WO2018037952A1

WO2018037952A1 - Medical bidirectional suturing device and operation method thereof

Info

Publication number: WO2018037952A1
Application number: PCT/JP2017/029248
Authority: WO
Inventors: 祥平鈴木
Original assignee: 株式会社カネカ
Priority date: 2016-08-23
Filing date: 2017-08-14
Publication date: 2018-03-01
Also published as: JPWO2018037952A1; JP6905532B2

Abstract

The present invention provides a medical bidirectional suturing device with which a suturing operation can be performed with ease, and which is operated in a manner that is safe and minimally invasive to a human body. A medical bidirectional suturing device 1 that has a distal/proximal direction and has: a needle mechanism 2 that extends in the distal/proximal direction, a tip of which is on the distal side; and a threadlike item retention member 30 that is provided to the distal side of the medical bidirectional suturing device 1, wherein the needle mechanism 2 has a passage 13 through which a threadlike item 70 passes, an entrance/exit section 12 that is provided to one side of the passage 13, and a terminal section 14 that is provided to the other side of the passage 13.

Description

Medical bi-directional suture device and method of operating the same

The present invention relates to a medical bi-directional suturing apparatus capable of suturing an object with a thread in both directions from the proximal side to the distal side and from the distal side to the proximal side, and an operation method thereof.

In order to remove the tumor formed in the pituitary gland, transsphenoid sinus pituitary tumor excision (TSS; Trans-Sphenoidal Surgery) is often performed. TSS is generally performed in the following procedure. First, the surgeon advances along the patient's nasal septum while peeling the nasal mucosa, and opens the sphenoid bone and opens the dura mater to reach the pituitary gland. Next, the pituitary tumor is removed. Finally, the dura is sutured to rebuild the sphenoid bone and nasal mucosa.

Conventionally, in TSS, dura stitching is performed by passing a thread through each side of the incised dura mater, closing the dura while pulling both ends of the thread, and then fixing and making knots (knots). It was. The method for passing the suture through the dura mater is as follows. First, after passing a suture needle with a suture through one dura mater from the proximal side to the distal side of the dura mater, that is, from the nasal cavity side to the pituitary side, A suture needle with a suture is passed from the distal side to the proximal side, that is, from the pituitary side to the nasal cavity side. At this time, the suture enters the pituitary side from the nasal cavity side and comes out again to the nasal cavity side.

The dural suture with TSS is performed manually by the operator holding a curved suture needle having a diameter of about 3 mm to 10 mm with a needle holder having a forceps-like tip. However, the distance from the operator's hand to the actual suture location is a few tens of centimeters, and the size of the incision is from 5 mm to 20 mm at most, so it is very small. Therefore, the surgeon must perform a suturing operation under a microscope or an endoscopic image, and there is a problem that the operation takes a long time. For this reason, a suturing device that can pass sutures in two directions from the distal side to the proximal side of the dura mater and from the proximal side to the distal side has been proposed.

For example, in Patent Document 1 and corresponding Patent Document 2, when a needle having a cutout for capturing a suture is moved on the side surface and the cutout and the groove of the boom arm housing are aligned, the cutout is captured by the cutout. A threading device is described in which a living tissue can be sutured in both directions by moving the suture thread in the groove of the boom arm housing.

In Patent Document 3 and the corresponding Patent Document 4, bilateral stitching of biological tissue is realized by releasably connecting a suture with a knot or the like prepared in advance to the distal side of the suture holder. A suture holder is described.

Patent Document 5 and corresponding Patent Document 6 describe a suturing tool that can tie a suture thread to a sharp needle at both ends and suture the tissue by reciprocating the needle.

Patent Document 7 describes a suturing tool that can sew a tissue by binding a suture to a ferrule and reciprocating the ferrule.

Also, although not a suturing device capable of suturing in two directions, the following suturing devices have also been proposed. Patent Document 8 describes an endoscopic suture machine in which a looper grips a thread loop formed by a needle, and a looper shaft carrying the looper is rotatably arranged in a case.

U.S. Patent No. 6,057,051 describes a suturing device in which a suture clasp arm is pivotally connected to a distal mount and the arm pivots about the distal or proximal end of the arm. .

Special table 2012-515636 International Publication No. 2010/088573 Special table 2014-528768 gazette International Publication No. 2013/024466 Special table 2011-509121 gazette International Publication No. 2009/089101 JP 2011-72790 A JP-T-2004-519299 JP 2014-23695 A

However, in the threading devices described in

Patent Documents

1 and 2, there is a problem that it is physically difficult to move the suture from the notch of the needle into the groove of the distal boom arm housing. Further, since it is necessary to move the suture needle while being in close contact with the boom arm housing, there is a risk that the suture thread may be broken or deformed by rubbing against the boom arm housing during the movement.

In the devices described in

Patent Documents

3 and 4 and Patent Document 7, it is necessary to produce a knot on the suture thread or to bind it to a ferrule, so that these operations take time.

In order to reciprocate the needle bi-directionally in the suture holders described in Patent Documents 5 and 6, it is necessary to change the holding position by re-holding the needle each time. There is a possibility of inadvertently damaging the tissue or searching for a dropped needle.

In the endoscopic suturing machine described in Patent Document 8, the suturing object is fed by hand while the looper is rotated along a multidimensional motion trajectory in order to reciprocate the annulus formed by the needle. Need to do. In addition, since the purpose is to overlap two biological tissues and stitch the edges, dura stitching in TSS cannot be performed.

The suturing device described in Patent Document 9 needs to grasp a tissue part that is a suture target with a suture clasp arm when suturing, and may possibly damage the tissue part. Since the suture cannot be performed unless the two biological tissues are in a position where they can be grasped by the clasp arm, it is necessary to arrange the biological tissues at appropriate positions before the suture.

Therefore, an object of the present invention is to provide a medical bidirectional suturing device that can perform a suturing operation easily and that operates safely with minimal invasiveness to a human body.

The medical bidirectional suturing device of the present invention that has solved the above problems is a medical bidirectional suturing device having a perspective direction, and extends in the perspective direction, and a needle mechanism having a distal end on the distal side. A thread holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism includes a passage through which the thread passes, an entrance / exit portion provided on one side of the passage, It has a gist in that it has a terminal portion provided on the other side.

The passage penetrates in one direction perpendicular to the axial direction of the needle mechanism, and the thread-like material holding member has a first direction other than the direction perpendicular to the two directions of the axial direction of the needle mechanism and the penetration direction of the passage. It is preferable to rotate around one direction.

The first direction may be perpendicular to the axial direction of the needle mechanism or the passage direction of the passage. The first direction may be parallel to the axial direction of the needle mechanism.

Furthermore, the medical bidirectional suturing device has an operation part on the proximal side, and the filamentous material holding member is provided on the one side across the rotation axis and the rotation axis with the first direction as an axis. It is preferable to have a fixing part that is directly or indirectly connected to the part and a pressing part that is provided on the other side across the rotation shaft and presses the filamentous material.

It is preferable that the thread-like material holding member slides in a direction perpendicular to the axial direction of the needle mechanism and hooks the middle part of the thread-like material.

The needle mechanism preferably has a capturing part that narrows the passage or the entrance / exit part.

The needle mechanism is provided inside the hollow member; and has an insertion member that can advance and retreat in the axial direction with respect to the hollow member; and the passage, the entrance / exit portion, and the terminal portion are provided in the hollow member. Preferably; the inlet / outlet portion is at the distal end of the hollow member; and the capture portion is at the proximal end of the passageway.

The needle mechanism is provided on the inner side of the hollow member having an inclined portion at the distal end portion, and at least of the rotation operation around the axis of the hollow member and the movement operation in the axial direction of the hollow member It is preferable that the insertion member has an insertion member capable of either one of the operations, and the entrance / exit portion is provided closer to the proximal side than the inclined portion.

It is preferable that the capturing part is constituted by a hollow member and an insertion member.

The needle mechanism has a hollow shape, and has a needle member in which an inlet / outlet portion is provided at a distal end of the needle member, and an inner cylinder that is provided in the needle member and rotates with respect to the needle member. Preferably, the inner cylinder member has an opening extending to its distal end.

The catch may be a projection that projects inward in the radial direction of the needle mechanism.

The needle mechanism is preferably provided with a terminal end proximal to the entrance / exit part.

It is preferable that the passage penetrates in a direction perpendicular to the axial direction of the needle mechanism.

It is preferable that the passage extends along the axial direction of the needle mechanism.

Moreover, the operation method of the medical bidirectional suturing device of the present invention that has solved the above-mentioned problems is a medical bidirectional suturing device having a perspective direction, extending in the perspective direction, and a distal end on the distal side. A needle mechanism and a thread holding member provided on a distal side of the medical bidirectional suturing device, the needle mechanism including a passage through which the thread passes and an entrance / exit portion provided on one side of the passage And a step of preparing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage, and a capturing portion that narrows the passage or the entrance and exit, and a step of holding the filament by the capturing portion of the needle mechanism Moving the needle mechanism distally to move the filamentous material distal to the object to be sutured; releasing the retention of the filamentous material by the trapping portion of the needle mechanism; Moving the end proximally of the sutured object , It includes the features to the point and a step of holding the threads of the thread-holding member at the distal side of the suturing object.

Furthermore, the operation method of the medical bi-directional suturing device of the present invention that has solved the above-mentioned problems is a bi-directional medical suturing device having a perspective direction, extending in the perspective direction, and a distal end on the distal side. A needle mechanism and a thread holding member provided on a distal side of the medical bidirectional suturing device, the needle mechanism including a passage through which the thread passes and an entrance / exit portion provided on one side of the passage And a step of preparing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage, and a capturing portion for narrowing the passage or the entrance / exit, and a state in which the filament is not held by the filament holding member The step of moving the needle mechanism to the distal side of the suture object, the step of holding the filament by the trapping portion of the needle mechanism, and the distal end of the needle mechanism to the proximal side of the suture object And having a gist in terms of having .

The operation method of the medical bi-directional suturing device of the present invention that has solved the above problems is a medical bi-directional suturing device having a perspective direction, extending in the perspective direction, and a needle mechanism having a distal end on the distal side And a thread holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism includes a passage through which the thread passes, and an entrance / exit portion provided on one side of the passage, Providing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage, and a capturing portion for narrowing the passage or the entrance and exit, and replacing the needle mechanism with another needle mechanism. It has a gist in terms of having.

The medical bi-directional suturing device of the present invention can form the folded portion of the thread-like object on the distal side of the suture object by a simple operation of passing the thread-like object through the passage of the needle mechanism. The holding of the filamentous material on the distal side can be facilitated. Further, it is safe because there is no need to change the holding position of the needle or to move the needle while keeping the members in close contact with each other as in a conventional suturing apparatus. Furthermore, since it is not necessary to directly grasp the suture object, it is minimally invasive to the human body.
In addition, according to the operation method of the medical bidirectional suturing device of the present invention, since the folded portion that can easily hold the filamentous material can be arranged on the distal side of the suture object, the distal side of the suture object. Even on the side, the filamentous material can be easily held.

The side view of the medical bidirectional suturing device of this invention is represented. The side view of the medical bidirectional suturing device of this invention is represented. The side view which expanded the distal side of the medical bidirectional suturing device of this invention is represented. The side view of the needle mechanism which concerns on Embodiment 1 is represented. The perspective view which expanded the distal side of the needle mechanism shown in FIG. 4 is represented. The side view to which the distal side of the needle mechanism shown in FIG. 4 was expanded is represented. The front view which looked at the needle mechanism shown in FIG. 4 from the distal side is represented. The side view of the inner cylinder member which concerns on Embodiment 1 is represented. The perspective view which expanded the distal side of the inner cylinder member shown in FIG. 8 is represented. The perspective view in the distal side of the needle mechanism which concerns on Embodiment 1 is represented. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 1 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 1 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 1 is expressed. The side view which expanded the distal side of the needle mechanism which concerns on Embodiment 2 is represented. The side view which expanded the distal side which shows the modification of the needle mechanism shown in FIG. 14 is represented. The side view which expanded the distal side of the needle mechanism which concerns on Embodiment 3 is represented. The perspective view which expanded the distal side of the needle mechanism which concerns on Embodiment 4 is represented. The side view which expanded the distal side of the needle mechanism shown in FIG. 17 is represented. The perspective view which expanded the distal side of the needle mechanism which concerns on Embodiment 5 is represented. The front view which looked at the needle mechanism shown in FIG. 19 from the distal side is represented. The side view which looked at the needle mechanism shown in Drawing 19 from the 1st side is expressed. The side view which looked at the needle mechanism shown in Drawing 19 from the 2nd side is expressed. The side view which expanded the distal side of the hollow member which concerns on Embodiment 6 is represented. The perspective view which expanded the distal side of the hollow member shown in FIG. 23 is represented. The side view which expanded the distal side of the insertion member which concerns on Embodiment 6 is represented. The perspective view which expanded the distal side of the insertion member shown in FIG. 25 is represented. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 6 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 6 is expressed. The side view which expanded the distal side of the hollow member which concerns on Embodiment 7 is represented. The perspective view which expanded the distal side of the hollow member shown in FIG. 29 is represented. The side view which expanded the distal side of the insertion member which concerns on Embodiment 7 is represented. The perspective view which expanded the distal side of the insertion member shown in FIG. 31 is represented. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 7 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 7 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 7 is expressed. The side view which expanded the distal side of the hollow member which concerns on Embodiment 8 is represented. The perspective view which expanded the distal side of the hollow member shown in FIG. 36 is represented. The side view which expanded the distal side of the insertion member which concerns on Embodiment 8 is represented. The perspective view which expanded the distal side of the insertion member shown in FIG. 38 is represented. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 8 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 8 is expressed. The side view which expanded the distal side of the hollow member which concerns on Embodiment 9 is represented. FIG. 43 is an enlarged perspective view of the distal side of the hollow member shown in FIG. 42. The perspective view which expanded the distal side of the insertion member which concerns on Embodiment 9 is represented. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 9 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 9 is expressed. The side view (partial sectional view) which expanded the distal side of the needle mechanism concerning Embodiment 9 is expressed. The perspective view of the filament holding member which concerns on this invention is represented. The perspective view which expanded the distal side of the medical bidirectional suturing device of the present invention is represented. The perspective view which expanded the distal side of the medical bidirectional suturing device of the present invention is represented. The perspective view which shows the direction perpendicular | vertical to the virtual plane which enters the channel | path of a needle | hook mechanism is represented. The perspective view which expanded the distal side of the medical bidirectional suturing device using the other filamentous material holding member which concerns on this invention is represented. The perspective view which expanded the distal side of the medical bidirectional suturing device using the other filamentous material holding member which concerns on this invention is represented. The perspective view which expanded the distal side of the medical bidirectional suturing device using the other filamentous material holding member which concerns on this invention is represented. The perspective view which expanded the distal side of the medical bidirectional suturing device using the other filamentous material holding member which concerns on this invention is represented. The perspective view which expanded the distal side of the medical two-way suture device using the further another filamentous material holding member which concerns on this invention is represented. The perspective view which expanded the distal side of the medical two-way suture device using the further another filamentous material holding member which concerns on this invention is represented. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the operation method of the medical bidirectional suturing device of the present invention is shown. The explanatory view of the suture method of the living tissue of the present invention is shown.

