WO2019189400A1

WO2019189400A1 - External tube member for endoscope

Info

Publication number: WO2019189400A1
Application number: PCT/JP2019/013260
Authority: WO
Inventors: 駿佑川瀬
Original assignee: 日本ゼオン株式会社
Priority date: 2018-03-30
Filing date: 2019-03-27
Publication date: 2019-10-03
Also published as: JPWO2019189400A1; JP7251543B2

Abstract

Provided is an external tube member for an endoscope which may improve versatility. This external tube member for an endoscope may be externally attached to an endoscope according to need, and has: a tube 33 disposed along the endoscope from the proximal end to the distal end thereof; and multiple substantially cylindrical endoscope attachment parts which are provided at the distal end of the tube 33, each have a lumen through which an endoscope is inserted, and differ in lumen diameter.

Description

External tube member for endoscope

The present invention relates to an endoscope external tube member that is used by being attached to the outside of an endoscope as necessary.

For example, in a transluminal endoscopic operation (NOTES: Natural Orifice Transluminal Endoscopic Surgary), as a suturing device for suturing an incision (including a perforation or a defect) formed in a body tissue such as a digestive tract The thing of patent document 1 is proposed. The suturing device is provided at a sheath portion (arm moving means) disposed along the endoscope shaft, an operation portion provided at a proximal end of the sheath portion, and a distal end of the sheath portion. The stitching portion (front arm and rear arm) is generally provided.

The sheath portion includes a wire for relatively moving the needle of the suture portion and a member on which the suture is supported, and a sheath through which the wire is inserted, and the sheath portion is detachably attached to the endoscope. An external tube member for an endoscope is provided. The external tube member for endoscope is provided integrally with the tube through which the sheath is slidably inserted and the distal end portion of the tube, and the distal end portion of the shaft of the endoscope is press-fitted. Thus, the tube is configured to include a single endoscope mounting portion (cylindrical fixing portion) formed in a substantially cylindrical shape for removably fixing the distal end portion of the tube to the endoscope. .

By the way, there are various types of endoscopes to which such a suturing device is externally attached, and the outer diameters of the distal end portions of the shafts are various. However, conventionally, the endoscope external tube member has only one endoscope mounting portion and is low in versatility, and therefore, a plurality of types in which the inner diameters of the endoscope mounting portions are different from each other. It is necessary to select and use an endoscope external tube member having an endoscope mounting portion that matches the outer diameter of the endoscope to be used or a suturing device having the tube member. Met.

JP 2017-169941 A

The present invention has been made in view of such a situation, and an object thereof is to provide an external tube member for an endoscope that can improve versatility.

In order to achieve the above object, an endoscope external tube member according to the present invention includes:
An external tube member for an endoscope that is attached to the outside of an endoscope as needed,
A tube disposed from the proximal end to the distal end of the endoscope;
A plurality of endoscope mounting portions each having a substantially cylindrical shape, each provided at a distal end portion of the tube and having different diameters of lumens into which the endoscope is inserted.

The external tube member for an endoscope according to the present invention has a plurality of endoscope mounting portions in which the inner diameter of the portion into which the endoscope is inserted is different from each other, so that it is inserted into the endoscope mounting portion. It is possible to adapt to a plurality of types of endoscopes having different outer diameters at the distal end portion, and improve versatility.

In the endoscope external tube member according to the present invention, it is preferable that the endoscope mounting portion can be individually separated from the tube. By selectively separating and removing the endoscope mounting portion other than the endoscope mounting portion that matches the endoscope to be used, it is possible to prevent the procedure from being hindered.

In the endoscope external tube member according to the present invention, the lumen of the endoscope mounting portion can be tapered so as to expand in the direction in which the endoscope is inserted. With this configuration, resistance during insertion of the distal end portion of the endoscope can be reduced, the mounting operation can be facilitated, and the mounting reliability can be improved.

