch of the guide plate 136b combination of 139b is formed parts, functions as a second holding member for holding the needle 50. In a first cylindrical rotating mechanism 104a, and a portion inside arcuate notches 144a and inner rectangular notch 148a of the locking flange 130a formed in the bevel gear member 132a is formed,-out outer arc-shaped notch of the guide plate 136a combination of 140a is formed parts, functions as a third holding member for holding the needle 51. In the second cylindrical rotary mechanism 104b, and a portion inside arcuate notches 144b and the inner square notch 148b of the locking flange 130b formed on the bevel gear member 132b is formed,-out outer arc-shaped notch of the guide plate 136b combination of 140b is formed parts, functions as a fourth holding member for holding the needle 51.

As shown in FIG. 34, the proximal end portion of the longitudinal substrate 12 of the knotting apparatus 100 of this embodiment includes a cylindrical opening and closing member 106 provided to be operated to rotate around its axis line C1, and opening and closing operation member 106 rotates the operation member 108 cylindrical provided rotation operably about the axis line C1 of the longitudinal substrate 12 adjacent to are provided independently of each other to be operated. Opening and closing member 106 integrally includes a cylindrical grooved cam 64 of the arm opening and closing cam groove 60 is formed in an annular shape for opening and closing the first arm mechanism 102a and the second arm mechanism 102b on the inside. Although cylindrical grooved cam 64 is formed so the operating member 16 integrally, are shown separated on for convenience of illustration in FIG. 34.

The inner peripheral surface of the rotation operating member 108, for rotating the cylindrical member 128b of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a, and switches the locking and unlocking of the needle 50 and 51 for, inner peripheral teeth 68a of the pinion 66b is engaged each pinion 66a and the second rotational operating force transmission shaft 70b of the first rotation manipulation force transmission shaft 70a is formed as shown in FIGS. 45 and 46. Figure 45 shows a state where the pair of first arm mechanism 102a and the second arm mechanism 102b is opened, FIG. 46 shows a state where the first arm mechanism 102a and the second arm mechanism 102b is closed.

Figure 43 is a longitudinal sectional view of FIG. 32 and, as shown in FIG. 44 is a longitudinal sectional view of FIG. 33, the operation force transmission mechanism 18 transmits the rotational operation force for rotating the first cylindrical rotary mechanism 104a a first rotation manipulation force transmission shaft 70a which pinion 66a and the universal joint 32a is fixed to both meshing with the internal teeth 68a of the rotation operating member 108 shown in FIG. 45 for an operation force for rotating the second rotary mechanism 104b a second rotation manipulation force transmission shaft 70b of the pinion 66b and the universal joint 32b meshing with the internal teeth 68a of the rotation operating member 108 is fixed at both ends as shown in Figure 45 for transmitting it includes. The operation force transmission mechanism 18, in order to transmit the opening and closing forces for opening and closing the first arm mechanism 102a in the open position and a closed position, the distal end portion is rotatably connected to open and close the connecting arm 26a, longitudinal a first opening and closing force transfer link 72a having a proximal end a cam engaging portion 71a which engages the arm opening and closing cam groove 60 projects at right angles to the second arm mechanism 102b to an open position and a closed position in order to transmit the opening and closing forces for opening and closing the tip portion is pivotally connected to the closing connecting arm 26b, the cam engaging portion 71b that engages the arm opening and closing cam groove 60 projects at right angles to the longitudinal direction and a second opening and closing force transfer link 72b having a proximal end portion.

Figure 47 is opening and closing the first arm mechanism according to one rotation operating member 106 102a and the opening and closing operation of the second arm mechanism 102b, a first cylindrical rotating mechanism according to the rotation operating member 108 in a predetermined rotational phase in the interval 104a and the second and exchange operation of the cylindrical rotary mechanism 104b of the rotation and the needle 50 and needle 51 is a chart for explaining a state that is executed in a predetermined order for knot formation. The horizontal axis of the chart of Figure 47 shows the angle of rotating the opening and closing operation member 106 clockwise when viewed from the direction of FIGS. 45 and 46. Rotation operating member 108, in the case of the operation of the cylindrical member 128b of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a rotates winding the thread-like member L includes a first arm mechanism 102a and the second arm mechanism 102b is operated in a section in the open position, when replacing the needle 50 and the needle 51 between the first cylindrical rotary mechanism 104a and the second cylindrical rotary mechanism 104b, the first arm mechanism 102 and the second arm mechanism 102b is operated in the section in the closed position. Figure 45 is approximately 135 degrees from the origin of the horizontal axis of the chart, FIG. 46 is a illustration of a position rotated approximately 45 degrees. Rotating operation of the opening and closing member 106 and the rotation operating member 108 may be a manual operation, it may be remotely operated to be rotated by a motor drive.

In knotting apparatus 100 configured as described above, by operating the opening and closing member 106 and the rotation operating member 108, specifically the operation, below the loop automatically formed and knot M1 thread members L are formed It will be described. Note that in FIG. 53 from FIG. 48, for ease of explanation, by changing the position of the needle 50 and the needle 51 in the vertical direction.

For example, if the thread-like members L is applied to the suture of the living tissue T is the needle 50 from the locked state by the second cylindrical rotary mechanism 104b of the second arm mechanism 102b, the first arm mechanism 102a and the second arm mechanism Close and 102b. Thus, passing the suture portion sandwiched biological tissue T between the tip portion of the distal end portion of the first arm mechanism 102a and the second arm mechanism 102b with the needle 50. Then, by opening a first arm mechanism 102a in a state of locking the needle 50 by the first cylindrical rotating mechanism 104a of the first arm mechanism 102a and a second arm mechanism 102b, a part of the filamentous members L of the living tissue T, the 1 arm mechanism 102a, the second arm mechanism 102b, a state enclosed in a closed path consisting of longitudinal base 12. The first arm mechanism 102a and the second needle 51 is passed through the position the second cylindrical rotary mechanism 104b of the thread members L of the needle 50 is passed through the first position and locked by the first cylindrical rotating mechanism 104a of the thread-like member L in the state immediately after opening the second arm mechanism 102b that locked, opening and closing operation member 106 is in the operating position in the vicinity of 45 degrees. Figure 48 shows this state schematically.

Next, the operation sequence to around opening and closing member 106 is 135 degrees, by rotating the operation member 108 is operated, the cylindrical member 128b of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a rotation but parallel to the longitudinal direction of the first arm mechanism 102a and the second arm mechanism 102b parallel and first opening and closing surface of the arm mechanism 102a first arm mechanism 102a in the longitudinal direction parallel to the rotation axis C4 second arm mechanism 102b the rotation axis C6, about C7 perpendicular to the axis C4, C5 are then half rotation i.e. relatively one revolution. Thus, the thread-like member L is wound around the cylindrical member 128b around the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a, a loop is formed. Schematic diagram of Figure 49 shows the state of being the loop forming operations.

Here, rotating the operation member 108, a first rotation manipulation member having an inner peripheral teeth pinion 66a of the first rotation manipulation force transmission shaft 70a for rotationally driving the first cylinder rotating mechanism 104a meshes, second cylindrical rotary mechanism 104b may be a provision is divided into the second rotation manipulation member having an inner peripheral teeth pinion 66b of the second rotation manipulation force transmission shaft 70b for rotating meshes. In this case configured as above, since the first cylindrical rotary mechanism 104a and the second cylindrical rotary mechanism 104b by the first rotation manipulation member and the second rotation manipulation member can rotate independently operated, the first cylindrical rotary mechanism 104a relatively 1 is rotated by rotating the cylindrical member 128a and the one of the cylindrical member 128b of the second cylindrical rotary mechanism 104b, the cylinder of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a on one outer peripheral surface of the member 128b may be wound around the threadlike members L. Further, as described above, when rotating one of the cylindrical member 128b of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a, the other of the cylindrical rotary mechanism may be removed.

Subsequently, the first arm close operation for operating the opening and closing member 106 to near 135 degrees, and the first arm mechanism 102a and the second arm mechanism 102b is closed. Schematic diagram of Figure 50 illustrates this first arm close operation. Then, in a state where the first arm mechanism 102a and the second arm mechanism 102b is closed, the first switching operation for operating the return of the rotation operating member 108 a predetermined angle, one end of the needle 50 is first cylindrical rotary mechanism 104a the other end of the release by the locking flange 130a and the needle 50 is locked by the locking flange 130b of the second cylindrical rotary mechanism 104b. At the same time, the other end of the needle 51, one end of the second cylindrical rotary mechanism 104b is released by the locking flange 130b of and the needle 51 is locked by the locking flange 130a of the first cylindrical rotary mechanism 104a. Figure 50 shows a state before the first switching operation, FIG. 51 shows a state after the first switching operation. In Figures 50 and 51, a state where the needle 50 and the needle 51 is locked is indicated by oblique lines in the cylindrical member 128b of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a.