Hereinafter, the present invention will be described in more detail based on the following embodiments, but the present invention is not limited by the following embodiments as a matter of course, and appropriate modifications are made within a range that can meet the purpose described above and below. In addition, it is of course possible to carry out them, all of which are included in the technical scope of the present invention. In addition, in each drawing, although hatching, a member code | symbol, etc. may be abbreviate | omitted for convenience, in this case, a description and another drawing shall be referred. In addition, the dimensions of the various members in the drawings are given priority to contribute to the understanding of the characteristics of the present invention, and may be different from the actual dimensions.

1. Medical bi-directional suturing device The bi-directional medical suturing device is, for example, visually, under a microscope, under an endoscopic image, to a suture target such as a living tissue from one side to the other side and from the other side to one side. This is a treatment tool capable of passing a thread in both directions. In this specification, it may be simply referred to as “device” or “suture device”.

The thread-like material is a suture used for medical purposes, and may be a single yarn or a knitting yarn. The outer diameter can be appropriately selected as long as it is a diameter used for a general suture. Moreover, the filamentous material may be formed of a degradable material. The length of the filamentous material is desirably long enough not to interfere with the operation, and is preferably 20 cm or more and 200 cm or less. For example, in TSS, a length that allows a suture to reciprocate from the outside of the body to the dura mater, plus a length sufficient for a doctor to make a knot in the suture outside the patient's body is preferred, and is preferred in TSS. Specifically, the length of the filamentous material is 70 cm or more and 150 cm or less.

First, the overall configuration of the apparatus will be described with reference to FIGS. 1 and 2 are a side view and a side view showing the interior of the suturing device of the present invention, respectively, and FIG. 3 is an enlarged side view of the distal side. As shown in FIGS. 1 to 3, the suturing device 1 of the present invention has a perspective direction. In the present invention, the proximal side of the device 1 refers to the direction of the user's hand side, and the distal side refers to the opposite direction of the proximal side (that is, the direction of the treatment target side). Further, the upper side of the device 1 refers to the upper side of FIG. 1, and the lower side refers to the opposite side of the upper side (that is, the lower side of FIG. 1).

The suturing device 1 of the present invention has a needle mechanism 2 extending in the perspective direction and having a distal end on the distal side. A puncture portion 11 for puncturing a suture object is preferably provided on the distal side of the needle mechanism 2. The suturing device 1 includes a needle mechanism 2 and a thread-like material holding member 30 provided on the distal side of the device 1. 1 to 3, the needle mechanism 2 and the thread-like material holding member 30 are held by a casing 50 that is formed in a hollow shape. Although FIGS. 1 to 3 show examples in which the needle mechanism 2 has a hollow needle member 10, the invention is not limited to this embodiment. It is preferable that the device 1 is provided with an operation unit on the proximal side. In FIG. 1, the 1st operation part 61 and the 3rd operation part 63 for operating the needle mechanism 2 and the filamentous material holding member 30, respectively are provided. When the apparatus 1 is used, the suture object 100 is positioned between the needle mechanism 2 and the filamentous material holding member 30 with the needle mechanism 2 moved proximally as shown in FIG. By operating the operation unit, the needle mechanism 2 with the thread 70 is moved in the perspective direction to penetrate the suture object 100, or the thread 70 is held by the thread holding member 30 as appropriate. Do. As a result, the suture object 100 can be sutured from the proximal side to the distal side, or from the distal side to the proximal side.

(1) Needle mechanism The needle mechanism is a mechanism used to pass a thread-like material through a living tissue such as a dura mater, which is a suture target. The needle mechanism may be composed of one member or may be composed by combining a plurality of members. The needle mechanism according to the present invention has a passage through which the filamentous material passes, an entrance / exit portion provided on one side of the passage, and a terminal portion provided on the other side of the passage. For this reason, by inserting the midway part of the thread-like material into the passage from the entrance / exit part of the needle mechanism and hooking it on the passage or the terminal part, the thread-like substance can be retained in the passage while being folded back in the axial direction of the needle mechanism. . In addition, the needle mechanism and the filamentous material are moved to the distal side of the suture object while the middle part of the filamentous material remains in the passage, and then only the needle mechanism is moved to the proximal side to perform the suture. A folded portion of the thread-like material can be arranged on the distal side of the object. By forming such a folded portion of the filamentous material, the filamentous material can be easily held on the distal side of the suture target.

The suturing device of the present invention can form the folded portion of the thread-like material on the distal side of the suture object by a simple operation of passing the thread-like object through the passage of the needle mechanism. It is possible to easily hold the filamentous material. Further, it is safe because there is no need to change the holding position of the needle or to move the needle while keeping the members in close contact with each other as in a conventional suturing apparatus. Furthermore, since it is not necessary to directly grasp the suture object, it is minimally invasive to the human body.

When the suture target is a living tissue, the range of motion of the device is limited. For example, when the dura is sutured under an endoscope, it is necessary to perform an operation while observing only the proximal side of the dura for the convenience of the insertion direction of the endoscope. For this reason, the tip of the needle mechanism is provided on the distal side so that the suturing position can be confirmed. A puncture portion is preferably provided on the distal side of the needle mechanism, and is preferably provided on the distal end portion of the needle mechanism. The puncture portion only needs to be formed so as to have one or a plurality of sharp tips pointed toward the distal side, for example, even if formed so that the cross-sectional area decreases toward the distal side. It may be formed in a tapered shape. The puncture portion may have a constant outer diameter. The needle mechanism may be provided with one distal end portion or a plurality of distal end portions. When the needle mechanism is composed of a plurality of members, the puncture part may be provided only on one member, or the puncture part may be provided on the plurality of members.

The needle mechanism is arranged to be movable in the perspective direction of the device. By moving the needle mechanism from the proximal side to the distal side, the needle mechanism can be pierced into an object to be sutured disposed further to the distal side than the needle mechanism. By moving the needle mechanism that punctures the suture object to the proximal side, the needle mechanism can be removed from the suture object. The needle mechanism extends in the perspective direction, and at least the distal end portion thereof preferably extends in the perspective direction, and more preferably extends in the perspective direction as a whole.

The length of the needle mechanism can be set to about 2 cm to 30 cm, which is the distance from the nasal cavity to the pituitary gland, for example, when used for TSS.

The needle mechanism may be linear or curved, and may have a combination thereof or a bent portion. Further, the member constituting the needle mechanism may be hollow or solid.

The outer diameter of the needle mechanism is not particularly limited as long as it is a diameter used for a general suture needle, but is preferably 0.05 mm or more and 1.5 mm or less, for example. When the needle mechanism is a hollow needle member, the thickness of the needle member is preferably 0.01 mm or more and 0.5 mm or less, for example.

The material of the needle mechanism is preferably biocompatible and strong enough to puncture an object such as a biological tissue, for example, a metal material such as stainless steel or a resin material is preferable. Stainless steel is preferable from the viewpoint of ease.

The needle mechanism may be connected to a first operation unit 61 (described later) provided on the operator's hand side, for example, via a needle support member 65 connected to the proximal side of the needle mechanism. One operation unit 61 may be connected. Moreover, you may be connected to the 1st operation part 61 through one or more other members.

The passage is a portion that appears when viewed from the side of the needle mechanism, and is a portion through which the thread-like material passes. Therefore, for example, a lumen that does not appear on the side surface of the hollow needle mechanism is not defined as a passage in the present invention. The shape of the passage may be, for example, linear, curved, or a combination thereof.

The entrance / exit part is a part that functions as an entrance / exit for passing the filamentous material through the passage of the needle mechanism. The entrance / exit part is provided on one side of the passage. When working while observing only the proximal side of the suture object, the entrance / exit part is preferably the distal end of the needle mechanism (more preferably It is preferably provided at the distal end.

The terminal portion is a portion provided on the other side of the passage. For example, when the needle mechanism is moved to the distal side or the proximal side, the thread-like material can be retained in the passage.

The size of the passage may be constant, and a wide part or a narrow part may be provided. In the axial direction of the needle mechanism, the length of the passage can be set in a range of 0.1 mm to 100 mm, for example. The size of the passage may be formed so as to increase toward the distal side in the puncture portion of the needle mechanism. Here, the size of the passage means the maximum diameter in a cross section perpendicular to the extending direction of the passage, and the length of the passage means a length in the extending direction of the passage.

The size of the entrance / exit part and the passage is not particularly limited as long as it has a size that allows the thread-like material to pass therethrough. For example, in order to prevent excessive deformation and cutting of the thread-like object, the entrance / exit part of the needle mechanism And the size of the passage is preferably larger than the outer diameter of the filamentous material. Here, the size of the entrance / exit portion means the maximum diameter in a cross section perpendicular to the extending direction of the passage. Moreover, the magnitude | size of an entrance / exit part is not specifically limited, It may be larger than the length of a channel | path, and may be small.

The needle mechanism preferably has a capturing part that narrows at least one of the entrance / exit part, the passage, and the terminal part. More preferably, the needle mechanism has a capture portion that narrows the passage or the entrance / exit portion. Since it becomes easy to hold the thread-like material by the capturing portion, it is possible to suppress the thread-like material from being detached from the needle mechanism during the movement of the needle mechanism.

(Embodiment 1 of the needle mechanism)
An example of the needle member 10 (10A) in which the needle mechanism 2 (2A) is hollow and the doorway portion is provided at the distal end will be described with reference to FIGS. The needle member 10A has two distal ends. 4 shows a side view of the needle mechanism 2A, FIG. 5 shows an enlarged perspective view of the distal side of the needle mechanism 2A shown in FIG. 4, and FIG. 6 shows a distant view of the needle mechanism 2A shown in FIG. FIG. 7 shows a front view of the needle mechanism 2A shown in FIG. 4 as viewed from the distal side.

4 to 7, since the needle mechanism 2A is composed of the needle member 10A, the passage 13 is formed in the needle member 10A. It is preferable that the passage 13 extends along the axial direction of the needle mechanism 2A. The channel 13 shown in FIGS. 4 to 7 extends along the axial direction of the needle member 10. For this reason, by moving the needle member 10 in the axial direction, the filamentous material 70 positioned in the passage 13 can be moved in the perspective direction of the needle member 10. As shown in FIG. 6, the passage 13 preferably passes through the axis C of the needle member 10. Thereby, the filamentous material 70 is stably hold | maintained. Since the entrance / exit part 12 is provided at the distal end of the needle member 10, it is easy to guide the thread 70 into the passage 13 of the needle member 10 even when the distal side is not visible under the endoscope.

When the needle member 10 is hollow, a plurality of distal end portions are preferably provided, and in particular, two are preferably provided. In this case, it is more preferable that the distal end portion has a shape that is tapered toward the distal side (so-called twin peak shape). As shown in FIGS. 4 to 6, the outer diameter of the needle member 10 may be constant. In that case, in order to facilitate the insertion of the thread 70 into the passage 13, it is preferable that the size of the passage 13 of the needle member 10 increases toward the distal side.

It is preferable that the passage 13 penetrates in a direction perpendicular to the axial direction of the needle mechanism 2A. As shown in FIGS. 5 to 7, it is more preferable that the passage 13 penetrates in a direction perpendicular to the axial direction of the needle member 10. More preferably, the passage 13 penetrates in a direction perpendicular to the axial direction of the needle member 10 when viewed from the distal side of the needle member 10. Thereby, since the folding | returning part 71 of the thread-like thing 70 becomes easy to be formed in the distal side of the sewing target object, it becomes easy to hold the thread-like object 70 by the needle member 10 or the thread-like object holding member.