FIG. 1A is a front view showing a configuration of an operation unit of the suturing device according to the embodiment of the present invention. FIG. 1B is a front view showing a configuration of a suturing portion of the suturing device according to the embodiment of the present invention. FIG. 2A is a perspective view showing a configuration of an endoscope external tube member having the case tube and the mounting adapter shown in FIG. 1B. 2B is a cross-sectional view taken along the line IIb-IIb in FIG. 2A. FIG. 2C is a cross-sectional view showing a configuration obtained by changing a part of the configuration of FIG. 2B. FIG. 3A is a diagram illustrating a procedure of a procedure (suture) performed using the suturing device according to the embodiment of the present invention, and is a diagram illustrating a first step. FIG. 3B is a diagram showing a second step subsequent to FIG. 3A. FIG. 3C is a diagram showing a third step subsequent to FIG. 3B. FIG. 3D is a diagram showing a fourth step that follows FIG. 3C. FIG. 3E is a diagram showing a fifth step subsequent to FIG. 3D. FIG. 3F is a diagram showing a sixth step that follows FIG. 3E. FIG. 3G is a diagram showing a seventh step that follows FIG. 3F. FIG. 3H is a diagram showing an eighth step that follows FIG. 3G. FIG. 3I is a diagram showing a ninth step that follows FIG. 3H. FIG. 3J is a diagram showing a tenth process continued from FIG. 3I. FIG. 3K is a diagram showing a final step subsequent to FIG. 3J.

Hereinafter, as an embodiment of the present invention, a suturing device including an external tube member for an endoscope to which the present invention is applied will be described in detail with reference to the drawings. However, the present invention can be applied not only to the endoscope external tube member provided in the suturing apparatus but also to the endoscope external tube member provided in other medical instruments.

Further, the present invention is used for introducing various treatment tools (forceps, dilator, high-frequency knife, clip device, ligation device, etc.), or for injecting or aspirating fluid (chemical solution, etc.), for example, A tube arranged along the endoscope, such as “impact shooter (trade name)” sold by Top, and a distal end of the endoscope provided at the distal end of the tube It can also be used as a medical instrument having a generally cylindrical tip hood (endoscope mounting portion) to be press-fitted.

First, refer to FIG. 1A and FIG. 1B. The suturing device 1 is a device that is inserted into the body while being attached along the outside of an endoscope (soft endoscope) 2, while being visually recognized by a camera (not shown) of the endoscope 2. This is a device for suturing an incision part (including a defect part or a perforation part) formed in an organ or digestive tract by an operation outside the body.

The suturing device 1 is provided at a sheath portion 3 disposed along the shaft of the endoscope 2, an operation portion (handle) 4 provided at the proximal end of the sheath portion 3, and a distal end of the sheath portion 3. The sewing part 5 is generally provided.

(Sheath part)
The sheath part 3 is a long member extending along the axial direction, and has two tubes and one wire (or one having flexibility enough to follow the bending of the shaft of the endoscope 2). 3 tubes). That is, the sheath portion 3 is configured to include a front arm moving wire 31, a rear arm moving tube 32, and a case tube (tube) 33.

The front arm moving wire 31 is made of a flexible wire, and is slidably inserted into the rear arm moving tube 32. The front arm moving wire 31 moves along the axial direction of the rear arm moving tube 32 and around the axis. It is provided so that it can rotate. As the front arm moving wire 31, a wire rope is used in this embodiment. The wire rope is a rope made of a stranded wire formed by twisting a plurality of wires made of metal (stainless steel) or the like in a spiral shape. However, the wire 31 may be a single wire. Further, a hollow tube may be used instead of the wire 31.

The rear arm moving tube 32 is a hollow tube that is slidably inserted into the case tube 33, and is provided in the case tube 33 so as to move along the axial direction and rotate about the axis. The rear arm moving tube 32 has flexibility and may be a tube made of resin or the like, but in this embodiment, a coil tube having excellent durability is used. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used.

Note that a wire tube may be used as the rear arm moving tube 32. The wire tube is a tube formed by spirally twisting a plurality of wires made of, for example, metal (stainless steel) or the like.

The rear arm moving tube 32 may be a uniform member (for example, a coil tube) from the proximal end to the distal end, but in this embodiment, the distal end of the coil tube is substantially made of a rigid metal. A cylindrical member is fixed by welding to form a distal end portion (tube distal end portion) 32a of the rear arm moving tube 32.