When the opening and closing operation member 106 is operated to near 225 degrees, and the first arm mechanism 102a and the second arm mechanism 102b is opened. Figure 52 shows a state after the spacing operation between the first arm mechanism 102a and the second arm mechanism 102b. In this state, the threadlike members L is wound around the singlet to the second arm mechanism 102b have loops R are formed, and the cylindrical member 128b of the cylindrical member 128a and the second cylindrical rotary mechanism 104b of the first cylindrical rotary mechanism 104a among, transfer needle 50 and needle 51 has been completed. In the state shown in FIG. 52, similarly to FIG. 19, the thread-like members L, the first arm mechanism 102a, the second arm mechanism 102b, closed path consisting of longitudinal base 12 already knot topological sense at this point It has become. Threadlike members L, the first arm mechanism 102a, the second arm mechanism 102b, closed path consisting of longitudinal base 12, only by a continuous deformation, so that the knot shape exists only in the portion made of thread-like members L of closed path is a state in which the deformation can in these ways.

For example, in this step, when removing the thread members L by performing the arrow direction of the protruding operation of the movable member 78 from the first arm mechanism 102a and the second arm mechanism 102b, a continuous still keeping the identity of the topology of the closed path the deformation, as shown in the schematic diagram of FIG. 53, a state in which the knot M1 is formed only in the so-called single ligature thread members L. Then, by operating tightening the thread members L, for example a single ligation M1 in FIG. 23 is obtained. That is, a single ligation M1 by the filament member L Such single ligating forming operation is automatically formed.

Here, the period in which the first arm mechanism 102a and the second arm mechanism 102b is opened by operating the opening and closing member 106, for example, the operation process from 45 degrees to 135 degrees, the rotation operating member 108, cylindrical member 128a and the cylinder relative rotation between the member 128b can be two revolutions. In this case, the thread-like member L is wound around the double in the cylindrical member 128a and 128b loop is formed. Then it passes the needle 50 and the needle 51 from this state, by performing the projecting operation of the moving member 78 release the thread-like member L from the first arm mechanism 102a and the second arm mechanism 102b, Fig by manipulating tightening thread-like member L 25 double ligation M2 is obtained. That is, according to the knotting apparatus 100 of this embodiment, such a double ligature forming operations by a double ligature M2 is automatically formed.

Also, by tightening the thread members L to form a loop by repeating twice the single ligature forming operation by the above-described opening and closing operation member 106 and the rotation operating member 108, On'namusubi M3 of Figure 27 is obtained. That is, according to the knotting device 10 of the present embodiment, by repeating twice the single ligature forming operations described above, On'namusubi M3 is automatically formed. Further, when the two the single ligating forming operation is performed with respect to the first cylindrical member 128a and 128b in the direction of relative rotation during a single ligating form, the direction of rotation during a single ligation formed the second time in the opposite to form a loop by tightening the thread-like member L by, square knot M4 in FIG. 29 is obtained. Further, after forming a double ligature M2 by the double ligature forming operation, by subsequently forming a single ligating M1 by performing the single ligating forming operation, the two in the first stage as shown in FIG. 30 the surgical ligation M5 with single ligation M1 heavy ligation M2,2 stage can be automatically formed.

According to the knotting apparatus 100 of the present embodiment, in addition to the same effect as the knot forming device 10 of the foregoing embodiment can be obtained, the separating operation of the first cylindrical rotary mechanism 104a and the second cylindrical rotary mechanism 104b the direction of, since the loop passage direction of the first position engaging the needle 50 of the thread-like member L are the same, utilizing the separation operation of the first arm mechanism 102a and the second arm mechanism 102b there is an advantage that the first position in engagement can be passed through the loop to the needle 50 of the threadlike members L Te. Further, since the cylindrical member 128b that functions as a cylinder member 128a and the second holder serves as a first holder is rotated in the opposite direction 180 degrees or a multiple thereof, respectively, the loop forming operation of the cylindrical member 128a and the cylindrical member 128b since symmetrically with parts are common, there is an advantage that the operation stroke of the drive unit can be halved.

Figure 54 is a front view showing a state where the first arm mechanism 172a and the second arm mechanism 172b knot forming apparatus 170 according to another embodiment of the present invention is opened, FIG. 55, the first knot forming device 170 arm mechanism 172a and the second arm mechanism 172b is a front view showing a state in which the closed, FIG. 56 is an exploded perspective view showing a knot forming device 170. Knot forming device 170 of this embodiment, on the basis of the rotational operation force transmitted respectively through the first rotation manipulation force transmission shaft 70a and the second rotational operating force transmission shaft 70b, and functions as a loop forming means and the minute hand 198 and a pair of first needle holding mechanism that functions as a needle locking mechanism for detachably holding the hour hand 200 174a and second needle holding mechanism 174b are respectively provided on the front end of the first arm mechanism 172a and the second arm mechanism 172b and that point, the operation force transmission mechanism 18 is first push rod 76a, that it does not include the second push rod 76 b, and, as the operation member, the rotation operably paired provided at the proximal end portion of the longitudinal substrate 12 in that the opening and closing member 106 and the rotation operating member 108 is provided, but are different compared to the knot forming apparatus 10 of FIG. 1, the It is similarly configured.

Knot forming device 170 includes a cylindrical longitudinal substrate 12, a pair of first arm mechanism 172a and the second arm mechanism 172 b, a pair of opening and closing member 106 and the rotation operating member 108, the operation force transmission mechanism 18. A pair of first arm mechanism 172a and the second arm mechanism 172b is openably provided, respectively so as to be rotatable about axial line C2 and axial center line C3 in parallel with each other at the tip portion of the longitudinal substrate 12 is supported by ing. Paired handling member 106 and the rotary operation member 108 is at the proximal end of the longitudinal substrate 12 provided rotatably operated about the axis line C1 of the longitudinal substrate 12, and another disposed relatively rotatably there. Operating force transmitting mechanism 18 is provided in the longitudinal base 12, opening and closing the first arm mechanism the rotational operation force of the opening and closing force and the rotation operating member 108 of the pair of members 106 172a and the second arm mechanism 172 b, a pair respectively transmitted to the first needle holding mechanism 174a and second needle holding rolling mechanism 174b. In this embodiment, a pair of opening and closing member 106 and the rotation operating member 108 functions as the operation unit.

Since the first arm mechanism 172a and the second arm mechanism 172b is similarly configured to each other, it will be described first arm mechanism 172a. Shows the open state of Fig. 57, shows a closed state of FIG. 58, as also shown in the exploded view of FIG. 59, the first arm mechanism 172a is arm body 178a, a cover 182a, a first needle holding mechanism 174a, the rotary drive shaft 186a, and includes. Arm body 178a is a universal joint 32a rotatable with open connecting arm 26a is positioned sandwiched a projecting shaft 24a projecting to one which is fixed to and outwardly to a pair of parallel plates 110a and the pair of parallel plates 110a having respective having a distal portion and the first bearing portion 176a has a proximal portion and a through hole 28a joints are formed receiving member 112a for receiving the. Cover 182a has a second bearing portion 180a for rotatably supporting the first needle holding mechanism 174a by being combined with the first bearing portion 176a at the distal end, the arm main body so as to cover the opposing face of the arm body 178a and it is fixed to the 178a. First needle holding mechanism 174a includes a first bearing portion 176a and the second bearing portion 180a at the distal end of the arm body 178a and a cover 182a, and perpendicular the opening and closing surface of the first arm mechanism 172a and the second arm mechanism 172 b 1 is rotatably supported about the rotation axis C8 perpendicular to the longitudinal direction, i.e. the rotation axis C4 direction of the arm mechanism 172a. Rotary drive shaft 186a is provided between the arm body 178a and a cover 182a, is rotatably supported around the central axis i.e. rotation axis C4 of the through hole 28a, the universal joint 32a is connected to the proximal end, the pinion 184a on the tip It has been fixed.

Figure 57, as shown in FIG. 58, first needle holding mechanism 174a provided on the tip portion of the first arm mechanism 172a, as shown in detail in main components exploded perspective view of FIG. 59, the rotation shaft 192a , a cylindrical pair of first locking gear member 194a and the second locking gear member 196a, and includes. Rotary shaft 192a has a first bearing portion 176a and being rotatably supported about the rotation axis C8 by the first needle holding mechanism 174a, bottomed cylindrical first cap 188a and the second cap 190a is fixed to both there. A pair of first locking gear member 194a and the second locking gear member 196a is the first cap 188a and is fitted into each of the second inner cap 190a and the first cap 188a and the second cap 190a is rotatably supported there. Thus, by brought pinion 184a Togakamiawa is fixed to the tip of the rotary drive shaft 186a and a pair of first locking gear member 194a and the second locking gear member 196a, pair of first locking gear member 194a and the second locking gear member 196a is adapted to be rotated in the reverse around about the rotation axis C8.

In this embodiment, the long hand 198 and ends with pointed ends flat hour hand 200 are used. Minute hand 198 and hour hand 200, similar to needle 50 and 51 described above, a same diameter to one another, an annular engaging groove 52 and 53 are formed on both ends, and, the thread-like members which function as ligating member L through hole 54 is formed in the center portion in the longitudinal direction is passed. Minute hand 198 is passed between the first locking gear member 194a and the second locking gear member 194b, hour hand 200, so as to be passed between the second locking gear member 196a and the second locking gear member 196ba It has become. Long hand 198 and hour hand 200 in this embodiment so as to be lured smoothly into the insertion hole 202a and 204a, are formed in an arc shape with a first arm mechanism 172a and the curvature of the order of the radius of rotation of the second arm mechanism 172b radius , no problem even if a straight needle shape.