A passage 13 is formed in the needle member 10, and an opening is provided on the side surface of the needle member 10. When the passage 13 is formed so that there are two distal ends of the needle member 10 and two openings are provided on the side surface of the needle member 10, one opening and the other in the circumferential direction of the needle member 10 are provided. It is preferable that the openings face each other across the axis C of the needle member 10. The opening provided on the side surface of the needle member 10 may be arranged rotationally symmetrically with the major axis direction of the needle member 10 as the central axis. Thereby, since the folding | returning part 71 of the thread-like thing 70 can be formed in a left-right symmetric shape, it becomes easy to hold | maintain the thread-like thing 70 in the distal side of a sewing target object.

The needle mechanism 2 A may be provided with a terminal portion 14 on the proximal side of the entrance / exit portion 12. The needle member 10 may be provided with a terminal portion 14 on the proximal side of the entrance / exit portion 12. Thereby, when the needle member 10 is moved from the proximal side to the distal side, the thread-like material 70 is caught by the terminal end portion 14, so that the thread-like material 70 easily stays in the passage 13.

It is preferable to hold and release the filament 70 by the needle member 10 by combining with the inner cylinder member described below. That is, the needle mechanism 2A preferably includes the needle member 10A and the inner cylinder member 20 provided inside the needle member.

8 and 9 show a side view and an enlarged perspective view of the inner cylinder member 20 according to the present invention, respectively, and FIG. 10 shows a perspective view of the distal side of the needle mechanism 2A according to the present invention. 11 to 13 are side views (partially sectional views) of the needle mechanism 2A according to the present invention.

As shown in FIG. 10, the needle mechanism 2 A is hollow, the entrance / exit part 12 has a needle member 10 provided at the distal end, and the capturing part 15 is provided inside the needle member 10. The inner cylinder member 20 that rotates with respect to the member 10 is preferable. When the inner cylinder member 20 rotates with respect to the needle member 10, the inlet / outlet portion 12 or the passage 13 of the needle member 10 is covered with the inner cylinder member 20 and becomes narrower. As a result, the thread-like material 70 can be held in the narrow entrance / exit part 12 or the passage 13.

The outer diameter of the inner cylinder member 20 only needs to be smaller than the inner diameter of the needle member 10, and can be set to 0.02 mm or more and 1.5 mm or less, for example.

The thickness of the inner cylinder member 20 can be set to 0.01 mm or more and 0.5 mm or less, for example.

As with the needle member 10, the material of the inner cylinder member 20 is preferably a metal material such as stainless steel or a resin material, and particularly preferably stainless steel from the viewpoint of anti-rust properties and ease of processing.

The inner cylinder member 20 preferably has an opening 21 extending to the distal end. In FIG. 10, an opening 21 is provided on the side portion of the inner cylinder member 20. Thereby, the thread 70 can be hung on the opening 21 from the distal end of the inner cylinder member 20.

By rotating the inner cylinder member 20 with respect to the needle member 10, the shape and size of the region where the inlet / outlet portion 12 or the passage 13 of the needle member 10 overlaps the opening 21 provided on the side portion of the inner cylinder member 20 is changed. can do. 11, 12, and 13 show states in which the inner cylinder member 20 is rotated by 0 degrees, 40 degrees, and 70 degrees with respect to the needle member 10. As shown in FIG. 11, when the inner cylinder member 20 is not rotated, that is, when the rotation angle is 0 degree, the inlet / outlet part 12 or the passage 13 of the needle member 10 and the opening 21 of the inner cylinder member 20 overlap each other. It is preferable that The filament 70 can be guided into the passage 13 from the distal side of the region where the entrance / exit portion 12 or the passage 13 and the opening 21 of the inner cylinder member 20 overlap.

As shown in FIG. 12, when the inner cylinder member 20 is rotated with respect to the needle member 10, a part of the entrance / exit portion 12 or the passage 13 of the needle member 10 is covered with the inner cylinder member 20, and the entrance / exit of the needle member 10 is covered. Part 12 and a part of passage 13 narrow. Thereby, the thread-like object 70 can be held at the narrowed portion of the entrance / exit part 12 or the passage 13 of the needle member 10.

As shown in FIG. 13, when the inner cylinder member 20 is further rotated with respect to the needle member 10, a region where the inlet / outlet portion 12 or the passage 13 of the needle member 10 and the opening 21 of the inner cylinder member 20 overlap is further reduced. . Since the entrance / exit part 12 or the passage 13 of the needle member 10 is narrowed, the filament 70 is sandwiched and held between the needle member 10 and the inner cylinder member 20.

The release of the holding of the filament 70 may be performed by reducing the rotation angle by rotating the inner cylinder member 20 in the reverse direction with respect to the needle member 10.

In this example, the example in which the filament 70 is held between the needle member 10 and the inner cylinder member 20 by rotating the inner cylinder member 20 from 0 degrees to 70 degrees is shown, but the rotation angle is limited to this. The angle may be any angle as long as it is larger than 0 degree and smaller than 180 degrees, and more preferably 30 degrees or more and 90 degrees or less.

In order to easily hold and release the thread-like material 70 by rotating the inner cylinder member 20 with respect to the needle member 10, the inner cylinder member 20 preferably has an opening 21 as shown in FIG. . That is, the opening 21 of the inner cylinder member 20 has a distal region 21A and a proximal region 21B that is connected to the distal region 21A and is more proximal than the distal region 21A. The width of the distal region 21A in the circumferential direction is preferably smaller than the width of the proximal region 21B. Thereby, when the inner cylinder member 20 is rotated with respect to the needle member 10, the distal region 21A of the inner cylinder member 20 is entirely covered with the needle member 10 before the proximal region 21B. For this reason, the filament 70 existing in the proximal region 21B can be prevented from passing through the entrance / exit part 12 of the needle member 10 during rotation.

The shape of the opening 21 of the inner cylinder member 20 is not particularly limited as long as the thread-like object 70 can be inserted. When the opening 21 is viewed from the side, a polygonal shape such as a triangle or a quadrangle, a circular shape, an elliptical shape, or a combination thereof Can be. In FIG. 9, the opening 21 has a shape in which a rectangular distal region 21A and a rectangular proximal region 21B are combined.

The shape of the opening 21 of the inner cylinder member 20 may be a combination of a rectangular distal region 21A and a rectangular proximal region 21B as shown in FIG. preferable. Further, from the viewpoint of ease of processing, it is preferable that the shape is one rectangular shape.

The number of openings 21 in the inner cylinder member 20 is preferably 1 or more, and more preferably 2 or more. In particular, the number of openings 21 in the inner cylinder member 20 is preferably the same as the number of openings in the needle member 10. When the needle member 10 has a twin peak shape, the number of the openings 21 of the inner cylinder member 20 may be two in order to provide a region where the opening of the needle member 10 and the opening 21 of the inner cylinder member 20 overlap. preferable.

In order to prevent deformation or cutting of the thread 70, the minimum diameter of the opening 21 of the inner cylinder member 20 is preferably larger than the outer diameter of the thread 70.

Although not shown, in order to control the rotation angle of the inner cylinder member 20 with respect to the needle member 10, a fixing portion may be provided on the inner cylinder member 20. As the fixed portion, for example, a convex portion may be provided on the outer side of the inner cylinder member 20, and a groove that engages with the convex portion of the inner cylinder member 20 may be provided on the inner side of the needle member 10.

(Embodiment 2 of the needle mechanism)
The needle mechanism 2 (2B) according to Embodiment 2 will be described with reference to FIG. 14 shows a side view of the needle mechanism 2B, and FIG. 15 shows a side view showing a modification of the needle mechanism 2B shown in FIG.

The needle mechanism 2B is formed in a solid shape and has a needle member 10 (10B) provided with one distal end. An entrance / exit part 12, a passage 13 and a terminal part 14 are provided in the needle member 10. The entrance / exit part 12 of the needle member 10 shown in FIG. 14 is provided more proximally than the distal end of the needle member 10. In this case, it is preferable that the entrance / exit part 12 is provided in the side part of the needle member 10. As a result, the needle member 10 shown in FIG. 14 is provided with one distal end. The passage 13 extends along the radial direction of the needle member 10.

Even if the needle member 10 is solid and the capturing portion 15 is a portion protruding to narrow the entrance / exit portion 12 or the passage 13 of the needle mechanism 2B (needle member 10) (hereinafter simply referred to as “protrusion”). Good. In FIG. 14, the protrusion 16 protrudes toward the proximal side of the needle member 10, but may protrude toward the distal side of the needle member 10. The protrusion 16 preferably protrudes in a direction perpendicular to the extending direction of the passage 13. Since the thread-like object 70 is held at the portion where the protrusion 16 is formed, the thread-like object 70 is prevented from falling off.

The protrusion 16 preferably has a size of 1/5 or more of the size of the passage 13, more preferably 1/4 or more, and still more preferably 1/3 or more.

The shape of the protrusion 16 can be formed in, for example, a polygonal column shape, a cone shape such as a cone shape or a pyramid shape, a truncated cone shape such as a truncated cone shape or a truncated pyramid shape, a hemispherical shape, or a semi-elliptical spherical shape.

The protrusion 16 may be formed in a rounded shape such as a truncated cone shape, a hemispherical shape, a semi-elliptical sphere shape, etc., in order to prevent the threaded material 70 from being damaged by coming into contact with the threaded material 70. preferable.

In FIG. 15, a narrow portion 17 in which the passage 13 is narrowed instead of the protrusion 16 is provided as the capturing portion 15. In FIG. 15, the narrow portion 17 is provided on the end portion 14 side and the end portion 14 of the passage 13, but the narrow portion 17 is provided on at least one of the entrance / exit portion 12, the passage 13, and the end portion 14. It only has to be done.

The narrow portion 17 is formed in a staircase shape in FIG. 15, and the size of the passage 13 is abruptly reduced. However, the narrow portion 17 is not limited to this, and a taper shape that gradually decreases may be adopted. .

The size of the passage in the narrow portion 17 is preferably smaller than the outer diameter of the thread 70. Thereby, it becomes possible to hold the thread-like material 70 firmly with the narrow portion 17, and to prevent the thread-like material 70 from dropping out of the passage 13.

As described above, by providing the needle member 10 with the protrusion 16 or the narrow portion 17 as the capturing portion 15, the needle member 10 alone can be used without combining other members as described in the first embodiment of the needle mechanism. The thread 70 can be held and released.

(Embodiment 3 of the needle mechanism)
The needle mechanism 2 (2C) according to Embodiment 3 will be described with reference to FIG. FIG. 16 shows a side view of the needle mechanism 2C. The needle mechanism 2C is formed in a solid shape and has a needle member 10 (10C) provided with two distal end portions. In the solid needle member 10 shown in FIG. 16, the entrance / exit part 12 is provided at the distal end of the needle member 10. The passage 13 extends along the axial direction of the needle member 10. Compared with Embodiment 2 of the needle mechanism, the path of the passage 13 can be made longer, so that the thread-like object 70 is less likely to fall out of the passage 13. The needle member 10 has a distal end portion (puncture portion 11) with an outer diameter that decreases toward the distal end. The passage 13 is formed so as to pass through the axis C of the needle member 10, and the needle member 10 has two distal ends.

In FIG. 16, the capturing part 15 is a protrusion 16 (16A, 16B) that protrudes inward in the radial direction of the needle mechanism 2B (needle member 10). The protrusion 16A provided on the entrance / exit portion 12 side protrudes toward the lower side of the device 1, and the protrusion 16B provided on the end portion 14 side protrudes toward the upper side of the device 1. When a plurality of protrusions 16 are provided, it is preferable that the protrusions 16 are formed in opposite directions. Thereby, the filamentous material 70 can be firmly held. In order to suppress the unintended thread-like material 70 from falling off from the passage 13, at least one protrusion 16 may be provided in each of the entrance / exit portion 12 and the passage 13. Although not shown, a narrow portion may be provided instead of the protrusion.

(Embodiment 4 of the needle mechanism)
The needle mechanism 2 (2D) according to the fourth embodiment will be described with reference to FIGS. 17 shows an enlarged perspective view of the distal side of the needle mechanism 2D, and FIG. 18 shows a side view of the needle mechanism 2D shown in FIG. The needle mechanism 2D has a needle member 10 (10D) in which a plurality of passages 13 having shapes extending in different directions are formed.

The passage 13 is a combination of a section 13A extending along the axial direction of the needle member 10 and a section 13B extending along a direction perpendicular to the axial direction of the needle member 10. By connecting the section 13B to the proximal end of the section 13A, the

sections

13A and 13B are in communication. The entrance / exit part 12 is provided on one side of the section 13B, and the other side of the section 13B is connected to one side of the section 13A. A terminating portion 14 is provided on the other side of the section 13A.

By moving the thread 70 from the section 13B of the passage 13 of the needle member 10 to the section 13A, the thread 70 can be held. Further, by moving the thread 70 from the section 13A of the passage 13 of the needle member 10 to the section 13B, the holding of the thread 70 can be released.

When moving the needle member 10 hung on the thread 70 to the distal side, the thread 70 can be hooked on the connecting portion of the section 13A and the section 13B. On the other hand, when the needle member 10 is moved to the proximal side, the thread 70 can be hooked on the distal end portion (that is, the end portion 14) of the section 13A. In FIG. 17 to FIG. 18, one section 13A and one section 13B are provided, but one or

more sections

13A and 13B may be provided. Moreover, although the section 13B was connected to the proximal end of the section 13A, the section 13B may be connected to the distal end of the section 13A.