The case tube 33 is a hollow tube disposed along the distal end of the endoscope 2 from the proximal end to the distal end, and is formed of a flexible material made of resin or the like. The proximal ends of the front arm moving wire 31 and the rear arm moving tube 32 are connected to the operation unit 4, and the distal ends of the front arm moving wire 31 and the rear arm moving tube 32 are connected to the suture unit 5. Yes. The proximal end of the case tube 33 reaches the vicinity of the operation unit 4, but is not connected to the operation unit 4, and the distal end of the case tube 33 reaches the vicinity of the suture unit 5, It is not connected to the stitched portion 5. The case tube 33 can be formed of a material such as polyethylene or polyvinyl chloride, for example.

The mounting adapter 34 is integrally attached to the distal end portion of the case tube 33 as shown in FIGS. 2A and 2B. The case tube 33 and the mounting adapter 34 correspond to the endoscope external tube member according to the present invention.

The mounting adapter 34 has a tube mounting portion 34a, an endoscope mounting portion 34b, and an endoscope mounting portion 34c each formed in a substantially cylindrical shape. The mounting adapter 34 is fixed to the distal end portion of the case tube 33 by inserting the distal end portion of the case tube 33 into the tube mounting portion 34a and fixing the mounting adapter 34 by bonding or fusion.

The endoscope mounting part 34b and the endoscope mounting part 34c are arranged on both sides with the tube mounting part 34a interposed therebetween. In this embodiment, the mounting adapter 34 is integrally formed as a whole by injection molding. However, at least one of the tube mounting portion 34a, the endoscope mounting portion 34b, and the endoscope mounting portion 34c and the remaining portion may be formed independently of each other, and then integrated with each other by adhesion, fusion, or the like. .

The endoscope mounting part 34b and the endoscope mounting part 34c are respectively substantially cylindrical portions into which the distal end portion of the endoscope shaft is press-fitted and fixed. The inner diameter of the endoscope mounting portion 34b and the inner diameter of the endoscope mounting portion 34c are different from each other. In this embodiment, the endoscope mounting portion 34b has a relatively large diameter (thick diameter). The endoscope mounting portion 34c is set to have a relatively small diameter (thin diameter) distal end portion so as to be adapted to an endoscope having a distal end portion. A relatively small inner diameter is set to fit the mirror.

In order to distinguish between the endoscope mounting part 34b and the endoscope mounting part 34c, in this embodiment, as shown in FIG. 2A, the endoscope mounting part 34b has a large size (large diameter inner diameter). The character “L” indicating that the attachment portion is for the endoscope) is displayed on the endoscope attachment portion 34c, and the character “S” indicating that the attachment portion is for the small size (small diameter endoscope) is displayed on the endoscope attachment portion 34c. Has been. By displaying such identification characters, it is possible to easily perform visual identification when the distal end portion of the endoscope is press-fitted (inserted) into the

endoscope mounting portion

34b or 34c. These identification characters may be formed by printing or stamping after the mounting adapter 34 is formed, or may be formed integrally so as to be concave or convex at the time of injection molding. In addition, as these identification information, characters other than these characters, a symbol, a figure, etc. may be sufficient.

The endoscope mounting part 34b and the endoscope mounting part 34c can be separated from the tube mounting part 34a. That is, the joint portion of the endoscope attachment portion 34b and the endoscope attachment portion 34c to the tube attachment portion 34a can be cut using a medical cutter (a surgical knife or the like may be substituted). It has become. You may comprise so that it can cut | disconnect by forming a groove | channel etc. in the said junction part, making it thin and weak, and tearing without using a cutter etc. By doing in this way, the effort which a cutting | disconnection requires can be reduced significantly.

The

endoscope attachment portions

34b and 34c are easy to press-fit when attached to the endoscope, and are preferably difficult to come off after attachment. As a material for forming the attachment adapter 34, a polyether block amide copolymer or the like is used. A flexible thermoplastic elastomer or the like can be used.