Figure 60 is a perspective view showing a state where a pinion 184a that is fixed to the tip of the rotary drive shaft 186a and the first locking gear member 194a are engaged, FIG. 61, the width direction of the first locking gear member 194a center it is a cross-sectional view perpendicular to the axis of rotation C8 through. FIGS. 60 and 61, and each illustrate a unlocked (released) state of the minute hand 198. Figure 62 is a perspective view similar to FIG. 60 shows a lock (engagement) state of the minute hand 198.

In a first needle holding mechanism 174a, of the outer peripheral surface of the first cap 188a and the second cap 190a, the first arm mechanism 172a of the pivoting motion on the arc passing through the rotation axis and C8, insert the long hand 198 and hour hand 200 insertion holes 202a and 204a of the large diameter are formed than the outer diameter thereof in order. Further, the first locking gear member 194a and the second locking gear member 196a, the minute hand 198 and hour hand 200 than the outer diameter of the engaging groove 52, 53 of the circular holes 206a and 208a and the minute hand 198 and hour hand 200 of the large-diameter engaging holes 214a and 216a of Zenpokoen shape and a rectangular hole 210a and 212a of the width smaller than the outer diameter is bonded in large and long hand 198 and hour hand 200 than Mizosoko径 are formed.

Thus, in FIGS. 60 and 61, the minute hand 198 is inserted into the insertion hole 202a of the first cap 188a is put into the engaging groove 53 engagement hole 214a formed in the first lock gear members 194a Although the resulting state, the rotational phase between the insertion hole 202a and a circular hole 206a of the engaging hole 214a is matched, not engaged and the engaging groove 53 and the engaging hole 214a of the long hand 198, minute hand 198 It is the unlocked state. In Figure 62, the first locking gear member 194a is rotated phase has advanced to the left direction about the first cap 188a, engage the rectangular hole 210a is in the engaging groove 53 of the minute hand 198 of the engaging hole 214a Te state missing is prevented in the long hand 198, that is, the locked state. When the first locking gear member 194a is then further rotated in the left direction about in this state, the first cap 188a is pressed by the long hand 198 is also rotated about the rotation axis C8. In contrast, the first locking gear member 194a is moved rotated by a predetermined phase in the clockwise direction, the rotational phase between the insertion hole 202a and a circular hole 206a of the engaging hole 214a is matched, the minute hand 198 There is unlocked as shown in FIGS. 60 and 61. In other words, in or rotated in either direction Finally, it is switched locked state of the minute hand 198.

In this embodiment, the first needle holding mechanism 174a, a portion rectangular hole 210a is formed of the first locking gear member 194a which is formed in the engaging hole 214a, the insertion hole 202a of the first cap 188a is formed combination of the portions that function as a first holding member that holds the minute hand 198. In a second needle holding mechanism 174b, a portion rectangular hole 210b is formed of the engaging hole 214b formed in the first lock gear members 194b, the insertion hole 202b is formed portion of the first cap 188b combinations, functions as a second holding member for holding the minute hand 198. In a first needle holding mechanism 174a, the rectangular holes 212a are formed portion and the insertion hole 204a is formed portion of the second cap 190a of the engaging hole 216a formed in the second lock gear members 216a combinations, functions as a third holding member for holding the minute hand 198. In a second needle holding mechanism 174b, with a rectangular hole 212b is formed portion and an insertion hole 204b is formed portion of the second cap 190b of the second locking gear member 216b which is formed on the engagement hole 216b combinations, functions as a fourth holding member for holding the minute hand 198.

As shown in FIG. 56, the proximal end portion of the longitudinal substrate 12 of the knotting apparatus 170 of this embodiment includes a cylindrical opening and closing member 106 provided to be operated to rotate around its axis line C1, and opening and closing operation member 106 rotates the operation member 108 a cylindrical provided rotation operably about the axis line C1 of the longitudinal substrate 12 adjacent to are provided independently of each other to be operated. Opening and closing member 106 integrally includes a cylindrical grooved cam 64 of the arm opening and closing cam groove 60 is formed in an annular shape for opening and closing the first arm mechanism 172a and the second arm mechanism 172b on the inside. Although cylindrical grooved cam 64 is formed so the operating member 16 integrally, are shown separated on for convenience of illustration in FIG. 56.

The inner peripheral surface of the rotation operating member 108, for rotating the first needle holding mechanism 174a and the second needle holding mechanism 174b, to switch the long hand 198 and hour hand 200 locking and unlocking, the first rotational operating force transmitting shaft inner teeth 68a of the pinion 66a and the pinion 66b of the second rotation manipulation force transmission shaft 70b of 70a are engaged respectively, are formed as shown in FIGS. 63 and 64. Figure 63 shows a state where the pair of first arm mechanism 172a and the second arm mechanism 172b is opened, FIG. 64 shows a state where the first arm mechanism 172a and the second arm mechanism 172b is closed.

Figure 65 and a longitudinal sectional view of FIG. 54, as shown in FIG. 66 is a longitudinal sectional view of FIG. 55, the operation force transmission mechanism 18 transmits the rotational operation force for rotating the first needle holding mechanism 174a a first rotation manipulation force transmission shaft 70a which pinion 66a and the universal joint 32a is fixed to both meshing with the internal teeth 68a of the rotation operating member 108 shown in FIG. 63 for an operation force for rotating the second needle holding mechanism 174b pinion 66b and the universal joint 32b meshing with the internal teeth 68a of the rotation operating member 108 shown in FIG. 63 and the second rotational operating force transmission shaft 70b that is fixed at both ends, are provided to convey. The operation force transmission mechanism 18, in order to transmit the opening and closing forces for opening and closing the first arm mechanism 172a in the open position and a closed position, the distal end portion is rotatably connected to open and close the connecting arm 26a, longitudinal a first opening and closing force transfer link 72a having a proximal end a cam engaging portion 71a which engages the arm opening and closing cam groove 60 projects at right angles to the second arm mechanism 172b to an open position and a closed position in order to transmit the opening and closing forces for opening and closing the tip portion is pivotally connected to the closing connecting arm 26b, the cam engaging portion 71b that engages the arm opening and closing cam groove 60 projects at right angles to the longitudinal direction and a second opening and closing force transfer link 72b having a proximal end portion.

Figure 67 is opening and closing operation 1 and the opening and closing operation of the first arm mechanism by rotational operation 172a and the second arm mechanism 172b of the member 106, first needle holding mechanism by the rotation operating member 108 in a predetermined rotational phase in the interval 174a and the second and exchange operation of the minute hand 198 and hour hand 200 between the needle holding mechanism rotation and the first needle holding mechanism 174a and the second needle holding mechanism 174b 174b may explain the condition to be executed in a predetermined order for knotting a chart. The horizontal axis of the chart of Figure 67 shows the angle of rotating the opening and closing operation member 106 clockwise when viewed from the direction of FIGS. 63 and 64. Rotation operating member 108, the first cap 188a and the second cap 190a and the first cap 188b and the second and the cap 190b is rotated threadlike members L of the second needle holding mechanism 174b cylindrical first needle holding mechanism 174a in case of an operation for winding is operated in a section where the first arm mechanism 172a and the second arm mechanism 172b is in the open position, the long hand 198 and between the first needle holding mechanism 174a and second needle holding mechanism 174b when replacing the hour hand 200, first arm mechanism 172 and the second arm mechanism 172b is operated in the section in the closed position. Figure 63 is approximately 135 degrees from the origin of the horizontal axis of the chart, FIG. 64 is a illustration of a position rotated approximately 45 degrees. Rotating operation of the opening and closing member 106 and the rotation operating member 108 may be a manual operation, it may be remotely operated to be rotated by a motor drive.

In knotting apparatus 170 configured as described above, by operating the opening and closing member 106 and the rotation operating member 108, specifically the operation, below the loop automatically formed and knot M1 thread members L are formed It will be described.

For example, if the thread-like members L to the suture of the living tissue T is applied, while locking the long hand 198 by second needle holding mechanism 174b of the second arm mechanism 172 b, a first arm mechanism 172a and the second arm mechanism Close and 172b. Thus, passing the suture portion sandwiched biological tissue T between the tip portion of the distal end portion of the first arm mechanism 172a and the second arm mechanism 172b in the minute hand 198. Then, open the first arm mechanism 172a in a state of locking the long hand 198 second arm mechanism 172b by the first needle holding mechanism 174a of the first arm mechanism 172a. Thus, part of thread-like members L of the living tissue T, the first arm mechanism 172a, the second arm mechanism 172 b, a state enclosed in a closed path consisting of longitudinal base 12. A first arm mechanism 172a that the long hand 198 through the first position of the thread-like member L was locked by the first needle holding mechanism 174a, the hour hand 200 is passed through the second position of the thread-like member L second needle holding mechanism 174b in the state immediately after opening the second arm mechanism 172b that locked, opening and closing operation member 106 is in the operating position in the vicinity of 45 degrees. Figure 68 shows this state schematically.