Also in the needle member 10 according to the fourth embodiment of the needle mechanism, similar to the second and third embodiments of the needle mechanism, protrusions and narrow portions may be provided. In particular, the section 13B in which the entrance / exit part 12 is provided has a risk of the filament 70 falling off as compared with the section 13A in which the terminal part 14 is provided. Therefore, the protrusion and the narrow part may be provided in the section 13B. preferable. On the other hand, in order to guide the thread-like material 70 smoothly to the passage 13, the capturing part 15 may be provided in a section where the terminal part 14 is provided.

(Embodiment 5 of the needle mechanism)
The needle mechanism 2 (2E) according to the fifth embodiment will be described with reference to FIGS. 19 represents an enlarged perspective view of the distal side of the needle mechanism 2E according to the present invention, FIG. 20 represents a front view of the needle mechanism 2E shown in FIG. 19 viewed from the distal side, and FIG. FIG. 22 shows side views of the needle mechanism 2E shown in FIG. 19 as viewed from the first side surface and the second side surface. The needle mechanism 2 (2E) is solid and has a needle member 10 (10E) provided with four distal ends. The distal end portion of the needle member 10 has a larger passage toward the distal side. The passage 13 for fastening the thread 70 has four openings 18 as seen from the side. As shown in FIG. 21, when viewed from the first side surface, the passage 13 of the needle member 10 has a certain size on the proximal side of the puncture portion 11. On the other hand, as shown in FIG. 22, when viewed from the second side surface, there is a narrow portion 17 in which the passage 13 is narrow.

In addition, it is preferable that the first side surface and the second side surface are at positions different by 90 degrees when viewed from a direction perpendicular to the axial direction of the needle member 10.

In the so-called four-peak needle member 10 having four distal end portions, it is preferable that the shapes of the openings 18 adjacent to each other in the circumferential direction are different. Moreover, in order to make it easy to hang the thread-like object 70, it is preferable that the shapes of the openings 18 facing each other across the axis C of the needle member 10 are the same.

It is preferable that the minimum width of the opening 18A viewed from the first side surface is larger than the minimum width of the opening 18B viewed from the second side surface. By changing the opening 18 on which the thread 70 is applied, the holding strength of the thread 70 can be changed. For example, in the case of suture from the proximal side to the distal side where the thread 70 is difficult to drop from the needle member 10, the thread 70 is hung on the opening 18A visible from the first side surface, and the thread 70 drops from the needle member 10. In the possibility of suturing from the distal side to the proximal side, the strength of holding the filament 70 can be changed in accordance with the stitching direction by using the opening 18B viewed from the second side surface. That is, as shown in FIG. 20, it is preferable that the passage 13 is formed in a cross shape when the needle member 10 is viewed from the distal side.

The needle member 10 shown in FIG. 21 can be advanced distally while holding the thread 70 in the opening 18A by hooking the thread 70 on the opening 18A viewed from the first side face. When the needle member 10 is retracted proximally, the holding of the thread 70 is released. In order to wind the thread 70 around the needle member 10 and strengthen the holding, the needle member 10 may be rotated by a predetermined angle about the major axis direction as the central axis before the needle member 10 is advanced. The needle member 10 shown in FIG. 22 can be retracted by holding the thread 70 in the opening 18B by hooking the thread 70 on the proximal opening 18B as viewed from the second side. The filament 70 can be held by contacting the distal end of the proximal opening 18B as viewed from the second side surface. At this time, if the narrow portion 17 is provided in the opening 18 B viewed from the second side surface, the thread-like material 70 can be firmly held. Therefore, even if the needle member 10 is retracted, the opening of the needle member 10. It becomes difficult for the thread-like material 70 to come off from 18. Release of the holding of the thread 70 is performed by removing the thread 70 from the side surface of the opening 18 or moving the thread 70 to the distal side of the opening 18. In order to wind the thread 70 around the needle member 10 and strengthen the holding, the needle member 10 may be rotated by a predetermined angle about the major axis direction of the needle member 10 as the central axis before the needle member 10 is retracted.

(Embodiment 6 of the needle mechanism)
The needle mechanism 2 (2F) according to the sixth embodiment will be described with reference to FIGS. The needle mechanism 2F includes a hollow member 22 (22F) and an insertion member 25 (25F) that is provided on the inner side of the hollow member 22F and can advance and retract in the axial direction with respect to the hollow member 22F. 23 to 24 show a side view and a perspective view of the distal side of the hollow member 22F, respectively. 25 to 26 show a side view and a perspective view showing the distal side of the insertion member 25F, respectively. 27 to 28 are side views (partial side views) of the needle mechanism 2F according to the sixth embodiment.

The passage 13, the entrance / exit portion 12, and the end portion 14 are provided in the hollow member 22 F, the entrance / exit portion 12 is at the distal end of the hollow member 22 F, and the capturing portion 15 is the proximal end portion of the passage 13. Is preferred. By forming the capturing part 15 in this way, the thread-like object 70 can be held by the needle mechanism 2F. Further, the holding of the thread-like object 70 can be released by moving the insertion member 25F forward and backward in the axial direction of the needle mechanism 2F.

Of the first embodiment, the needle mechanism 2A having the inner cylinder member 20 holds and releases the filamentous material 70 by rotating the inner cylinder member 20, whereas in the sixth embodiment, the passage 13 of the hollow member 22F. Is different in that the thread-like object 70 is held at the proximal end portion thereof and the holding of the thread-like object 70 is released by the insertion member 25F.

The passage 13 of the needle mechanism 2F shown in FIGS. 23 to 24 extends along the axial direction of the hollow member 22F. For this reason, by moving the hollow member 22F in the axial direction, the filament 70 located in the passage 13 can be relatively moved. As shown in FIGS. 23 to 24, the passage 13 preferably passes through the axis C of the hollow member 22F. Thereby, the filamentous material 70 is stably hold | maintained. Since the entrance / exit part 12 is provided at the distal end of the hollow member 22F, it is easy to guide the filament 70 into the passage 13 of the hollow member 22F even when the distal side is not visible under the endoscope.

It is preferable that a plurality of distal end portions of the hollow member 22F are provided, and it is preferable that two are provided. In this case, it is more preferable that the distal end portion of the hollow member 22F be tapered toward the distal side (so-called twin peak shape). As shown in FIGS. 23 to 24, the outer diameter of the hollow member 22F may be constant. In that case, in order to facilitate the insertion of the filament 70 into the passage 13, it is preferable that the width of the passage 13 increases toward the distal side. Since the width of the passage 13 is narrowed toward the proximal side, the filament 70 is held at the proximal end of the passage 13. That is, in the needle mechanism 2 F shown in FIG. 27, the capturing portion 15 is configured by the proximal end portion of the passage 13.

23, it is preferable that the passage 13 penetrates in a direction perpendicular to the axial direction of the hollow member 22F. Thereby, since the folded part of the thread-like object 70 is easily formed on the distal side of the suture object, the thread-like object 70 is easily held by the needle member 10 and the thread-like object holding member.

The shape of the passage is not particularly limited, and the passage may be narrowed by inclining with respect to the axial direction, or may be narrowed by changing the width in a staircase shape. When the passage is inclined in the axial direction, the inclination angle may be changed at a plurality of locations, and the inclination angle may not be constant.

The insertion member 25F is provided inside the hollow member 22F. The shape of the insertion member 25F is preferably a solid shape such as a columnar shape or a prismatic shape, or a hollow shape such as a cylindrical shape or a polygonal cylindrical shape, and is solid to increase the strength of the needle mechanism 2F. Is more preferable.

The shape of the distal end portion of the insertion member 25F is not particularly limited as long as the filament 70 held by the capturing portion 15 can be pushed out to the distal side. However, as shown in FIGS. A pointed needle shape is preferred. In that case, it is preferable that the tip of the insertion member 25F is located at the outermost side in the radial direction of the insertion member 25F. If the insertion member 25F is a needle shape, the insertion member 25F can easily puncture the suture target. When the suture target is punctured with the needle-shaped insertion member 25F, puncture waste is less likely to be generated and dropped from the suture target as compared with the case of puncturing with the twin-peak needle mechanism. Here, the removal of the puncture lint means that the cut portion of the suture target (for example, the dura mater) that is punctured, that is, cut off by the needle mechanism 2F, is completely cut out and detached from the suture target. If the puncture lint falls off near the thread 70 and the needle mechanism 2F, it becomes a factor that hinders the movement of the needle mechanism 2F and the thread 70 during the suturing operation. It is advantageous.

In order to make the distal end portion of the insertion member 25F into a needle shape, an inclined portion 26 may be provided at the distal end portion of the insertion member 25F. The inclined portion 26 only needs to have an inclination angle similar to that of a medical suture needle. The inclined portion 26 is 5 degrees or more, 8 degrees or more, 10 degrees or more, 15 with respect to the axial direction of the hollow member 22G. It is preferable to incline below 20 degrees or below 20 degrees.

The hollow member 22F and the insertion member 25F are preferably made of a metal material such as stainless steel or a resin material, like the needle member 10 and the inner cylinder member 20 of the first to fifth embodiments.

A method of gripping the thread-like object 70 by the needle mechanism 2F will be described with reference to FIGS. A part of the thread 70 is arranged on the distal side of the needle mechanism 2F, and the needle mechanism 2F is moved to the distal side, so that the thread 70 passes through the entrance / exit part 12. Further, by moving the needle mechanism 2F to the distal side, as shown in FIG. 27, the thread 70 is entered into the passage 13, and the thread 70 is press-fitted toward the end portion 14, so that the passage 13 The filament 70 can be held at the proximal end.
As a method for press-fitting the thread-like material 70 into the terminal end portion 14, two locations of the thread-like material 70 are fixed and the needle mechanism 2F is moved so as to grip between the two locations, After inserting in the channel | path 13, the method of pulling the other side is mentioned by pinching the thread-like object 70 with the needle mechanism 2F, and fixing one side.

As shown in FIG. 28, the release of the holding of the thread 70 is performed by moving the insertion member 25F to the distal side with respect to the needle mechanism 2F, and moving the thread 70 to the distal side at the tip of the insertion member 25F. This can be done by extruding. At this time, it is preferable not to rotate the insertion member 25F with respect to the hollow member 22F.

In Embodiments 7 to 9 to be described next, the needle mechanism 2 is provided with a hollow member 22 having an inclined portion 23 at the distal end, and inside the hollow member 22, and the axis of the hollow member 22 is centered. And an insertion member 25 capable of at least one of a rotation operation and a movement operation of the hollow member 22 in the axial direction. The entrance / exit portion 12 is provided on the proximal side of the inclined portion 23. An example is shown. The inclined portion 23 can be configured in the same manner as the hollow member 22F described in the sixth embodiment of the needle mechanism. By providing the entrance / exit part 12 on the more proximal side than the inclined part 23, the filament 70 can be easily guided to the entrance / exit part 12 along the side surface of the inclined part 23, so that the filament 70 can be easily held.

(Embodiment 7 of the needle mechanism)
The needle mechanism 2 (2G) according to the seventh embodiment will be described with reference to FIGS. 29 to 30 show a side view and a perspective view of the distal side of the hollow member 22G. 31 to 32 are a side view and a perspective view showing the distal side of the insertion member 25 (25G). 33 to 35 are side views (partially sectional views) showing the distal side of the needle mechanism 2G.

A groove 24 is provided at the distal end of the hollow member 22G shown in FIGS. The groove part 24 of the hollow member 22G can constitute at least a part of the entrance / exit part 12, the passage 13 and the terminal part 14 for holding the filament 70. For example, the entrance / exit part 12 is provided on the distal side of the groove part 24. Can be provided.

The depth of the groove 24 of the hollow member 22G is not particularly limited as long as the depth is equal to or larger than the diameter of the thread 70, but from the viewpoint of ease of processing, strength of the needle mechanism, and ease of holding the thread 70. The radius is preferably equal to or less than the radius of the hollow member 22G. The width of the groove portion 24 of the hollow member 22G is not particularly limited as long as it is equal to or larger than the diameter of the thread 70, but from the viewpoint of ease of processing and the strength of the hollow member 22G, it is twice or more the diameter of the thread 70 or It is preferable that it is twice or more. Here, the depth of the groove portion 24 of the hollow member 22G indicates a length along the radial direction, and the width of the groove portion 24 indicates a length in a direction perpendicular to the axial direction when the groove portion 24 is viewed from above.

In the hollow member 22G, the groove 24 is formed by three inner walls of a bottom wall 24A, a distal side wall 24B, and a proximal side wall 24C. From the viewpoint of manufacturability of the hollow member 22G, the distal side wall 24B and the proximal side wall 24C are preferably formed perpendicular to the axial direction of the needle mechanism 2G as shown in FIG. In the radial direction, the proximal side wall 24C is preferably formed higher than the distal side wall 24B. Thereby, the thread-like object 70 can be prevented from dropping unintentionally from the proximal side of the needle mechanism 2G.

An inclined portion 23 is provided at the distal end of the hollow member 22G. In the seventh embodiment, the inclined portion 23 functions as a portion that punctures a suture target. In the hollow member 22G, it is preferable that the inclined portion 23 is provided on the distal side of the groove portion 24. By arranging the inclined portion 23 and the groove portion 24 in this manner, the thread-like material 70 can be easily guided to the groove portion 24 and can be held smoothly by having the thread-like material 70 along the side surface of the inclined portion 23. In addition, the thread 70 can be hung on the step between the proximal end of the inclined portion 23 and the distal end of the groove portion 24 (that is, the proximal side wall 24C constituting the groove portion 24).