When the attachment adapter 34 is attached to the distal end portion of the endoscope, the endoscope attachment portion 34b is selected when a large-diameter endoscope is used, and when the small-diameter endoscope is used. The endoscope attachment part 34c is selected, and the endoscope is inserted into the lumen of the selected endoscope attachment part (here, the endoscope attachment part 34c is selected as a small-diameter endoscope). Press fit the distal end of the mirror. When the endoscope is press-fitted into the

endoscope mounting portion

34b or 34c, a lubricant such as xylocaine jelly is used in order to reduce friction and enable smooth work or to improve the mounting reliability. Then, after applying to one or both of the distal end portion of the endoscope and the lumen of the selected endoscope mounting portion 34b, press-fitting is performed.

As shown in FIG. 2B, the lumens of the

endoscope mounting portions

34b and 34c are arranged from the proximal end side (upstream side) to the distal end side (downstream side) with respect to the insertion direction A of the endoscope. 2C, the proximal end side (upstream side) to the distal end side (downstream side) along the insertion direction A of the endoscope as shown in FIG. 2C. It is good also as a taper shape (taper taper shape) which diameter-expands toward (). By adopting such a taper shape, it is possible to reduce the frictional resistance at the time of press-fitting between the lumen of the

endoscope mounting portion

34b or 34c and the distal end portion of the endoscope, and the workability of press-fitting And the certainty of mounting can be improved.

From the viewpoint of reducing the frictional resistance at the time of press-fitting, the taper is reduced in diameter from the proximal end side (upstream side) to the distal end side (downstream side) along the insertion direction A of the endoscope. It is good also as (taper taper shape). However, with such a taper taper shape, the distal end portion of the endoscope can be easily detached from the

endoscope mounting portion

34b or 34c by the action of the taper. It is preferable to do.

The longitudinal dimension (axial direction) dimension L1 of the endoscope mounting part 34b can be set in the range of 5 to 15 mm. The dimension L2 in the longitudinal direction (axial direction) of the endoscope mounting portion 34c can be set in the range of 5 to 15 mm. In the present embodiment, these dimensions L1 and L2 are set to the same value. However, they may be different from each other.

When the lumen is a straight body (see FIG. 2B), the inner diameter d1 of the endoscope mounting portion 34b is in the range of 12 to 15 mm, and the inner diameter d2 of the endoscope mounting portion 34c is in the range of 9 to 12 mm. Can be set. When the lumen has a tapered shape (see FIG. 2C), the inner diameter on the small diameter side of the endoscope mounting portion 34b is in the same range as d1 described above, and the inner diameter d3 on the large diameter side is d1 + (0.5 Can be set within a range of up to 3.0) mm, the inner diameter of the endoscope mounting portion 34c is in the same range as d2, and the inner diameter d4 of the large diameter side is d2 + (0.5 Can be set in a range of up to 3.0) mm.

The outer diameter D1 of the endoscope mounting portion 34b can be set in a range of d1 + (0.5 to 1.5) mm. The outer diameter D2 of the endoscope mounting portion 34c can be set in a range of d2 + (0.5 to 1.5) mm.

By inserting the distal end portion of the shaft of the endoscope 2 into the

endoscope mounting portion

34b or 34c of the mounting adapter 34, the suturing device 1 can be detachably fixed to the endoscope 2. It has become. Note that the case tube 33 may be fixed along the shaft by winding an attachment tape (not shown) at a plurality of locations at appropriate intervals around the shaft of the endoscope.

By moving (sliding) the entire operation unit 4 to the distal end side or the proximal end side with respect to the case tube 33, the entire suture unit 5 is moved with respect to the endoscope 2, and the operation unit 4 is moved. Is rotated about its axis with respect to the case tube 33, so that the entire suture portion 5 can be rotated.

(Suture)
The suturing portion 5 of the suturing apparatus 1 is configured as shown in FIG. 1B. That is, the suture part 5 includes a front arm 51 to which the suture thread 6 is attached and a rear arm 52 having a needle-like member 52a.

The rear arm 52 has a needle-like member 52a, a needle support portion 52b, and a rear guide portion 52c. The rear guide portion 52c is made of a substantially cylindrical member, and one end of a substantially strip-shaped needle support portion 52b is fixed to the upper end side of the rear guide portion 52c.