Next, the operation sequence to around opening and closing member 106 is 135 degrees, by rotating the operation member 108 is operated, the first cap 188a and the second cap of the second needle holding mechanism 174b of the first needle holding mechanism 174a 190b is caused to one rotation on its axis of rotation C8, about C9. Thus, the thread-like member L is wound around the second cap 190b around the first cap 188a and the second needle holding mechanism 174b of the first needle holding mechanism 174a, a loop is formed. Schematic diagram of Figure 69 shows the state of being the loop forming operations.

Subsequently, the first arm close operation for operating the opening and closing member 106 to near 135 degrees, and the first arm mechanism 172a and the second arm mechanism 172b is closed. Schematic diagram of Figure 70 illustrates this first arm close operation. Then, in a state where the first arm mechanism 172a and the second arm mechanism 172b is closed, the first switching operation for operating the return of the rotation operating member 108 a predetermined angle, the minute hand 198 one end of the first needle holding mechanism 174a At the same time the other end of the lock gear members is released by 194a and the minute hand 198 is locked by the lock gear member 194b of the second cylindrical rotary mechanism 174b, the other end of the hour hand 200 by a lock gear member 196b of the second needle holding mechanism 174b released and one end of the hour hand 200 is locked by the lock gear member 196a of the first needle holding mechanism 174a. Figure 70 shows a state before the first switching operation, FIG. 71 shows a state after the first switching operation. Figure in 70 and 71, the minute hand 198 and hour hand 200 first is locked state of the first cap 188a and the second cap 190a and the second needle holding mechanism 174b of the first needle holding mechanism 172a cap 188b and the second They indicated by oblique lines in the cap 190b.

When the opening and closing operation member 106 is operated to near 225 degrees, and the first arm mechanism 172a and the second arm mechanism 172b is opened. Figure 72 shows a state after the spacing operation between the first arm mechanism 172a and the second arm mechanism 172 b. In this state, the threadlike members L is wound around the singlet to the first needle holding mechanism 174a and the second needle holding mechanism 174b have loops R are formed, a first cap 188a of the first needle holding mechanism 174a second between the first cap 188b of the needle holding mechanism 174b, and between the second cap 190a and the second cap 190b of the second needle holding mechanism 174b of the first needle holding mechanism 174a, passing long hand 198 and hour hand 200 There has been completed. In the state shown in FIG. 72, similarly to FIG. 19, the thread-like members L, the first arm mechanism 102a, the second arm mechanism 102b, closed path consisting of longitudinal base 12 already knot topological sense at this point It has become. Threadlike members L, first arm mechanism 102a, second arms mechanism 102b, closed path consisting of longitudinal base 12, only by a continuous deformation, so that the knot shape exists only in part made of thread-like member L of closed path is a state in which the deformation can in these ways.

For example, in this step, when removing the thread members L by performing the arrow direction of the protruding operation of the movable member 78 from the first arm mechanism 172a and the second arm mechanism 172 b, a continuous still keeping the identity of the topology of the closed path the deformation, as shown in the schematic diagram of FIG. 73, a state in which the knot M1 is formed only in the so-called single ligature thread members L. Then, by operating tightening the thread members L, for example a single ligation M1 in FIG. 23 is obtained. That is, a single ligation M1 by the filament member L Such single ligating forming operation is automatically formed.

The first arm mechanism 172a and a second period in which the arm mechanism 172b is opened by operating the opening and closing member 106, for example, the operation process from 45 degrees to 135 degrees, the rotation operating member 108, first needle holding mechanism 174a and the rotation of the second needle holding mechanism 174 can be two revolutions. In this case, the thread-like member L is is wound in loop double is formed in the first needle holding mechanism 174a and second needle holding mechanism 174b. Then it passes long hand 198 and hour hand 200 from this state, by performing the projecting operation of the moving member 78 release the thread-like member L from the first arm mechanism 102a and the second arm mechanism 102b, Fig by manipulating tightening thread-like member L double ligature M2 shown in 25 is obtained. That is, according to the knotting apparatus 170 of this embodiment, such a double ligature forming operations by a double ligature M2 is automatically formed.

Also, by tightening the thread members L to form a loop by repeating twice the single ligature forming operation by the above-described opening and closing operation member 106 and the rotation operating member 108, On'namusubi M3 of Figure 27 is obtained. That is, according to the knotting apparatus 170 of the present embodiment, by repeating twice the single ligature forming operations described above, On'namusubi M3 is automatically formed. Further, when the two the single ligating forming operation is performed with respect to first and first needle holding mechanism 174a in the single ligation formed the rotating direction of the second needle holding mechanism 174b, a single ligature formed of second by forming a loop tightening thread members L by reversing the rotational direction of the case, square knot M4 in FIG. 29 is obtained. Further, after forming a double ligature M2 by the double ligature forming operation, by subsequently forming a single ligating M1 by performing the single ligating forming operation, the two in the first stage as shown in FIG. 30 the surgical ligation M5 with single ligation M1 heavy ligation M2,2 stage can be automatically formed.

According to the knotting apparatus 170 of this embodiment, in addition to the same effect as the knot forming device 10 of the foregoing embodiment can be obtained, between the first needle holding mechanism 174a and second needle holding mechanism 174b since another member is not present, the first needle holding mechanism 174a and device does not become large in the direction of the separating operation of the second needle holding mechanism 174b, also the thread-like member L first arm mechanism 172a and second needle holding mechanism it is possible to handle near the tip of the 174b, and compactness of the device, a good balance between the operability of the winding operability and loop passage of the thread-like members L. Further, according to the knotting apparatus 170 of this embodiment, the rotational axis C9 of the fourth holding member is linear i.e. elongated second arm mechanism 172b connecting the said fourth retaining member and the connection portion of the longitudinal substrate 12 which is a direction orthogonal to the direction of the rotation axis C5 is the direction. Thus, even when the second position of the thread-like member L is rigid member such as a needle, by rotating the fourth holding member, to be housed in a compact and along the threadlike members L to the second arm mechanism 172b it can. The first arm mechanism 172a and the second arm mechanism 172b first holder and the second holder (cylindrical first cap and second cap closing direction and the direction to which both intersect the longitudinal axis of rotation C8, C9 of ) When rotated, even if the needle and attached to the yarn end, the needle can be directed in the longitudinal direction of the first arm mechanism and the second arm mechanism, without being restricted by the length of the needle, knotting device It can be reduced in size.

Figure 74 is a front view showing a state where the first arm mechanism 232a and the second arm mechanism 232b knot forming apparatus 230 according to another embodiment of the present invention is opened, FIG. 75, the first knot forming device 230 a front view showing a state where the arm mechanism 232a and the second arm mechanism 232b is closed, FIG. 76 is an exploded perspective view showing a knot forming device 230. Knot forming device 230 of this embodiment, and the needle 50 and functions as a loop forming means based on the rotational operation force transmitted respectively through the first rotation manipulation force transmission shaft 70a and the second rotational operating force transmitting shaft 70b a pair of first needle disc holding mechanism functions as a needle locking mechanism for detachably holding the needle with disc 234 236a and the second needle disc holding mechanism 236b is, the first arm mechanism 232a and the second arm mechanism 232b that are provided at the distal end, the operation force transmission mechanism 18 is first push rod 76a, that it does not include the second push rod 76 b, and, as the operation member, the rotating operation can to a proximal end of the longitudinal substrate 12 that is paired handling member 106 and the rotary operation member 108 provided is provided, and in that the moving member 78 is not provided, Yui FIG Although different in comparison with the eye forming unit 10, others are configured similarly.

Knot forming device 230 includes a cylindrical longitudinal substrate 12, a pair of first arm mechanism 232a and the second arm mechanism 232b, a pair of opening and closing member 106 and the rotation operating member 108, the operation force transmission mechanism 18 includes . A pair of first arm mechanism 232a and the second arm mechanism 232b is openably provided, respectively so as to be rotatable about axial line C2 and axial center line C3 in parallel with each other at the tip portion of the longitudinal substrate 12 is supported by ing. Paired handling member 106 and the rotary operation member 108 is at the proximal end of the longitudinal substrate 12 provided rotatably operated about the axis line C1 of the longitudinal substrate 12, and another disposed relatively rotatably there. Operating force transmitting mechanism 18 is provided in the longitudinal base 12, opening and closing the first arm mechanism 232a and the second arm mechanism 232b for opening and closing force and rotational operation force of the rotational operation member 108 of the pair of members 106, a pair first needle disc holding mechanism 236a, respectively transfer and the second needle disc holding mechanism 236b. In this embodiment, a pair of opening and closing member 106 and the rotation operating member 108 functions as the operation unit.