The insertion member 25G is provided inside the hollow member 22G, and can perform at least one of a rotation operation around the axis of the hollow member 22G and a movement operation in the axial direction of the hollow member 22G. It is. The passage 13 can be formed in the needle mechanism 2 by moving or rotating the insertion member 25G in the axial direction with respect to the hollow member 22G. Moreover, the width | variety of the channel | path 13 or the entrance / exit part 12 can be narrowed by adjusting the position and rotation angle of the axial direction of the insertion member 25G. That is, in the needle mechanism 2G shown in FIG. 33, the capturing unit 15 is configured by the hollow member 22G and the insertion member 25G.

The shape of the insertion member 25G can be configured similarly to the insertion member 25G described in the sixth embodiment, but from the viewpoint of ensuring the strength of the needle mechanism 2G and firmly holding the filament 70, The shape of the insertion member 25G is preferably solid.

A method of gripping the thread-like object 70 by the needle mechanism G will be described with reference to FIGS. In the axial direction, the insertion member 25G is moved closer to the proximal side than the groove 24 of the hollow member 22G. At this time, it is preferable that the distal end of the insertion member 25G and the distal end of the hollow member 22G are arranged so as to face each other across the axis C of the needle mechanism 2G when the needle mechanism 2G is viewed from the distal side. Thereby, it becomes easy to adjust the passage 13 and the entrance / exit part 12 to an appropriate width that can easily hold the filament 70.

By disposing a part of the thread 70 on the distal side of the needle mechanism 2G and moving the needle mechanism 2G to the distal side, a part of the thread 70 is guided to the inclined portion 23 of the hollow member 22G. Thus, it reaches the entrance / exit part 12 constituted by the groove part 24. Furthermore, the filament 70 enters the passage 13 by moving the hollow member 22G to the distal side. Next, when the insertion member 25G is moved to the distal side, the width of the passage 13 is narrowed by the inclined portion 27 of the insertion member 25G. As shown in FIG. 33, the thread-like material 70 can be held by sandwiching the thread-like material 70 at three locations, that is, the bottom wall 24A of the groove portion 24, the distal side wall 24B, and the inclined portion 27 of the insertion member 25G.

As shown in FIG. 34, the holding of the filament 70 can be released by moving the insertion member 25G proximally with respect to the hollow member 22G. Furthermore, in order to easily release the holding of the filament 70, the insertion member 25G is moved proximally with respect to the hollow member 22G, and then the insertion member 25G is rotated. As shown in FIG. It is preferable to move the insertion member 25G to the distal side again. Thereby, the filament 70 can be pushed out to the distal side by the inclined portion 26 of the insertion member 25G. Instead of moving the insertion member 25G proximally relative to the hollow member 22G, the insertion member 25G may be rotated and the insertion member 25G moved again to the distal side. When the holding of the thread-like material 70 is released by moving the entire suturing apparatus or the like without pushing the thread-like object 70 by the insertion member 25G, the insertion member 25G only holds the thread-like object 70. In that case, the thread-like object 70 can be held only by either one of the rotation operation of the insertion member 25G or the movement operation in the axial direction.

(Embodiment 8 of the needle mechanism)
A needle mechanism 2 (2H) according to the eighth embodiment will be described with reference to FIGS. 36 to 37 respectively show a side view and a perspective view of the distal side of the hollow member 22 (22H). 38 to 39 respectively show a side view and a perspective view of the distal side of the insertion member 25H. 40 to 41 are side views (partially sectional views) showing the distal side of the needle mechanism 2H.

As shown in FIGS. 36 to 37, an inclined portion 23 is provided at the distal end of the hollow member 22H. The inclined portion 23 of the hollow member 22H functions as a portion that punctures a suture target. As the configuration of the inclined portion 23, the configuration described in the seventh embodiment can be employed.

38 to 39, it is preferable that a groove 27 is provided at the distal end of the insertion member 25H. By the groove portion 27 of the insertion member 25H, at least a part of the entrance / exit portion 12, the passage 13 and the terminal portion 14 for holding the filament 70 can be formed.

The depth of the groove 27 of the insertion member 25H is not particularly limited as long as the depth is equal to or greater than the diameter of the thread 70, but from the viewpoint of ease of processing, strength of the needle mechanism, and ease of holding the thread 70. To the radius of the hollow member 22H. The width of the groove 27 of the insertion member 25H is not particularly limited as long as it is equal to or larger than the diameter of the thread 70, but is three times or more the diameter of the thread 70 from the viewpoint of ease of processing and the strength of the needle mechanism, or 5 It is preferably at least twice, preferably at most 8 times, or at most 10 times.

The groove portion 27 of the insertion member 25H is formed by three inner walls of a bottom wall 27A, a distal side wall 27B, and a proximal side wall 27C. The distal side wall 27B and the proximal side wall 27C of the groove portion 27 may be formed perpendicular to the axial direction of the needle mechanism 2H as shown in FIG. 38, and are inclined with respect to the axial direction of the needle mechanism 2H. It may be formed.

It is preferable that a semi-cylindrical portion 28 is provided closer to the proximal side than the proximal end of the inclined portion 23 of the hollow member 22H. The semi-cylindrical portion 28 is preferably a portion starting from the proximal end of the inclined portion 23 in a side view in which the long axis of the hollow member 22H is in the horizontal direction. In the side view, the semi-cylindrical portion is preferably linear along the long axis of the hollow member 22H, and may be linear or curved inclined with respect to the axial direction. The passage 13 can be formed in the needle mechanism 2 by exposing the groove portion 27 of the insertion member 25H and the distal portion of the groove portion 27 from the semi-cylindrical portion 28 of the hollow member 22H in the axial direction of the needle mechanism 2H. it can. Here, the exposure means a state in which the groove portion 27 of the insertion member 25H is disposed on the distal side of the proximal end of the semi-cylindrical portion 28, and the distal side wall 27B and the semi-cylindrical portion 28 of the insertion member 25H are arranged. This includes both the case where the proximal side wall 28C faces (FIG. 40) and the case where it does not face (FIG. 41). Moreover, the width | variety of the channel | path 13 or the entrance / exit part 12 can be narrowed by adjusting the position and rotation angle of the axial direction of the insertion member 25H. That is, in the needle mechanism 2H, the capturing part 15 is configured by the hollow member 22H and the insertion member 25H.

39, the insertion member 25H may have a flat portion 29 on the distal side. In that case, the flat portion 29 is preferably provided with a groove portion 27. Since the passage 13 is not formed in the needle mechanism 2 by rotating the insertion member 25H with respect to the hollow member 22H, the holding of the thread-like object 70 can be easily released.

The thickness of the flat portion 29 is preferably smaller than the maximum outer diameter of the insertion member 25H, more preferably not more than three-quarters of the maximum outer diameter of the insertion member 25H, and more preferably not more than two-thirds. The size is preferred. The thickness of the flat portion 29 may be constant in the axial direction of the insertion member 25H, or may decrease toward the distal end.

In the axial direction, the flat portion 29 of the insertion member 25H preferably has a length equal to or shorter than the semi-cylindrical portion 28 of the hollow member 22H. Accordingly, when the insertion member 25H is rotated with respect to the hollow member 22H, the height at which the distal portion of the insertion member 25H is exposed from the semi-cylindrical portion 28 becomes lower than the groove portion 27. Can be released smoothly. The exposed height is the distance between the plane parallel to the axial direction of the semi-cylindrical portion 28 and the point farthest from the plane parallel to the axial direction of the semi-cylindrical portion 28 among the exposed portions of the flat portion 29. That is. In order to lower the height at which the distal portion is exposed from the semi-cylindrical portion 28 than the groove portion of the insertion member 25H, the distal side wall 27B of the insertion member 25H and the proximal side wall 28C of the semi-cylindrical portion 28 are surfaces. The insertion member is rotated so that the facing portion is small.

A method for gripping the thread-like object 70 by the needle mechanism 2H will be described with reference to FIGS. In the axial direction, the insertion member 25H is moved more proximally than the groove 24 of the hollow member 22H. Alternatively, the distal portion of the insertion member 25H is disposed more distally than the proximal end of the semi-cylindrical portion 28 of the hollow member 22H. At this time, the insertion member 25H is hollow so that the height at which the distal portion of the insertion member 25H is exposed from the semi-cylindrical portion 28 is made as low as possible and the thread 70 is easily guided to the semi-cylindrical portion 28. It is preferable to rotate the member 22H. That is, it is preferable that the depth direction of the groove portion 24 of the insertion member 25H is rotated so as to be parallel to a plane parallel to the axial direction of the semi-cylindrical portion 28.

By disposing a part of the thread 70 on the distal side of the needle mechanism 2H and moving the needle mechanism 2H to the distal side, a part of the thread 70 is guided to the inclined portion 23 of the hollow member 22H. Thus, the hollow member 22H is caught by the proximal side wall 28C which is a surface perpendicular to the axial direction at the proximal end of the semi-cylindrical portion 28 of the hollow member 22H. Next, when the insertion member 25H is rotated with respect to the hollow member 22H and the height at which the distal portion is exposed from the semi-cylindrical portion 28 is higher than the groove portion of the insertion member 25H, the hollow member 22H and the insertion are inserted. The passage 13 is formed by the member 25H. That is, when the depth direction of the groove portion 24 of the insertion member 25H is rotated so as to be perpendicular to the plane parallel to the axial direction of the semi-cylindrical portion 28, the passage 13 is formed by the hollow member 22H and the insertion member 25H. The When the hollow member 22H is further moved to the distal side, the width of the passage 13 is narrowed. As shown in FIG. 40, the thread-like material 70 is held by sandwiching the thread-like material 70 at two locations, the distal side wall 27B of the groove portion 27 of the insertion member 25H and the proximal side wall 28C of the semi-cylindrical portion 28 of the hollow member 22H. can do.

As shown in FIG. 41, when the insertion member 25H is rotated with respect to the hollow member 22H and the height at which the distal portion of the insertion member 25H is exposed from the semi-cylindrical portion 28 is lower than the groove portion 27, the filamentous material is obtained. 70 is released from the needle mechanism 2H. That is, when the depth direction of the groove portion 24 of the insertion member 25H is rotated so as to be parallel to a plane parallel to the axial direction of the semi-cylindrical portion 28, the thread-like object 70 is released from the needle mechanism 2H.

(Ninth Embodiment of Needle Mechanism)
The needle mechanism 2 (2I) according to the ninth embodiment will be described with reference to FIGS. The needle mechanism 2 (2I) has a hollow member 22 (22I) and an insertion member 25 (25I) provided inside the hollow member 22I. The hollow member 22I and the insertion member 25I are provided with

groove portions

24 and 27, respectively. 42 to 43 respectively show a side view and a perspective view of the distal side of the hollow member 22I. FIG. 44 shows a perspective view of the distal side of the insertion member 25I. 45 to 47 are enlarged side views (partially sectional views) of the distal side of the needle mechanism 2 (2I) according to the ninth embodiment.

42 to 43, an inclined portion 23 is provided at the distal end portion of the hollow member 22I. Moreover, as shown in FIG. 44, the inclined part 26 is provided also in the distal end part of the insertion member 25I. As configurations of the inclined portion 23 of the hollow member 22I and the inclined portion 26 of the insertion member 25I, the configurations described in the seventh embodiment can be employed.

In the axial direction, the length of the inclined portion 23 of the hollow member 22I and the length of the inclined portion 26 of the insertion member 25I may be the same or different. It suffices that at least one of the

inclined portions

23 and 26 functions as a portion that punctures the suture target. 45 to 47, the inclined portion 23 of the hollow member 22I is formed longer in the axial direction than the inclined portion 26 of the insertion member 25I.

Further, the inclined portion 23 of the hollow member 22I and the inclined portion 26 of the insertion member 25I may have the same or different inclination angles. These inclination angles may be, for example, 45 degrees or more, 60 degrees or more, 70 degrees or more, and even if they are 85 degrees or less or 80 degrees or less. 45 to 47 show examples in which the inclination angle of the inclined portion 23 is smaller than the inclination angle of the inclined portion 26. FIG.

In the seventh to eighth embodiments, the groove portion is provided in one of the hollow member 22 and the insertion member 25, whereas in the ninth embodiment, the groove portion 24 is provided in both the hollow member 22I and the insertion member 25I. , 27 is different. In the seventh to eighth embodiments, the proximal side walls (24C, 27C) and the distal side walls (24B, 27B) of the

groove portions

24, 27 of the hollow member 22I or the insertion member 25I are arranged with respect to the axial direction of the needle mechanism 2. However, the ninth embodiment is different in that the side wall forming the groove is formed so as to be inclined with respect to the axial direction of the needle mechanism 2.

The depth and width of the groove 24 of the hollow member 22I can be set similarly to the hollow member 22I of the seventh embodiment. Further, the depth and width of the groove 27 of the insertion member 25I can be set similarly to the insertion member 25I of the eighth embodiment.