The proximal end portion of the needle-like member 52a is fixed to the other end of the needle support portion 52b so as to be directed forward (distal end side). The needle-like member 52a, the needle support portion 52b, and the rear guide portion 52c are made of, for example, a metal such as stainless steel, and are formed as separate parts, and then fixed integrally with each other by laser welding or the like. Yes.

In the rear arm 52, the rear end surface (the end surface on the proximal end side) of the rear guide portion 52c is integrally fixed to the distal end portion 32a of the rear arm moving tube 32 by laser welding or the like. The rear guide portion 52c is inserted inside a front guide portion 53, which will be described later, and is held so as to be slidable along the axial direction and rotatable about the axis.

The needle-like member 52a has a straight barrel-shaped ligature attachment portion, a tapered tapered central shaft portion, and a straight barrel-shaped tissue from the proximal end side (needle support portion 52b side) to the distal end side (open end side). It has a penetrating part and a twisting part. A ligation tool 7 for ligating the suture thread 6 is detachably mounted on the ligation tool mounting portion of the needle-like member 52a. The tapping portion is a tapered, generally conical portion whose tip is sharply formed so as to be able to pierce the body tissue, and the outer diameter of the maximum diameter portion of the proximal end is larger than the outer diameter of the tip of the tissue penetrating portion. And is formed so that there is a slight step (barbing) at the connection portion with the tissue penetrating portion.

The needle-like member 52a has a base end at the needle support portion 52b so that the tip end thereof (the edge portion) faces the front arm 51 and the center axis thereof is substantially parallel to the center axis of the rear guide portion 52c. Is fixed to the needle support portion 52b. If the rear arm moving tube 32 is rotated around its central axis, the needle-like member 52a is moved to the tip 32a while the central axis of the needle-like member 52a is maintained substantially parallel to the central axis of the tip 32a. It can be rotated (turned) around the central axis.

The ligation tool 7 that is detachably attached to the base end portion (ligation tool attachment portion) of the needle-like member 52a has a tightening tube 7a and a main body portion. The main body portion is a connection loop 7b to which a ligation device (not shown) is connected, a ligation loop 7c through which a suture thread 6 to be described later is passed, and an abbreviation for connecting these connection loop 7b and ligation loop 7c. The fastening tube 7a is slidably fitted to the connecting portion. The tightening tube 7a is made of a substantially cylindrical member made of a material having elasticity, and is slid toward the ligation loop 7c so that the ligation loop 7c is drawn into the inner cavity thereof. The ligation loop 7c is used as a locking means for locking a part of the ligation loop 7c so that the ligation loop 7c is not drawn too far into the lumen of the tightening tube 7a and comes out of the tightening tube 7a. 7d.

The ligature tool 7 is detachably mounted on the needle-shaped member 52 by inserting (pressing) the proximal end portion (ligation tool mounting portion) of the needle-shaped member 52a into the ligation loop 7c. When ligating the suture thread 6 after the body tissue has been sutured, the coupling loop 7b is gripped by a ligation device (not shown) and moved (pushed down) to the distal end side of the needle-like member 52a. By pulling out from the ligation tool mounting portion and moving beyond the tying portion, both ends of the suture thread 6 are bundled and passed through the ligation loop 7c.

Next, using the ligating apparatus, the fastening tube 7a is slid toward the ligating loop 7c so that the ligating loop 7c is pulled into the fastening tube 7a (or the connecting loop 7b with respect to the fastening tube 7a). Pull). As a result, a part of the ligation loop 7c and the locking part 7d are press-fitted into the fastening tube 7a together with the suture thread 6, and the end part opposite to the connection part of the ligation loop 7c (the locking part 7d is provided). The drawn portion) is pulled to the middle portion in the fastening tube 7a, and the suture thread 6 is ligated.

The front arm 51 includes a pair of

yarn support portions

51 a and 51 a and a front guide portion 53. The pair of

thread support portions

51a and 51a is formed in a substantially V shape (which may be an arc shape, a U shape, a U shape, etc.) and has a bifurcated shape. The suture thread 6 is attached so as to extend between the vicinity of the respective distal end portions.