Since the first arm mechanism 232a and the second arm mechanism 232b is constructed similarly to each other, it will be described first arm mechanism 232a. Exploded view of Figure 76, shows an open state of FIG. 77, as shown in diagram illustrating a closed state of FIG. 78, the first arm mechanism 232a is arm body 238a, a cover 240a, first needle disc holding mechanism 236a, the telescopic rotary drive shaft 242a, and includes. Arm body 238a is a universal joint 32a rotatable with open connecting arm 26a is positioned sandwiched a projecting shaft 24a projecting to one which is fixed to and outwardly to a pair of parallel plates 110a and the pair of parallel plates 110a having respective and first needle disc supporting mechanism 236a has a proximal portion and a joint receiving member 112a through hole 28a is formed for receiving the with the tip portion. Cover 240a is secured to the arm body 238a so as to cover the opposing face of the arm body 238a. First needle disc holding mechanism 236a includes an arm body 238a and arranged in the distal end portion of the cover 240a, with detachably holding a needle 50 and a needle with a disk 234, a needle with a disk 234 first arm mechanism 232a and rotatably supporting the parallel and longitudinally or around the rotation axis C6 orthogonal to the rotation axis C4 direction of the first arm mechanism 232a in the cover face of the second arm mechanism 232b. Telescopic rotary drive shaft 242a is provided between the arm body 238a and a cover 240a, is rotatably supported around the central axis i.e. rotation axis C4 of the through hole 28a, the universal joint 32a is connected to the proximal end, a pinion 184a on the tip There has been fixed.

As shown in detail in main components exploded perspective view of FIG. 79, the elastic rotary drive shaft 242a of the first needle disc holding mechanism 236a includes a tubular base shaft 244a, the moving shaft 248a, the gear box member 254a, a spring 258a, comprising ing. Tubular base shaft 244a is a universal joint 32a is connected to its proximal end. Moving shaft 248a is a pinion 246a is fixed to the distal end portion, and pledged relatively movably in relative rotation and axially from the distal end side in the base shaft 244a. Gear box member 254a is guided to be movable in the longitudinal or rotational axis C4 direction of the first arm mechanism 232a by being sandwiched between a pair of guide surfaces 250a formed on the arm body 238a, and the pinion 246a and the bevel gear holding the 252a in a state of meshing with each other. Spring 258a is interposed between the spring receiving surface 256a and the gear box member 254a formed on the arm body 238a and a cover 240a, urges the moving shaft 248a in the direction of elongation.

Further, with needle disc 234 has four circumferential protrusions provided been chosen on the outer peripheral portion in a circumferential direction on one side, a pair of circles their circumferential projections are stacked in a state of being butted to each other plates 260a, 262a is fixed to the needle 51 by press-fitting. Thus, with needle disc 234, between a pair of discs 260a and 262a, the through hole 54 of and has four communication holes on the outer peripheral portion the needle 51 has an internal space which is open. In this embodiment, the needle 50 of the thread-like member L is inserted into the space of the opposite end is a needle with a disk 234 from one of the four communication holes, one of the other communication holes They are arranged in the form drawn from One. This configuration, along with the rotation of the needle with the disc 234, a part of the threadlike members L also can be rotated, also by pulling the end of the thread-like members L pulled out from the needle with a disk 234, a filamentous it is possible to generate a tension to the entire member L. The end portion of the thread-like members L may be fixed to the needle with the disc 234, but this can not be generated tension throughout the thread-like members by pulling the ends of the thread-like member L in the case, with needle circle some of rotation of the thread-like member L in accordance with the rotation of the plate 234 is realized. Further, the outer peripheral portion of the needle with the disc 234, from the outer peripheral edge for preventing interference between the needle 50 toward the center-out U-shaped notch 263a is formed one place. Further, the cover 240a, and a long hole 264a which is a through hole elongated in a direction parallel to the rotation axis C4 to pass needle 51, to pass the needle 50 of circular positioned in the longitudinal direction of the elongated hole 264a a through hole 266a is formed.

Figure 80, as shown in FIG. 81, FIG. 82, the bevel gear 252a is the center of rotation is fixed so that its center of rotation concentric with the eccentric plate 268a is a disc is eccentric. The outer peripheral edge of the eccentric plate 268 is engaged with the engaging groove 52 of the needle 50 prevents the needle dislodgement 50. Of the outer peripheral edge of the eccentric plate 268, the shortest position between the rotation center of the eccentric plate 268a is-out arcuate cutout for the passage of the needle 50 270a is formed. The rotation center of the eccentric plate 268a is a circle hole 272a for passing the needle 51 is formed. On both sides of the through hole 266a of the cover 240a, a pair of the longitudinal or positioning of the rotation axis C4 direction of the first arm mechanism 232a on the outer peripheral surface of the eccentric plate 268 while permitting rotation of the sliding contact with the eccentric plate 268 the roller 274a is rotatably provided.

As shown in detail in FIG. 82, center hole 276a provided in the bevel gear 252a, as well as having a D-shaped cross section, the end shape of the engaging groove 52 of the needle 51 so as not to rotate relative to the center hole 276a since it has insertable D-shaped cross-section, in a state where one end portion of the needle 51 is fitted into the center hole 276a of the bevel gear 252a, with needle disc 234 can rotated by telescopic rotary drive shaft 242a there is a. Further, long holes 264a formed in the cover 240a is larger than the diameter of the engaging groove 52 of the needle 51 is formed into a small width dimension than the minimum outer diameter of D-shaped cross-sectional shape of the needle 51. The upper and lower end portions of the elongated hole 264a is smaller than the outer diameter of the needle 51 (maximum diameter) is formed larger than the diameter of the engaging groove 52, and is locally formed on the D-shape. D-shaped upper and lower end portions of the elongated hole 264a is smaller than the maximum diameter of D-shaped cross-sectional shape of the needle 51 than the minimum outer diameter of D-shaped cross-sectional shape of the needle 51 is larger width dimension. Thus, the needle 51, the upper and lower ends of the elongated hole 264a, but its end is can pass through only in certain rotational phase state, at a position other than the upper and lower end portions of the elongated hole 264a is is impossible withdrawal by the engagement between the engaging groove 52 and the elongated hole 264a. In the upper and lower end portions of the elongated hole 264a is passed through the allowable position of the needle 51 is formed differently 180 degrees.

In this embodiment, needle 50 is passed between the eccentric plate 268b of the eccentric plate 268a and the second needle disc holding mechanism 236b of the first needle disc holding mechanism 236a, the needle 51 is first Harien It adapted to be passed between the long hole 264 of the elongated hole 264a and the second needle disc holding mechanism 236b of the plate holding mechanism 236a. D-shaped cross section of the central hole 276a provided in the bevel gear 252a of the first needle plate holding mechanism 236a, compared D-shaped cross section of the central hole 276b provided in the bevel gear 252b of the second needle plate holding mechanism 236b phase is shifted Te.

Thus, the needle 50 is capable held out the first needle disc holding mechanism within 236a when the a through hole 266a formed in the cover 240a-out arcuate cutout formed in the outer periphery of the eccentric plate 268 270a matches such but in the unlocked state, the eccentric plate 268 from the state is rotated, the engagement groove 52 of the outer peripheral edge and the needle 50 of the eccentric plate 268 is engaged with needle dislodgement 50 was blocked Figure 81 It is in the locked state shown in. Further, the needle 51, when the unlocked state of the needle 50 is rotated slightly eccentric plate 268, the end of the needle 51 passing through the upper portion of the D-shaped cross-section and slots 264a of the center hole 276a of the bevel gear 252a since part of the cross-sectional shape is matched, it is unlocked. FIGS. 80 and 81 shows this state. When the eccentric plate 268 from this state is the rotational phase between the Figure 80 and Figure 81 is rotated, center hole 276a in the mated needle 51 of the bevel gear 252a is rotated together with the eccentric plate 268a that engages since the groove 52 engages with the long hole 264a, the locked state.

In this embodiment, the first needle disc holding mechanism 236a, and a portion through hole 266a of the cover 240a is formed, and the arc-shaped notch 270a is formed portion of the eccentric plate 268a holds the needle 50 functions as a first holding member. In the second needle disc holding mechanism 236b, a portion through hole 266b of the cover 240b is formed, and the arc-shaped notches 270b are formed portion of the eccentric plate 268b is, as a second holding member for holding the needle 50 It is functioning. In the first needle disc holding mechanism 236a, and a long hole 264a is formed portion of the cover 240a, and the center hole 276a is formed portion of the bevel gear 252a is, functions as a third holding member for holding the needle 51 ing. In the second needle disc holding mechanism 236b, a portion long hole 264b of the cover 240b is formed, and the center hole 276b is formed portion of the bevel gear 252b is, functions as a fourth holding member for holding the needle 51 ing.

As shown in FIG. 76, the proximal end portion of the longitudinal substrate 12 of the knotting apparatus 230 of this embodiment includes a cylindrical opening and closing member 106 provided to be operated to rotate around its axis line C1, and opening and closing operation member 106 rotates the operation member 108 cylindrical provided rotation operably about the axis line C1 of the longitudinal substrate 12 adjacent to are provided independently of each other to be operated. Opening and closing member 106 integrally includes a cylindrical grooved cam 64 of the arm opening and closing cam groove 60 is formed in an annular shape for opening and closing the first arm mechanism 232a and the second arm mechanism 232b on the inside. Although cylindrical grooved cam 64 is formed so the operating member 16 integrally, are shown separated on for convenience of illustration in FIG. 76.