It is preferable that at least one of the distal side wall 24B and the proximal side wall 24C constituting the groove 24 of the hollow member 22I is inclined with respect to the axial direction. In addition, it is preferable that at least one of the distal side wall 27B and the proximal side wall 27C of the groove portion 27 of the insertion member 25I is inclined with respect to the axial direction. In this way, by inclining the inner wall of the groove portion of the hollow member 22I or the insertion member 25I, the thread-like material 70 can be easily held and released.

In the hollow member 22I, it is preferable that one of the distal side wall 24B and the proximal side wall 24C of the groove portion 24 is inclined with respect to the axial direction, and the other is perpendicular to the axial direction. Similarly, in the insertion member 25I, it is preferable that one of the distal side wall 27B and the proximal side wall 27C of the groove portion 27 is inclined with respect to the axial direction and the other is perpendicular to the axial direction. By adjusting the inclination angles of the distal side wall and the proximal side wall of the groove portion in this way, it becomes easier to hold and release the filament 70.

As shown in FIGS. 45 to 47, the distal side wall 24B of the groove portion 24 of the hollow member 22I is inclined distally with respect to the axial direction, and the proximal side wall 27C of the groove portion 27 of the insertion member 25I is axial. It is preferable to incline proximally with respect to the direction. In that case, it is preferable that the proximal side wall 24C of the groove part 24 of the hollow member 22I and the distal side wall 27B of the groove part 27 of the insertion member 25I are each formed perpendicular to the axial direction. The filament 70 is sandwiched between the proximal side wall 24C of the groove 24 of the hollow member 22I and the distal side wall 27C of the groove 27 of the insertion member 25I, that is, two side walls formed perpendicular to the axial direction. If held, it is possible to prevent the filamentous material 70 from falling off the needle mechanism 2I. On the other hand, the width of the passage 13 is determined by the distal side wall 24B of the groove part 24 of the hollow member 22I and the proximal side wall 27C of the groove part 27 of the insertion member 25I, that is, two side walls inclined with respect to the axial direction. Becomes narrower inward in the radial direction. For this reason, the thread-like object 70 is easily pushed outward in the radial direction, and the thread-like object 70 is easily released from the needle mechanism 2I. By adjusting the axial position and rotation angle of the insertion member 25I with respect to the hollow member 22I, the width of the passage 13 and the entrance / exit part 12 can be reduced. That is, also in the needle mechanism 2I, the capturing part 15 is configured by the hollow member 22I and the insertion member 25I.

A method for holding and releasing the thread-like material 70 by the needle mechanism 2I will be described with reference to FIGS. It arrange | positions so that the groove part 24 of the hollow member 22I and the groove part 27 of the insertion member 25I may overlap in an axial direction and the circumferential direction.

By disposing a part of the thread 70 on the distal side of the needle mechanism 2I and moving the needle mechanism 2I to the distal side, a part of the thread 70 is guided to the inclined portion of the hollow member 22I. The inlet / outlet part 12 constituted by the groove part 24 of the hollow member 22I and the groove part 27 of the insertion member 25 is reached. Further, by moving the hollow member 22I to the distal side, as shown in FIG. 45, the filament 70 enters the passage 13 constituted by the groove 24 of the hollow member 22I and the groove 27 of the insertion member 25I. Next, the insertion member 25I is moved proximally with respect to the hollow member 22I. As shown in FIG. 46, the filament 70 can be held by sandwiching the filament 70 between the proximal side wall 24C of the groove 24 of the hollow member 22I and the distal side wall 27B of the groove 27 of the insertion member 25I.

As shown in FIG. 47, when the insertion member 25I is moved distally with respect to the hollow member 22I, the distal side wall 24B of the inclined groove portion 24 of the hollow member 22I and the groove portion 27 of the insertion member 25I are provided. The width of the passage 13 formed by the proximal side wall 27 C is narrowed, and the filament 70 is pushed out of the needle mechanism 2 I. In this way, the holding of the thread-like material 70 can be released.

In the sixth embodiment of the needle mechanism, the configuration example in which the inlet / outlet part 12, the passage 13, and the terminal part 14 are formed in the hollow member 22 is shown. In the seventh to ninth embodiments of the needle mechanism, the configuration example in which the inlet / outlet portion 12, the passage 13, and the terminal portion 14 are formed by the hollow member 22 and the insertion member 25 is shown. Although not shown, the inlet / outlet part 12, the passage 13, and the terminal part 14 may be formed in the insertion member 25. In any embodiment, the filamentous material 70 can be held and released.

(2) Threaded material holding member The threaded material holding member is a member provided to hold the threaded material 70 on the distal side of the suture object. The thread holding member only needs to have a mechanism capable of holding and releasing the thread 70. For example, a mechanism (not shown) having a slit for hanging the thread 70 and a stopper for preventing the thread 70 from dropping from the slit, a plurality of arms arranged in a circle gather in the diameter reducing direction, or increase in diameter A mechanism (not shown) for holding and releasing the thread-like material 70 by spreading in the direction, a mechanism for pressing the thread-like material 70, a mechanism for hanging the thread-like material 70, and the like.

The material of the thread-like material holding member is preferably biocompatible, for example, more preferably a metal material such as stainless steel or a resin material, and stainless steel from the viewpoint of anti-rust property and ease of processing. More preferably.

First, an example in which the thread-like material 70 is held by rotating the thread-like material holding member to hold and release the thread-like material 70 will be described. The thread-like material holding member contacts and holds the thread-like material by hooking the thread-like material onto the thread-like material holding member or pressing the thread-like material against an insertion portion described later. FIG. 48 shows a perspective view of the thread holding member according to the present invention, and FIGS. 49 to 50 show perspective views when the thread holding member is incorporated in the apparatus.

A thread holding member 30 (30A) shown in FIG. 48 is provided on a rotation shaft 31 having a first direction (described later) as an axis and on one side of the rotation shaft 31, and an operation unit (third operation) A fixing part 32 that is directly or indirectly connected to the part) and a pressing part 33 that is provided on the other side of the rotary shaft 31 and presses the filament 70.

The filament holding member 30A is provided on the distal side of the device 1 (housing 50). The housing 50 is formed in a shape capable of holding the filamentous material holding member 30A. In the thread-like material holding member 30 A, the axial direction of the rotary shaft 31 is arranged perpendicular to the axial direction of the needle mechanism 2. In addition, although the needle mechanism 2 demonstrates below using the structural example which has the needle member 10 and the inner cylinder member 20, the aspect of the needle mechanism 2 is not limited to this, The various aspect mentioned above is employ | adopted. can do.

The fixed portion 32 provided on one side across the rotating shaft 31 is connected to an operating portion (not shown) on the hand side via a connecting member 40. The connection between the fixing portion 32 and the connecting member 40 is, for example, mechanical fixing by fitting, screwing, caulking, etc., welding by laser, metal brazing, etc., adhesives such as polyurethane, epoxy, cyano, silicone, etc. It is possible to use a method such as adhesion using The shape of the connecting member 40 is not particularly limited as long as it extends in the perspective direction of the device 1, and may be a plate-like member as shown in FIGS. 49 to 50, or a linear member such as a wire. Or a rod-shaped member. The thread holding member 30 A and the connecting member 40 are disposed below the needle mechanism 2, but may be disposed above the needle mechanism 2. 49 to 50, the thread-like material holding member 30A and the connection member 40 are held in the housing 50, but may be provided outside the housing 50.

The pressing portion 33 can be formed in a plate shape or a lump shape, for example, but is preferably formed in a plate shape from the viewpoint of weight reduction.

The plate-shaped pressing portion 33 has a first main surface 33A that is most likely to come into contact with the filament 70, a second main surface 33B on the opposite side, and a side surface 33C. The surface of the pressing portion 33 may be flat or uneven. In order to prevent the filamentous material 70 from falling off the filamentous material holding member 30, it is preferable that the first main surface 33A and / or the side surface 33C of the pressing portion 33 be provided with irregularities. Alternatively, the thread holding member 30, preferably the pressing portion 33, may be provided with a groove or a protrusion for holding the thread 70.

The operation of the thread holding member 30A will be described with reference to FIGS. In FIG. 49 in which the connecting member 40 that connects the thread-like material holding member 30 and the operation portion is moved to the distal side, the fixing portion 32 is disposed on the distal side with respect to the rotating shaft 31, and the proximal side is located. A pressing portion 33 is disposed. In the vertical direction of the device 1, the pressing portion 33 is disposed between the needle mechanism 2 and the connection member 40. In the thread holding member 30A, the first main surface 33A of the pressing portion 33 faces the needle mechanism 2 side, and the second main surface 33B faces the connecting member 40 side. When the operation member is operated to move the connection member 40 to the proximal side, the fixing portion 32 connected to the connection member 40 is moved to the proximal side around the rotation shaft 31. Then, the pressing portion 33 rotates about the rotation shaft 31 so that the first main surface 33A of the pressing portion 33 faces the distal side and the second main surface 33B faces the proximal side as shown in FIG. Be placed.

The distal end of the housing 50 is preferably provided with an insertion portion 51 through which at least the distal end portion of the needle mechanism 2 of the housing 50 is inserted. When the thread 70 is moved to the distal side of the object to be sutured using the needle mechanism 2, the thread 70 is folded back in the axial direction of the needle mechanism 2 along the shape of the insertion portion 51 of the housing 50. A midway part (folding part 71) is arranged. The thread 70 is stretched in the direction of pushing the wall surface at a location where the thread 70 is in contact with the wall surface of the insertion portion 51 due to the tension. Thereby, the folding | returning part 71 is settled in the insertion part 51, and it can prevent that the filament 70 moves to the direction which is not intended, and becomes difficult to hold | maintain. The size of the insertion portion 51 may be larger than the outer diameter of the needle mechanism 2, but in order to firmly hold the thread-like material 70 by the thread-like material holding member 30, the maximum of the pressing portion 33 of the thread-like material holding member 30 is sufficient. The outer diameter is preferably 80% or more of the size of the insertion portion 51, and more preferably 90% or more. Here, the size of the insertion part 51 means the maximum diameter in a cross section perpendicular to the extending direction of the insertion part 51.

In order to firmly hold the thread-like material 70 by the thread-like material holding member 30A, the side surface 33C of the pressing portion 33 of the thread-like material holding member 30A and the insertion portion 51 in a state where the thread-like material 70 is held by the thread-like material holding member 30A. It is preferable to sandwich the thread 70.

The extending direction of the rotary shaft 31 provided in the thread holding member 30A is not particularly limited, but the passage 13 penetrates in one direction (M direction) perpendicular to the axial direction (L direction) of the needle mechanism 2. The filament holding member 30A has a first direction other than the direction (A direction) perpendicular to the two directions of the axial direction (L direction) of the needle mechanism 2 and the penetration direction (M direction) of the passage 13. It is preferable to rotate as FIG. 51 is a perspective view showing a direction perpendicular to the axial direction of the needle mechanism 2 and the penetrating direction of the passage 13. A portion of the thread-like object 70 that remains in the passage 13 of the needle mechanism 2 is released from being held by the needle mechanism 2 and moved to the distal side from the proximal side when the needle mechanism 2 is moved to the distal side. It is easy to extend along the virtual plane VP formed by the axial direction (L direction) of the needle mechanism and the penetration direction (M direction) of the passage. When the thread-like object holding member 30A is rotated in the direction B, for example, about a direction (A direction) perpendicular to the virtual plane VP entering the passage 13 of the needle mechanism 2, the pressing portion 33 of the thread-like object holding member 30A is moved to the thread 70. This is because the pressing portion 33 is less likely to come into contact with the thread-like object 70 because it moves substantially along the extending direction.

In order to make it easier to hold the thread 70 on the distal side of the suture object 100, as shown in FIGS. 49 to 50, the first direction that is the rotation shaft 31 of the thread holding member 30A is the needle mechanism 2. It is preferable that it is perpendicular | vertical to the axial direction (L direction) of this, and perpendicular | vertical also to the A direction mentioned above. That is, it is preferable that the first direction is a through direction of the passage 13.

The shape of the thread holding member 30A is not limited as long as the thread holding member 30A can be held and released by rotating the thread holding member 30A. 52 to 53 show perspective views of an apparatus using another embodiment of the thread-like material holding member. In order to make it easier to visually recognize the movement of the thread-like material holding member, the thread-like material is omitted in FIGS. For example, in FIGS. 48, 49, and 50, the fixed portion 32 is provided on one side with the rotation shaft 31 in between, and the pressing portion 33 is provided on the other side, but this is not limitative. For example, as shown in FIGS. 52 and 53, the thread-like object holding member 30 (30B) includes a pressing part 33 that presses the thread-like object and a rotating shaft 31 that rotates the pressing part 33. You may have the fixing | fixed part 32 connected directly or indirectly to the operation part. In this case, it is preferable that the pressing portion 33 is plate-shaped, and the fixing portion 32 that fixes the distal end portion of the connection member 40 is provided on the second main surface 33B of the pressing portion 33. 52 to 53, a bent connection member 40 (40A) is fixed to the second main surface 33B of the pressing portion 33. On the other hand, the connection member 40C is connected and fixed to the operation portion, and the connection member 40B connected to the

connection members

40A and 40C via the rivet 41 rotates. The shape and the number of the connecting members 40 are not particularly limited as long as the pressing portion can be rotated. The connection method between the

connection members

40A and 40B and 40C, the fixing method of the second main surface 33B of the connection member 40 and the pressing portion 33, and the connection method of the connection member 40 and the operation portion are the same as those described above. Without limitation, it can be selected from rivets, connection using screws and nuts, welding, fixing using an adhesive, and the like. As shown in FIG. 52, in a state where the connection member 40 is moved to the proximal side, the fixing portion 32 and the pressing portion 33 are disposed on the proximal side with respect to the rotation shaft 31. In the thread holding member 30B, the first main surface 33A of the pressing portion 33 faces the side surface of the needle mechanism 2 (the upper side of the device 1), and the second main surface 33B faces the lower side of the device 1. When the operation member is operated to move the connecting member 40 to the distal side as shown in FIG. 53, the fixing portion 32 connected to the connecting member 40 is moved to the distal side with the rotation shaft 31 as the center. If it does so, the holding | suppressing part 33 will rotate centering on the rotating shaft 31, and it arrange | positions so that 33 A of 1st main surfaces of the pressing part 33 may face a distal side, and the 2nd main surface 33B may face a proximal side.

As with the needle mechanism 2, the material of the thread-like material holding member 30 is preferably a metal material such as stainless steel or a resin material, and stainless steel is particularly preferable from the viewpoint of anti-rust property and ease of processing.

The shape of the thread holding member that holds the thread 70 by the rotation operation is not limited to the form shown in FIGS. 54 to 55 show perspective views of an apparatus using the filamentous material holding member of still another embodiment. For example, as shown in FIGS. 54 to 55, the thread-like material holding member 30 (30C) is provided on the rotating shaft 31 and one side of the rotating shaft 31, and is directly or indirectly connected to the operation unit. A fixing portion (not shown), and a pressing portion 33 that is provided on the other side of the rotating shaft 31 and presses the filamentous material 70. The pressing portion 33 has a plane including the axial direction of the rotation shaft 31. In this case, it is preferable that the proximal end part of the rotating shaft 31 is connected to the operation part.

54 to 55, the first direction A of the rotating shaft 31 may be parallel to the axial direction of the needle mechanism 2. The holding portion 33 is provided at the distal end portion of the rotation shaft 31. The pressing portion 33 is formed in a plate shape, and includes a first main surface 33A, a second main surface 33B opposite to the first main surface 33A, and a side surface connecting the first main surface 33A and the second main surface 33B. 33C. 54, the first main surface 33A of the pressing portion 33 faces the needle mechanism 2 side (the upper side of the device 1), and the second main surface 33B faces the lower side of the device 1.

As shown in FIG. 55, when the rotation shaft 31 of the filamentous material holding member is rotated clockwise (clockwise) when viewed from the proximal side, the first main surface 33A of the pressing portion 33 turns the folded portion 71 of the filamentous material 70. To touch. For this reason, the thread-like object 70 can be held by being sandwiched between the pressing portion 33 and the wall of the insertion path.

54 to 55, the rotating shaft 31 extends in the perspective direction of the device 1. However, the rotating shaft 31 is provided only at the distal end of the device 1, and the rotating shaft 31 is interposed via another member. It may be connected to the operation unit.

An example of holding and releasing the thread-like material 70 by sliding the thread-like material holding member will be described with reference to FIGS. 56 to 57 show perspective views of the apparatus 1 using the thread-like material holding member of still another embodiment.

As shown in FIGS. 56 to 57, the thread-like object holding member 30 (30D) hangs between the fixing part 32 (not shown) directly or indirectly connected to the operation part and the middle part of the thread-like object 70. And a hook portion 34. Since there is no need to provide a rotation mechanism, the apparatus 1 can be configured more simply. It is preferable that the thread-like object holding member 30 slides in a direction perpendicular to the axial direction of the needle mechanism 2 and hooks the middle part (folded part 71) of the thread-like object 70. As a result, even when the distal side cannot be seen under the endoscope, the filament 70 can be easily hooked and held on the distal side of the suture object 100.

The thread-like material holding member 30 is formed in a rod shape extending in the perspective direction of the device 1 and is held in the hollow portion 52 of the housing 50. At the distal end portion of the thread-like material holding member 30, a hooking portion 34 that hooks a folded portion 71 that is an intermediate portion of the thread-like material 70 is provided. The hollow portion 52 of the housing 50 extends in the perspective direction as a whole, and is bent toward the direction perpendicular to the axial direction of the needle mechanism 2 at the distal end portion. 56 to 57, the thread holding member 30 is made of an elastic material. Therefore, when the operating part is operated to move the filament holding member 30 to the distal side, the hook 34 is bent along the shape of the hollow part 52 of the housing 50 as shown in FIG. A midway portion 70 (folded portion 71) can be hooked.

56 to 57, the thread holding member 30 has a rod shape extending over the entire perspective direction of the device 1 and is described with an example in which the proximal end is connected to the operation unit. Alternatively, it may be connected to the operation unit via another member. Moreover, the said separate member may be extended in the perspective direction of the apparatus 1, and the filament holding member 30 formed from the elastic material may be provided in the distal end part of the separate member.

The hook portion 34 of the thread-like material holding member 30D is preferably formed from an elastic material. As the elastic material, for example, an organic material such as silicone rubber or polyamide elastomer, or a metal material such as stainless steel can be used. An elastic wire, a stranded wire, etc. can also be used as the filamentous material holding member 30D.

(3) Case The case 50 arranges at least a part of the filamentous material holding member 30 inside, and suppresses direct contact between each member and the living tissue. The case 50 extends in the perspective direction.

The length of the casing 50 in the perspective direction can be adjusted according to the distance from the user's hand to the stitching target 100, but when used for TSS, the length of the casing 50 in the perspective direction is, for example, It can be 5 cm or more and 50 cm or less.

As shown in FIGS. 1 and 2, the housing 50 preferably has a handle portion 53 that is gripped by the user's hand on the proximal side. The length from the distal end of the housing 50 to the handle portion 53 may be set with reference to the distance from the operator's hand side to the suture position, and may be, for example, 10 cm or more and 80 cm or less. In TSS, what is necessary is just to set with reference to the distance from a pituitary gland to a nostril, for example, 20 cm or more and 50 cm or less are preferable.

The material of the housing 50 is more preferably a metal material such as stainless steel or a resin material, like the thread-like material holding member 30.

(4) Positional relationship between the needle mechanism and the filamentous material holding member The distal end of the needle mechanism 2 is located closer to the proximal side than the filamentous material holding member 30 so as not to inadvertently damage the suture object 100 such as a biological tissue. The suture object 100 is placed between the needle mechanism 2 and the thread-like object holding member 30 in the state of being moved to the position. The separation distance from the distal end of the needle mechanism 2 to the proximal end of the filament holding member 30 needs to be larger than the thickness of the suture object 100 in the perspective direction of the device 1. When used for TSS, the separation distance from the distal end of the needle mechanism 2 to the proximal end of the filament holding member 30 in a state where the needle mechanism 2 is moved to the most proximal side is, for example, 0.5 mm. It can be set to 10 mm or less. On the other hand, the distance from the distal end of the needle mechanism 2 to the distal end of the filament holding member 30 when the needle mechanism 2 is moved to the most distal side is the suture object 100 on the distal side of the device 1. In order to prevent inadvertently damaging other living tissues or the like, for example, it is preferably within 10 mm.

(5) Operation part The present invention includes the device 1 connected to the proximal side of the needle mechanism 2 and provided with a first operation part 61 for moving the needle mechanism 2 in the perspective direction. 1 to 2 show examples in which the first operating portion 61 is a lever. When the lever is pulled proximally, the needle mechanism 2 moves to the distal side, and when the lever is returned to the distal side, the needle mechanism 2 Is adapted to move proximally.

When the needle mechanism 2 has a plurality of members, one member may be connected to the first operation unit 61 and the other member may be connected to the second operation unit. For example, as shown in FIG. 10, when the filamentous material 70 is held by the needle mechanism 2 having the hollow needle member 10 and the inner cylinder member 20 disposed inside the needle member 10, the needle member 10 may be connected to the first operation unit 61. In that case, it is preferable that the apparatus 1 is provided with the 2nd operation part which rotates the inner cylinder member 20 with respect to the needle member 10, or moves to a perspective direction.

The first operation unit 61 may also function as the second operation unit. That is, the first operation unit 61 may be connected to a plurality of members, for example, both the needle member 10 and the inner cylinder member 20. Thereby, both the operation of moving the needle member 10 in the perspective direction and the rotation or movement operation of the inner cylinder member 20 can be performed by the first operation unit 61.

The present invention includes a device 1 that is connected to the thread-like material holding member 30 and is provided with a third operation unit 63 for holding and releasing the thread-like material 70. When the third operation portion 63 is pulled proximally, the thread-like material 70 can be held or released.

As the first operation unit 61 to the third operation unit 63, various input means can be used, for example, a trigger (lever), a slider, a dial (a rotating body including a gear), a button, and the like. In addition, an input on / off operation or an input amount adjustment may be performed using a motor or an electronic component, the operation unit may be operated by a robot hand, or the operation unit may be installed outside the casing.

When using the same type of input means as the first operation unit 61 to the third operation unit 63, it is preferable that the user can easily grasp which operation unit is at hand. For example, when both the first operation unit 61 and the third operation unit 63 are levers, the length of the lever of the first operation unit 61 can be made shorter than the length of the lever of the third operation unit 63. In order to make the operation feeling of the user coincide with the member arrangement in the actual device 1, it is preferable that the first operation unit 61 is provided more proximally than the third operation unit 63.

2. The operation method of the medical bidirectional suturing device is a medical bidirectional suturing device having a perspective direction, extending in the perspective direction, and having a distal end distally. A needle mechanism on the side and a thread holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism is provided on a path through which the thread passes and on one side of the path Preparing a medical bidirectional suturing device having an entrance / exit part, a terminal part provided on the other side of the passage, and a capturing part for narrowing the passage or the entrance / exit part, and holding the filament by the capturing part of the needle mechanism A step of moving the needle mechanism to the distal side to move the filamentous material to the distal side of the object to be sutured, a step of releasing the retention of the filamentous material by the capturing part of the needle mechanism, A step for moving the distal end more proximally than the suture object. And holding the filamentous material by the filamentous material holding member on the distal side of the object to be sutured.

Further, the operation method of the medical bidirectional suturing device of the present invention is a medical bidirectional suturing device having a perspective direction, extending in the perspective direction, and a needle mechanism having a distal end on the distal side, A thread holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism includes a passage through which the thread passes, an entrance / exit portion provided on one side of the passage, and the other of the passage A step of preparing a medical bidirectional suturing device having a terminal portion provided on the side and a capturing portion for narrowing a passage or an entrance / exit port, and a needle mechanism in a state where the filamentous material is not held by the filamentous material holding member A step of moving the distal end of the needle mechanism, a step of holding the filament by the capturing part of the needle mechanism, and a step of moving the distal end of the needle mechanism to the proximal side of the suture target. It is characterized by having.

Furthermore, the operation method of the medical bidirectional suturing device of the present invention is a medical bidirectional suturing device having a perspective direction, extending in the perspective direction, and a needle mechanism having a distal end on the distal side, A thread holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism includes a passage through which the thread passes, an entrance / exit portion provided on one side of the passage, Providing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage, and a capturing portion for narrowing the passage or the entrance / exit port; and exchanging the needle mechanism with another needle mechanism; It is characterized by having.

Hereinafter, the operation method of the above apparatus will be described in detail with reference to FIGS. 58 to 69 are explanatory views of the operating method of the suturing apparatus. In addition, about each member which comprises an apparatus, it is as having described in "1. Bidirectional suture device for medical treatment" of this specification.

(1) Preparation of device First, a medical bi-directional suturing device having a perspective direction, extending in the perspective direction, a needle mechanism 2 having a puncture portion 11 on the distal side, and a distal side of the suturing device A medical bidirectional suturing device 1 having a thread-like material holding member 30 provided on the side is prepared (step S1). The needle mechanism 2 includes a passage 13 through which the thread-like material 70 passes, an entrance / exit portion 12 provided on one side of the passage 13, a terminal portion 14 provided on the other side of the passage 13, and a capturing portion that narrows the passage 13 or the entrance / exit portion 12. 15. Hereinafter, the needle mechanism 2 will be described by taking an example of the needle member 10 in which the inner cylinder member 20 is disposed on the inner side. However, the aspect of the needle mechanism 2 is not limited thereto.

(2) Suture from proximal side to distal side As shown in FIG. 58, the thread-like material 70 is held by the capturing portion 15 of the needle mechanism 2 (step S2). Specifically, the middle part of the thread 70 is inserted into the passage 13 from the inlet / outlet part 12 of the needle mechanism 2, and the thread 70 is held by the capturing part 15. If it does so, the thread-like thing 70 can remain in the channel | path 13 in the state folded in the axial direction of the needle mechanism 2. FIG. In FIG. 58, the inner cylindrical member 20 disposed inside the hollow needle member 10 functions as the capturing unit 15. The distal end of the inner cylinder member 20 does not move further to the distal side than the distal end of the needle member 10. For example, in FIG. 58, the inlet / outlet part 12 of the passage 13 is provided at the distal end of the needle member 10, and the opening 21 extending to the distal end is formed on the side part of the inner cylinder member 20. Yes. By pulling the lever that is the first operation portion proximally and rotating the inner cylinder member 20 with respect to the needle member 10, the region where the passage 13 of the needle member 10 and the opening 21 of the inner cylinder member 20 overlap is narrowed. Therefore, the thread-like object 70 can be held by the needle mechanism 2.