The inner peripheral surface of the rotation operating member 108 for rotating the needle with the disc 234, and, in order to switch the locking and unlocking of the needle 50 and 51, a pinion 66a of the first rotation manipulation force transmission shaft 70a and the inner teeth 68a of the pinion 66b of the second rotation operation force transmission shaft 70b is engaged respectively, are formed as shown in FIGS. 83 and 84. Figure 83 shows a state where the pair of first arm mechanism 232a and the second arm mechanism 232b is opened, FIG. 84 shows a state where the first arm mechanism 232a and the second arm mechanism 232b is closed.

Figure 85 is a longitudinal sectional view of FIG. 74, and, as shown in FIG. 86 is a longitudinal sectional view of FIG. 76, the operation force transmission mechanism 18, first rotational operating force transmission shaft 70a and the second rotational operating force transmitting a shaft 70b, are provided. Pinion 66a and the universal joint 32a meshing with the internal teeth 68a of the rotation operating member 108 shown in FIG. 83 in order to transmit the rotational operation force for rotating the first needle disc holding mechanism 236a of the bevel gear 252a is, first rotation manipulation It is fixed to both ends of the force transmission shaft 70a. Pinion 66b and the universal joint 32b meshing with the internal teeth 68a of the rotation operating member 108 shown in FIG. 83 in order to transmit the operating force to rotate the second needle disc holding mechanism 236b is, the second rotation manipulation force transmission shaft 70b It is fixed at both ends. The operation force transmission mechanism 18 includes a first opening and closing force transfer link 72a and a second opening and closing force transmission link 72b. The first opening and closing operation force transfer link 72a, in order to transmit the opening and closing forces for opening and closing the first arm mechanism 232a in the open and closed positions, and pivotally linked tip-off coupling arm 26a, and a proximal end having a cam engaging portion 71a which engages the arm opening and closing cam groove 60 projects at right angles to the longitudinal direction. The second opening and closing force transfer link 72b is a second to transmit an opening and closing operating force for opening and closing the arm mechanism 232b to an open position and a closed position, which is pivotally connected to the closing connecting arm 26b tip, and a proximal end having a cam engaging portion 71b to be engaged with the arm opening and closing cam groove 60 projects at right angles to the longitudinal direction.

Figure 87 is one rotation and opening and closing operations of the first arm mechanism 232a and the second arm mechanism 232b by the operation, the first needle disc holding mechanism 236a and by rotating the operating member 108 in a predetermined rotational phase in the interval of opening and closing member 106 exchange operation and second needle holding mechanism 236b of the rotation operation and the first needle disc holding mechanism 236a and the second needle disc holding mechanism 236b between at the needle 50 and needle 51, in a predetermined order for knotting is a chart for explaining a state to be performed. The horizontal axis of the chart of Figure 87 shows the angle of rotating the opening and closing operation member 106 clockwise when viewed from the direction of FIGS. 83 and 84. Rotation operating member 108, in the case of the operation of the needled disc 234 held by the first needle disc holding mechanism 236a or the second needle disc holding mechanism 236b by rotating winding the thread-like member L is first It is operated in a section where the arm mechanism 232a and the second arm mechanism 232b is in the open position, when replacing the needle 50 and the needle 51 between the first needle disc mechanism 236a and second disk needle holding mechanism 236b is the first arm mechanism 232a and the second arm mechanism 232b is operated in the section in the closed position. Figure 83 is approximately 135 degrees from the origin of the horizontal axis of the chart, FIG. 84 is a illustration of a position rotated approximately 45 degrees. Rotating operation of the opening and closing member 106 and the rotation operating member 108 may be a manual operation, it may be remotely operated to be rotated by a motor drive.

In knotting apparatus 230 configured as described above, by operating the opening and closing member 106 and the rotation operating member 108, specifically the operation, below the loop automatically formed and knot M1 thread members L are formed It will be described.

For example, if the thread-like members L to the suture of the living tissue T is applied, the second needle disc holding mechanism 236b of the second arm mechanism 232b to lock the needle 50, and moves the needle with disc 234 downward from a state of being closed and a first arm mechanism 232a and the second arm mechanism 232b. Thus, to penetrate with a needle 50 located suture portion sandwiched biological tissue T between the tip portion of the distal end portion of the first arm mechanism 232a and the second arm mechanism 232b distally. Then, the first needle disc holding mechanism 236a of the first arm mechanism 172a locks the needle 50, while locking the needle 51 by the second needle disc holding mechanism 236a of the second arm mechanism 172 b, the first arm mechanism open and 232a and the second arm mechanism 232b. Thus, a portion of the living tissue T filamentous member L, the first arm mechanism 232a, the second arm mechanism 232b, a state enclosed in a closed path consisting of longitudinal base 12. A first arm mechanism 232a that locks the first position the needle 50 is passed through the thread-like member L by the first needle disc holding mechanism 236a, the needle 51 is passed through the second position of the thread-like member L second circular Itamochi in the state immediately after opening the second arm mechanism 232b that is locked in mechanism 236b, opening and closing member 106 is in the operating position in the vicinity of 45 degrees. Figure 88 shows this state schematically.

Next, the operation sequence of up to about 135 ° opening and closing member 106, the rotation operation by the member 108 is operated, the needle with a disk having a needle 51 held by the second needle disc holding mechanism 236b 234 There is rotated once around its rotation axis C9. Thus, the thread-like member L is wound around the needle with the disc 234, a loop is formed. Schematic diagram of Figure 89 shows the state of being the loop forming operations.

Subsequently, the first arm close operation for operating the opening and closing member 106 to near 135 degrees, and the first arm mechanism 232a and the second arm mechanism 232b is closed. Schematic diagram of Figure 90 illustrates this first arm close operation. Then, in a state where the first arm mechanism 232a and the second arm mechanism 232b is closed, the first switching operation for further manipulation of the rotary operating member 108 a predetermined angle, one end of the needle 50 is held first needle disc At the same time the other end of the eccentric plate 268a is and needle 50 released by the mechanism 236a is locked by the eccentric plate 268a of the second needle disc holding mechanism 236b, the other end of the needle 51 and the second needle disc holding mechanism 236b one end of the release by the rotation of the bevel gear 252b and the needle 51 is locked by the rotation of the first needle disc holding mechanism 236a of the bevel gear 252a. Figure 90 shows a state before the first switching operation, FIG. 91 shows a state after the first switching operation. In Figure 90 and Figure 91, a state where the needle 50 Yobihari 51 is locked is indicated by oblique lines in the first arm mechanism 232a and the second arm mechanism 232b.

When the opening and closing operation member 106 is operated to near 225 degrees, and the first arm mechanism 232a and the second arm mechanism 232b is opened. Figure 92 shows a state after the spacing operation between the first arm mechanism 232a and the second arm mechanism 232b. In this state, the threadlike members L is wound around the singlet to the needle with the disc 234 of the first arm mechanism 232a have loops R are formed, the first needle disc holding mechanism 236a of the first arm mechanism 232a and the between the second needle disc holding mechanism 236b of the second arm mechanism 232b, passing the needle 50 and needle 51 has been completed. In the state shown in FIG. 92, similarly to FIG. 19, the thread-like members L, the first arm mechanism 102a, the second arm mechanism 102b, closed path consisting of longitudinal base 12 already knot topological sense at this point It has become. Threadlike members L, the first arm mechanism 102a, the second arm mechanism 102b, closed path consisting of longitudinal base 12, only by a continuous deformation, so that the knot shape exists only in the portion made of thread-like members L of closed path is a state in which the deformation can in these ways.

For example, in this step, when removing the threadlike members L from the first arm mechanism 172a and the second arm mechanism 172 b, by successive deformation while keeping the identity of the topology of the closed path, shown in the schematic diagram of FIG. 93 as such, a state in which the knot M1 is formed only in the so-called single ligature thread members L. Then, by operating tightening the thread members L, for example a single ligation M1 in FIG. 23 is obtained. That is, according to the knotting apparatus 230 of this embodiment, a single ligature M1 by the filament member L Such single ligating forming operation is automatically formed. Incidentally, tightening operation of threadlike members L, by pulling the opposite end can be easily realized from the needle 50 of the thread-like member L.

Here, the opening and closing the first arm mechanism 232a and the second arm mechanism period 232b is opened by the operation of the operating member 106, for example, the operation process from 45 degrees to 135 degrees, the rotation operating member 108, with needle disc 234 it can be 2 rotate. In this case, the thread-like member L is wound around the double on the outer periphery of the needle with the disc 234 loops. Then passes the needle 50 and the needle 51 from this state, the thread-like member L removed from the first arm mechanism 102a and the second arm mechanism 102b, the double ligature M2 is obtained as shown in FIG. 25 by manipulating tightening thread-like member L It is. That is, according to the knotting apparatus 230 of this embodiment, such a double ligature forming operations by a double ligature M2 is automatically formed.

Also, by tightening the thread members L to form a loop by repeating twice the single ligature forming operation by the above-described opening and closing operation member 106 and the rotation operating member 108, On'namusubi M3 of Figure 27 is obtained. That is, according to the knotting apparatus 230 of the present embodiment, by repeating twice the single ligature forming operations described above, On'namusubi M3 is automatically formed. Further, when the two the single ligating forming operation is performed with respect to first and first needle holding mechanism 174a in the single ligation formed the rotating direction of the second needle holding mechanism 174b, a single ligature formed of second by forming a loop tightening thread members L by reversing the rotational direction of the case, square knot M4 in FIG. 29 is obtained. Further, after forming a double ligature M2 by the double ligature forming operation, by subsequently forming a single ligating M1 by performing the single ligating forming operation, the two in the first stage as shown in FIG. 30 the surgical ligation M5 with single ligation M1 heavy ligation M2,2 stage can be automatically formed.

According to the knotting apparatus 230 of this embodiment, in addition to the same effect as the knot forming device 10 of the foregoing embodiment can be obtained, the separating operation of the first needle holding mechanism 174a and second needle holding mechanism 174b the direction of, since the loop passage direction of the first position engaging the minute hand 198 of the thread-like member L are the same, utilizing the separation operation of the first arm mechanism 172a and the second arm mechanism 172b there is an advantage that can be passed through the loop a first position engaging the minute hand 198 of the thread-like member L Te. Moreover, there is an advantage that tightening operation filamentous member L can be easily realized.

Figure 94 is a schematic diagram illustrating a knot forming device 300 of another embodiment of the present invention. The first arm mechanism 14a and the second arm mechanism 14b in this embodiment, is provided in the longitudinal base 12 movable relative in their longitudinal direction. Knotting apparatus 300 of this embodiment is different from the knot forming device 10 described above, the first arm mechanism 14a and the second arm mechanism 14b of the knotting apparatus 10 is opened and closed operated about the rotation axis C2 and the rotation axis C3 respect, the first arm mechanism 14a and the second arm mechanism 14b knot forming device 300 is different in that is moved relative to their longitudinal direction, the other is the same. The first arm mechanism 14a and the second arm mechanism 14b in this embodiment, via a sliding mechanism which the guide projection has been fitted, which is provided on the other to a guide groove provided on one of them, parallel to each other It is moved relative to the direction. Alternatively, the first arm mechanism 14a and the second arm mechanism 14b, by being connected through a parallel link provided therebetween, it is moved relative while maintaining a parallel orientation to each other.

Figure 95 shows a needle with a disk 334 of another embodiment of a knot forming device 230. With needle disc 334, while the outer peripheral surface of the needle with the disc 234 is the same diameter both in cross-section a cylindrical about the thickness direction, with needle disc 334, from the intermediate position in the thickness direction It is different in that an outer peripheral surface shape whose diameter along with towards the end faces. Other configurations of the needle with the disc 334 is the same as with needle disc 234. Ridge portion 336 showing a maximum diameter at an intermediate position in the thickness direction of the needle with the disc 334 of the outer peripheral surface of the needle with the disc 334 functions as a loop holding portion for holding the thread-like members L wound around, tapered surface 338 is between the maximum diameter portion position and the minimum diameter portion of the outer peripheral surface of the needle with the disc 334 functions as a loop forming unit for applying winding the thread-like member L. According to the needle with the disc 334 of the present embodiment, the stable loop Because the filamentous member L formed in the groove between the tapered surface and the second arm mechanism 232b of the needle with the disc 334 is held while being formed, the needle with the disc 334 is passed from the second arm mechanism 232b to the first arm mechanism 232a, the loop wound with needle disc 334 is liable advantage off naturally.

Figure 96 shows a state to tighten the knot with a knot forming device 230 comprises a needle with a disk 234 mentioned above. Threadlike members L is the site close to the needle 50 is inserted from the communication hole H1 1 one of the four communication holes H of the needle with the disc 234, longitudinal base 12 distant sites of the other one from the communication hole H2 from the needle 50 when the other one communication hole 2 than the one communication hole 1 in a state drawn to the side are in a positional relationship that close to the longitudinal substrate 12 side, tension is located in the longitudinal substrate 12 side of the thread members L knot pull the position is tightened easily and tight. Note that when tightening the knot by pulling the pull position of the thread-like members L, may be performed in the closed state of the first arm mechanism 14a and the second arm mechanism 14b. In this case, the edge of the needle with the disc 234 is pressed against the knot acts as a so-called pusher can tighten the knot.

While an embodiment of the present invention has been described with reference to the drawings, the invention is also applicable in other manners.

For example, the thread members L of the illustrated embodiments, preferably, the natural yarn twisted from vegetable or animal natural fibers, synthetic resin yarn consisting of a single wire or stranded wire of the synthetic fibers, metal single wire or twisted tinsel made of lines, such as a composite yarn consisting of natural fibers and synthetic fibers, ligated possible the object ligating member is used.

Further, the moving member 78 in the illustrated embodiment, cylindrical from the longitudinal base 12 within provided to be protruding in the longitudinal direction of the longitudinal substrate 12, the first arm mechanism that tip of the pair 14a and the second arm mechanism although 14b were those to be moved linearly between, on one of the pair of first arm mechanism 14a and the second arm mechanism 14b, with respect to movable or arm mechanism parallel to the longitudinal direction of the arm mechanism or it may be rotatably provided Te.

In the knotting device 10,100,170,230 in the illustrated embodiments, the arm body 36a and 36b as a loop forming means for forming a loop, the first cylindrical rotary mechanism 104a and the second cylindrical rotary mechanism 104b, first needle holding mechanism 174a and the second needle holding mechanism 174b, although the first needle disc holding mechanism 236a and the second needle disc holding mechanism 236b is provided to form a loop with a twist to the thread-like members L the yarn twist mechanism may be provided with a loop forming means.

Other Though not specifically exemplified, the present invention can be embodied with various modifications and improvements based on the knowledge of those skilled in the art.

10: knotting device 12: longitudinal base (base portion)
12a, 12b: partial cylindrical member 14a: first arm mechanism 14b: second arm mechanism 16: opening and closing member (operation member)
18: rotation operating member 20: operating force transmission mechanism 22a, 22b: support holes 24a, 24b: projecting shaft 26a, 26b: opening and closing the connecting arms 28a, 28b: through holes 30a, 30b: arm base 32a, 32 b: universal joint 34a , 34b: connecting shaft 36a, 36b: arm body (loop forming means, the first holder, a second holder)
38a, 38b: guide cover 40a, 40b: lock plate 42a, 42b: bar support 44a, 44b: engagement recess 46a, 46b: locking bars 50, 51: needle 52, 53: engaging groove 54: through-hole 56a : reception hole 57a: engaging hole 58a: through hole 59a: engaging hole 60: arm opening and closing cam groove 62: needle lock cam groove 64: cylindrical grooved cam 66a, 66b: a pinion 68a, 68b: inner peripheral teeth 70a: first rotational operation force transmission shaft 70b: second rotation manipulation force transmission shaft 71a, 71b: cam engaging portion 72a: first opening and closing operating force transmitting link 72b: second opening and closing force transfer link 74a, 74b: pushing portions 75a, 75b: cam engaging portion 76a: first push rod 76 b: second push rod 78: the moving member 78a: length wire section 78b: Tansen portion 78c: operating projection portion 80: long hole 82a: Guide De determining hole 82: support member 100: a knot forming device 102a: first arm mechanism 102b: second arm mechanism 104a: first cylindrical rotary mechanism (loop forming means)
104b: second cylindrical rotary mechanism (loop forming means)
106: opening and closing operation member 108: rotary operating member 110a, 110b: parallel plates 112a, 112b: joint receiving member 114a, 114b: arm body 116a, 116a: opening 118a, 118b: cover 120a, 120b: pinion 122a, 122b: rotary drive axis 124a, 124b: cylindrical bearing 126a, 126b: center shaft 128a, 128b: cylindrical member 130a, 130b: locking flange 132a, 132b: bevel gear member 134a, 134b: annular slot 136a, 136 b: guide plates 138a, 138b: spring 139a, 140a, 139b, 140b: outer arc-shaped notch 142a, 144a: inner arcuate notches 146a, 48a: inner square notch 150a, 152a: needle receiving groove 170: knotting instrumentation 172a: first arm mechanism 172 b: the second arm mechanism 174a: first needle holding mechanism (loop forming means)
174b: second needle holding mechanism (loop forming means)
176a: first bearing portion 178a, 174b: arm body 180a: second bearing portion 182a, 182b: cover 184a, 184b: pinion 186a, 186b: rotary drive shaft 188a: first cap 190a: second cap 192a: rotation shaft 194a : first locking gear member 196a: second locking gear member 198: a long needle 200: short hand 202a, 202b: insertion hole 204a, 204b: insertion holes 206a, 206 b: circular hole 208a, 208b: circular hole 210a, 210 b: rectangular hole 212a , 212b: rectangular holes 214a, 214b: engagement hole 216a of Zenpokoen shape, 216b: Zenpokoen shape of the engagement hole 230: knot forming device 232a: first arm mechanism 232b: second arm mechanism 234: with needle disc 236a: first needle disc holding mechanism (loop forming means)
236b: second needle disc holding mechanism (loop forming means)
238a, 238b: arm body 240a, 238b: cover 242a, 242b: telescopic rotary drive shaft 244a, 244b: base shaft 246a: pinion 248a, 248 b: moving shaft 250a, 250b: guide surface 252a, 252b: bevel gear 254a, 254b: gear the box member 256a, 256b: spring receiving surface 258a, 258b: spring 260a, 260b: disc 262a, 262b: disc 263a, 263b: U-shaped notch 264a, 264b: long hole 266a, 266b: through holes 268a, 268b : eccentric plate 270a, 270b: arcuate notches 272a, 272b: circular hole 274a, 274b: roller 276a, 276b: center hole 300: knot forming device 324: with needle disc 350: the guide member T: the living tissue L: filamentous member (the ligating member)
A: The first intersection B: second intersection M1: single ligature (knots)
M2: double ligature (knot)
M3: On'namusubi (knot)
M4: square knot (knot)
M5: surgical ligation (knot)
C1: axis line of the longitudinal substrate C2: axis line of the supporting hole is the center of rotation the first arm mechanism C3: axial line of the supporting hole is a center of rotation of the second arm mechanism C4: first arm mechanism 14a longitudinally at a rotational axis C5: provided on the second arm mechanism: second arm mechanism 14b in the longitudinal direction in which the rotational axis C6: rotation axis of the cylindrical member or needle with a disc provided on the first arm mechanism C7 It was cylindrical member or the rotational axis of the needle with the disc C8: axis of rotation of the first needle holding mechanism C9: the rotational axis of the second needle holding mechanism