As shown in FIG. 59, the needle mechanism 2 is moved to the distal side, and a part of the filamentous material 70 is moved to the distal side from the suture object 100 (step S3). Specifically, by passing the needle mechanism 2 holding the thread-like object 70 through the suture object 100, the folded portion 71 of the thread-like object 70 can be arranged on the distal side of the suture object 100. When the needle mechanism 2 is composed of a plurality of members, it suffices to penetrate the suture object 100 of at least one member. According to the operation method of the suturing device 1 of the present invention, the folded portion 71 that can easily hold the thread-like object 70 can be disposed on the distal side of the suturing object 100. Even so, the thread-like material 70 can be easily held.

As shown in FIG. 60, the holding of the filament 70 by the capturing unit 15 of the needle mechanism 2 is released (step S4). Even if the thread-like object 70 is not held by the needle mechanism 2, since the thread-like object 70 is fixed by penetrating the suture object 100, it is possible to prevent the thread-like object 70 from moving unintentionally. Release of holding of the thread-like object 70 by the needle mechanism 2 is performed, for example, by rotating the inner cylinder member 20 disposed inside the needle mechanism 2 in a direction opposite to that during holding (step S1). In order to prevent unintentional movement of the filament 70, it is preferable to arrange the device 1 so that the perspective direction is along the direction of gravity.

As shown in FIG. 61, the distal end of the needle mechanism 2 is moved more proximally than the suture object 100 (step S5). For preferred suturing, it is necessary to move only the needle mechanism 2 proximally without moving the filament 70 in the perspective direction. By moving the distal end of the needle mechanism 2 to the proximal side, the needle mechanism 2 is prevented from interfering with the holding of the filament 70 by the filament holding member 30 in step S6 described later.

62, the filamentous material 70 is held by the filamentous material holding member 30 on the distal side of the suture object 100 (step S6). Thereby, since the thread-like object 70 is reliably held at the distal side of the device 1, it is possible to prevent the thread-like object 70 from being detached from the suture object 100 even if the device 1 is moved. The proximal-to-distal suture is now complete. Here, when the work is finished, as shown in FIG. 63, the apparatus 1 is moved to the proximal side while holding the filament 70 with the filament holding member 30, thereby collecting one end of the filament 70. Can do.

(3) The suture from the distal side to the proximal side As shown in FIG. 64, it is different from the position where the needle mechanism 2 is punctured during the suture from the proximal side to the distal side described in the above item (2). The device 1 is moved so that the needle mechanism 2 is disposed at the position. In FIG. 64, in order to move the stitching position from the upper side to the lower side, the entire apparatus 1 is rotated and turned upside down. The steps after the apparatus 1 is turned upside down are divided into the following two types.
(A) As shown in FIG. 64, when the filamentous material holding member 30 is holding the filamentous material 70, the following step S7 and subsequent steps are performed.
(B) As shown in FIG. 65, when the filamentous material holding member 30 is not holding the filamentous material 70, the following step S8 and subsequent steps are performed.

65, the holding of the filament 70 by the filament holding member 30 is released (step S7). In step S8, which will be described later, the filament holding member 30 is prevented from obstructing the movement of the needle mechanism 2 toward the distal side.

As shown in FIG. 66, the needle mechanism 2 is moved further to the distal side than the suture object 100 in a state where the thread 70 is not held by the thread holding member 30 (step S8). At this time, the folded portion 71 of the filament 70 passes through the entrance / exit portion 12 of the needle mechanism 2 and is disposed in the passage 13 or the end portion 14. This makes it easier for the needle mechanism 2 to hold the thread 70 in step S9 described later.

As shown in FIG. 67, the thread-like object 70 is held by the capturing part 15 of the needle mechanism 2 (step S9). Thereby, even if the needle mechanism 2 is moved to the proximal side in step S10 to be described later, the thread-like object 70 can be prevented from dropping from the needle mechanism 2. Specifically, the folded portion 71 of the thread-like object 70 is preferably held by the capturing portion 15 of the needle mechanism 2. In addition, the method of holding the filament 70 with the needle mechanism 2 is the same as in step S2.

As shown in FIG. 68, the distal end of the needle mechanism 2 is moved closer to the suture object 100 (step S10). In this case, the needle mechanism 2 moves to the proximal side while holding the filament 70. Accordingly, the folded portion 71 of the thread-like object 70 is disposed on the proximal side of the suture object 100.

As shown in FIG. 69, the apparatus 1 is further moved to the proximal side, and the free end 72 of the filament 70 is pulled out to the proximal side of the suture object 100 (step S11).

Next, when continuing the suturing, the needle mechanism 2 can be performed from step S3 while holding the thread 70. The suture object 100 may be an object on the side where the filament 70 is passed from the distal side to the proximal side by the previous steps, or may be an object on the side passed from the proximal side to the distal side. Moreover, you may sew | sew another sewing target object which is not shown in figure through the step so far and which has not passed. The suture object 100 is determined by the operator comprehensively based on the purpose of the suture and the size and shape of the cut portion. When the suturing is completed, one side and the other side of the filamentous object 70 exposed on the proximal side of the suturing object 100 are pulled, and the suturing objects 100 are pulled together to produce a knot. Complete.

(4) Replacement of Needle Mechanism Although not shown, a step (S12) of replacing the needle mechanism 2 with another needle mechanism may be performed after the step (S1) of preparing the device 1. Thereby, since a new needle mechanism is attached to the device 1, the suture object can be sutured using the new needle mechanism. The needle mechanism before replacement and the new needle mechanism may be the same type or different types, and can be selected according to the procedure.

In the above description, the dural suture with TSS has been described as an example. For example, it can be used at any surgical position such as craniotomy, laparotomy, and thoracotomy, and without being limited to the use of an endoscope or a microscope. Furthermore, in the present invention, the operation unit has been described by taking an operation by a human being such as a doctor as an example. The biological tissue is not limited to membrane tissue such as dura mater, arachnoid membrane, pleura, pericardium, peritoneum, and includes all living tissue such as skin, blood vessel, lung, heart, digestive tract, bone, muscle, etc. be able to.

3. Method for Sustaining Biological Tissue The present invention includes a method for suturing the biological tissue 101 as follows, instead of the suturing device described in the section “1. Bidirectional suture device for medical use”. FIG. 70 is an explanatory diagram of the living tissue suturing method of the present invention. As shown in FIG. 70, the present invention is a method for suturing a living tissue 101 with a thread 70, and the first section 70 A and the second section 70 B of the thread 70 are arranged on the proximal side of the living tissue 101. And disposing the third section 70C between the first section 70A and the second section 70B on the distal side of the living tissue 101, and placing the third section 70C of the filament 70 on the proximal side of the living tissue 101. And moving to. According to the suturing method of the present invention, the third section 70 C (folded portion 71) of the thread-like material 70 that is easy to hold can be disposed on the distal side of the living tissue 101 as the suturing target. Even in a situation where the distal side cannot be seen under the mirror, the filament 70 can be easily held on the distal side of the living tissue 101.

This application claims the benefit of priority based on Japanese Patent Application No. 2016-163085 filed on August 23, 2016. The entire contents of the specification of Japanese Patent Application No. 2016-163085 filed on August 23, 2016 are incorporated herein by reference.

1: Medical

bidirectional suturing device

2, 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I: Needle mechanism 10: Needle member 11: Puncture part 12: Entrance / exit part 13: Passage 14: Terminal part 15 : Capture part 16: Protrusion 17: Narrow part 20: Inner cylinder member 21: Opening of inner cylinder member 22: Hollow member 23: Inclined part 24: Groove part 24A: Bottom wall, 24B: Distal side wall, 24C: Proximal side wall 25: Insertion member 26: Inclined portion 27: Groove 27A: Bottom wall, 27B: Distal side wall, 27C: Proximal side wall 28: Semi-cylindrical portion 28C of the hollow member: Proximal side wall 29: Flat portion 30 of the insert member : Thread-like material holding member 31: rotating shaft 32: fixed part 33: pressing part 33A: first main surface, 33B: second main surface, 33C: side surface 40: connecting member 50: housing 61: first operation part 63: 3rd operation part 70: Filamentous object 71: Folding part 100: Suture object

Claims

A medical bidirectional suturing device having a perspective direction, the needle mechanism extending in the perspective direction and having a distal end on a distal side, and provided on a distal side of the medical bidirectional suturing device A thread-like material holding member,
The said needle | hook mechanism has the channel | path through which a thread-like material passes, the entrance-and-exit part provided in the one side of this channel | path, and the terminal part provided in the other side of this channel | path, The medical bidirectional suture apparatus characterized by the above-mentioned.
The passage penetrates in one direction perpendicular to the axial direction of the needle mechanism,
The medical bi-directional suture according to claim 1, wherein the thread holding member rotates about a first direction other than a direction perpendicular to two directions of an axial direction of the needle mechanism and a penetrating direction of the passage. apparatus.
The medical bidirectional suturing device according to claim 2, wherein the first direction is perpendicular to an axial direction of the needle mechanism.
The medical bidirectional suturing device according to claim 2 or 3, wherein the first direction is a penetration direction of the passage.
The medical bidirectional suturing device according to claim 2, wherein the first direction is parallel to an axial direction of the needle mechanism.
Further, the medical bidirectional suturing device has an operation part on the proximal side,
The thread-like material holding member has a rotation shaft with the first direction as an axis,
A fixed portion that is provided on one side of the rotating shaft and is directly or indirectly connected to the operation portion;
The medical bidirectional suturing device according to any one of claims 2 to 5, further comprising a pressing portion that is provided on the other side of the rotating shaft and presses the filamentous material.
The medical bidirectional suturing device according to any one of claims 1 to 5, wherein the thread-like material holding member slides in a direction perpendicular to the axial direction of the needle mechanism and hangs the middle part of the thread-like material.
The medical bidirectional suturing device according to any one of claims 1 to 7, wherein the needle mechanism has a capturing part that narrows the passage or the entrance / exit part.
The needle mechanism includes a hollow member, and an insertion member that is provided inside the hollow member and is capable of moving back and forth in the axial direction with respect to the hollow member.
The passage, the entrance / exit part, and the terminal part are provided in the hollow member,
The doorway is at the distal end of the hollow member;
The medical suturing needle according to claim 8, wherein the capture portion is a proximal end portion of the passage.
The needle mechanism has a hollow member having an inclined portion at a distal end portion, and is provided inside the hollow member, and rotates around the axis of the hollow member and moves in the axial direction of the hollow member. An insertion member capable of at least one of the operations,
The medical bi-directional suture needle according to claim 8, wherein the entrance / exit part is provided on a more proximal side than the inclined part.
The medical bidirectional suturing device according to claim 10, wherein the capturing part is constituted by the hollow member and the insertion member.
The needle mechanism has a hollow shape, and has a needle member in which the inlet / outlet portion is provided at a distal end,
The capturing part is an inner cylinder member that is provided inside the needle member and rotates with respect to the needle member;
The medical bidirectional suturing device according to claim 8, wherein the inner cylindrical member has an opening extending to a distal end thereof.
The medical bidirectional suturing device according to claim 8, wherein the capturing part is a protrusion protruding radially inward of the needle mechanism.
The bidirectional suture device for medical use according to any one of claims 1 to 13, wherein the needle mechanism is provided with the end portion on the proximal side of the entrance / exit portion.
The medical bidirectional suturing device according to any one of claims 1 to 14, wherein the passage penetrates in a direction perpendicular to an axial direction of the needle mechanism.
The medical bidirectional suturing device according to any one of claims 1 to 15, wherein the passage extends along an axial direction of the needle mechanism.
A needle mechanism extending in the perspective direction and having a distal end on the distal side, and a thread-like material holding member provided on the distal side,
The needle mechanism includes a passage through which the filamentous material passes, an entrance / exit portion provided on one side of the passage, a terminal portion provided on the other side of the passage, and a capturing portion for narrowing the passage or the entrance / exit portion. Providing a medical bi-directional suture device;
Holding the filament by the catching portion of the needle mechanism;
Moving the needle mechanism distally to move the filamentous material distal to the suture object; and
Releasing the holding of the thread-like material by the capturing part of the needle mechanism;
Moving the distal end of the needle mechanism proximal to the suture object;
And a step of holding the filamentous material by the filamentous material holding member on the distal side of the object to be sutured.
A bidirectional medical suturing device having a perspective direction, extending in the perspective direction, a needle mechanism having a distal end on a distal side, and a thread-like shape provided on a distal side of the medical bidirectional suturing device An object holding member,
The needle mechanism includes a passage through which the filamentous material passes, an entrance / exit portion provided on one side of the passage, a terminal portion provided on the other side of the passage, and a capturing portion for narrowing the passage or the entrance / exit portion. Providing a medical bi-directional suture device;
Moving the needle mechanism more distally than the suture object in a state where the filament is not held by the filament holding member;
Holding the filament by the catching portion of the needle mechanism;
Moving the distal end of the needle mechanism to the proximal side of the object to be sutured.
A bidirectional medical suturing device having a perspective direction, extending in the perspective direction, a needle mechanism having a distal end on a distal side, and a thread-like shape provided on a distal side of the medical bidirectional suturing device An object holding member,
The needle mechanism includes a passage through which the filamentous material passes, an entrance / exit portion provided on one side of the passage, a terminal portion provided on the other side of the passage, and a capturing portion for narrowing the passage or the entrance / exit portion. Providing a medical bi-directional suture device;
And a step of exchanging the needle mechanism with another needle mechanism.