Claims (14)

  1. And the base portion,
    Provided on the base portion, a first arm mechanism and a second arm mechanism that is configured to be relatively movable,
    Provided in the first arm mechanism, the first holding member for detachably holding the first position of the ligature member,
    Provided on the second arm mechanism, and a second holding member for detachably holding the first position of the object to be ligated body,
    Provided in the first arm mechanism, and a third holding member for detachably holding the second position of the object to be ligated body,
    Provided on the second arm mechanism, and a fourth holding member for detachably holding the second position of the object to be ligated body,
    Wherein supporting the second position of the ligature member, by rotation, said loop forming means for forming a loop of the object ligating body 2 located between the second position and the first position of the ligature object intersects When,
    The first arm mechanism and the second arm mechanism mutually moved away, said in a state in which the first position and the second position of the ligature member was held in the fourth holding member and the first holding member, said loop forming means wherein the first loop-forming operation for forming a loop of the ligature member by the arm close operation to close the first arm mechanism and the second arm mechanism to each other, the first and second positions of said object to be ligated body a first switching operation for switching from the state held by said first holding member and the fourth holding member to the state held by the second holding member and third holding member, the first and second positions of said object to be ligated body the second holding member and the loop the first position by sequentially executing a first arm spacing operation for separating mutually the third the first arm mechanism in a state of holding by the holding member and the second arm mechanism Wherein by umbrella to form a knot to be ligated body, and an operation portion provided on the base portion, a knot forming device, which comprises.
  2. It said loop forming means is provided in the first arm mechanism and the second arm mechanism,
    The operation unit,
    The first arm mechanism and the second arm mechanism mutually moved away, said in a state in which the first position and the second position of the ligature member was held in the third holding member and the second holding member, said loop forming means It said second loop-forming operation for forming a loop of the ligature member by the arm close operation to close the first arm mechanism and the second arm mechanism to each other, the first and second positions of said object to be ligated body a second switching operation for switching from the state held by the second holding member and third holding member to the state held by said first holding member and the fourth holding member, the first and second positions of said object to be ligated body said loop to said first position by sequentially executing a second arm spaced operations of separating the first arm mechanism and the second arm mechanism to each other in a state held by the first holding member and the fourth holding member Knot forming apparatus according to claim 1, characterized in that to degrees pass.
  3. The knot is the first position of the ligature member, relative passing the loops to close the side position from the position farther than the first position of the two positions intersecting with said loop and those formed by,
    The operation unit is for forming a plurality of times the knot, in any of the knot of the plurality of times of knots, the loop forming unit, planned passage of said first position loop the previously formed knot forming apparatus according to claim 1 or 2, characterized in that to form a loop wound around the trajectory in the opposite direction.
  4. The knot is the first position of the ligature member, relative passing the loops to close the side position from the position farther than the first position of the two positions intersecting with said loop and those formed by,
    The operation unit is for forming a plurality of times the knot, in any of the knot of the plurality of times of knots, the loop forming means, the passage of the first position and the loop was last formed knot forming apparatus according to claim 1 or 2, characterized in that to form a loop wound around planned trajectory in the same direction.
  5. It said loop forming means, any one of the knotting apparatus 4 from claim 1, characterized in that one round form the loop.
  6. Said loop forming means, any one of the knotting apparatus 4 from claim 1, characterized in that two laps form said loop.
  7. Said loop forming means in loops formed one time, the said loop formed two rounds around imaginary axis is an axis that intersects the projection plane of the loop, the loop formation of the second time, around the imaginary axis knot forming apparatus according to claim 3 or 4, characterized in that one turn forming said loop.
  8. Said loop forming means, wherein the loop forming portion having a larger radius than the distance to the second holding member from the rotation center, the ligating member having a smaller radius than the distance from the rotational center to the second holding member and a passage portion,
    Said first position, said second retaining member and the first holding member through a region surrounded by the object to be ligated member forming a loop and said object to be ligated body passage portion around the rotational center of said loop forming means 7 knots forming apparatus of claim 1, characterized in that it is passed to and from.
  9. Said loop forming means, wherein the loop forming portion having a larger radius than the distance to the second holding member from the center of rotation at a position which is far from the second arm mechanisms along the axis of rotation than the loop forming section and a loop retaining portion having a larger radius than the loop forming unit there,
    The loop forming portion knot forming device of claims 1 7, characterized in that it has the second side close to the arm mechanism radius below the loop forming portion along the rotation axis than the loop forming section than.
  10. It said loop forming means is slidably supported along the second position of the object to be ligated body in the longitudinal direction of the object to be ligated body,
    The operation unit, the object to be ligated member second position claims 1 to 7 knot forming device characterized by tightening the knot by pulling a certain tension position farther from the first position than the.
  11. Said loop forming means, the second along the arm mechanism, knot forming apparatus according to claim 1 to 7 in which the distance between the second holding member, characterized in that the can be moved in a direction approaching.
  12. It said loop forming means, knot forming apparatus according to claim 1 to 7 in which the distance between the second arm mechanism is characterized in that it can be deformed along the direction approaching.
  13. Said loop forming means, wherein the first support portion away the first position side from the second position of the ligature member, a second supporting said spaced the pull position side from the second position of the ligature material parts supports a second position of said object to be ligated body and,
    The operating unit, the knot by pulling the pull position when the second support portion is closer to the base portion along the first arm mechanism or the second arm mechanism than the first support shaft It knots forming apparatus according to claim 10, wherein tightening the.
  14. Wherein the operating unit, the said tensioning position of the ligature body, operator knot forming apparatus according to claim 10, characterized in that provided in a position that can be drawn directly.
PCT/JP2016/058487 2015-03-31 2016-03-17 Knot formation device WO2016158452A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP2015074491A JP6380208B2 (en) 2015-03-31 2015-03-31 Knotting device
JP2015-074491 2015-03-31

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WO2016158452A1 true WO2016158452A1 (en) 2016-10-06

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WO (1) WO2016158452A1 (en)

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5318579A (en) * 1992-09-21 1994-06-07 Chow James C Y Arthroscopic knot tying device
US5480406A (en) * 1994-10-07 1996-01-02 United States Surgical Corporation Method of employing surgical suturing apparatus to tie knots
US6086601A (en) * 1998-04-29 2000-07-11 Yoon; Inbae Instrument and method for suturing anatomical tissue and tying suture material
WO2008058005A2 (en) * 2006-11-03 2008-05-15 The Penn State Research Foundation Endosurgery suturing device
US20090204127A1 (en) * 2008-01-31 2009-08-13 Medicinelodge, Inc. System and method for tying surgical knots

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5501690A (en) * 1994-09-02 1996-03-26 Ethicon Endo-Surgery Suturing device

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5318579A (en) * 1992-09-21 1994-06-07 Chow James C Y Arthroscopic knot tying device
US5480406A (en) * 1994-10-07 1996-01-02 United States Surgical Corporation Method of employing surgical suturing apparatus to tie knots
US6086601A (en) * 1998-04-29 2000-07-11 Yoon; Inbae Instrument and method for suturing anatomical tissue and tying suture material
WO2008058005A2 (en) * 2006-11-03 2008-05-15 The Penn State Research Foundation Endosurgery suturing device
US20090204127A1 (en) * 2008-01-31 2009-08-13 Medicinelodge, Inc. System and method for tying surgical knots

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JP2016193065A (en) 2016-11-17

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