Engagement members

6a and 6b formed in an annular shape are attached to both ends of the suture thread 6, respectively.

A through hole (not shown) penetrating over the front surface (distal end side surface) and the rear surface (proximal end side surface) is formed at the tip of each of the

yarn support portions

51a and 51a of the front arm 51. An accommodation space (not shown) in which the

engagement members

6a and 6b can be engaged is formed on the rear surface side of the through hole. The accommodation space has a diameter slightly larger than that of the through-hole, and the through-hole through which the engaging

members

6a and 6b penetrate the front and back are substantially concentric with the through-hole of the

yarn support portions

51a and 51a. The diameter is set such that the inner wall can be detachably engaged with the inner wall.

The through-holes of the engaging

members

6a and 6b can be inserted through the twisted portion of the needle-shaped member 52a. However, when the twisted portion is completely inserted through the through-hole, the engaging

members

6a and 6b are moved from the needle-shaped member 52a. It has a structure that does not fall out.

The distal end of the front arm moving wire 31 is integrally fixed to the front arm 51 by laser welding or the like via a guide shaft (not shown).

The front side guide part 53 is comprised from the substantially cylindrical member. A notch 53 a is formed in the upper part of the front side of the front guide part 53. On both sides of the bottom portion (front end side portion) of the notch 53a, a penetration guide is formed extending in the vertical direction (direction substantially parallel to the central axis) and penetrating inward and outward.

Grooves

53b and 53b are formed. These penetration guide

grooves

53b and 53b are portions in which the needle support portion 52b of the rear arm 52 is slidably fitted in either of them to guide the slide in the central axis direction of the rear arm 52. It is.

The upper ends (rear ends) of the through

guide grooves

53b and 53b reach the bottom side of the notch 53a, and the lower ends (front ends) do not reach the lower portion (front end) of the front guide portion 53. The positions of the lower ends (front ends) of the

penetration guide grooves

53b and 53b are such that when the needle support portion 52b of the front arm 51 is fitted and reaches the lower end, the rear end of the needle portion of the needle-like member 52a is sewn. The thread 6 is set at a position where it can be engaged through the engaging

member

6a or 6b.

(Operation section)
The operation unit (handle) 4 of the suturing device 1 is configured as shown in FIG. 1A. In other words, the operation unit 4 includes a slider unit 41 and a base unit 42. The slider part 41 is slidably provided on the base part 42, and the slider part 41 moves to the base end (distal end) side and the base end (proximal end) side with respect to the base part 42. It is possible to move to two positions.

Specifically, the slider part 41 is a cylindrical part 41a having a substantially cylindrical shape on the distal end side, and the distal end is fixed to the cylindrical part 41a on the proximal end side. A grip member 41b is provided. The cylindrical portion 41a of the slider portion 41 is formed with a substantially cylindrical wire insertion hole (not shown) that opens at the distal end thereof and extends along the axial center thereof. The portion on the proximal end side is connected and fixed to the cylindrical portion 41 a of the slider portion 41.

The base portion 42 is formed of a substantially cylindrical member formed by joining a pair of substantially symmetric half members by a plurality of screws or the like (not shown), and opens at a proximal end thereof. It has a substantially cylindrical slider portion insertion hole (not shown) extending along. By inserting the cylindrical portion 41a of the slider portion 41 into the slider portion insertion hole, the slider portion 41 can be slid along the axis and can rotate about the axis with respect to the base portion. It is attached.

Further, the base portion 42 has a substantially cylindrical tube insertion hole (not shown) that opens at the distal end thereof and extends along the axis thereof, and the rear arm moving tube is formed in the tube insertion hole. The proximal end side of the rear arm moving tube 32 is connected and fixed to the base portion 42.

(Suture process)
Hereinafter, the stitching process (sewing operation) of the incision using the suturing device 1 will be described with reference to FIGS. 3A to 3K. Hereinafter, a case where an incision formed in the stomach wall is sutured will be described as an example.

Prior to performing the suturing step, first, an attaching operation (attaching step) for attaching the suturing device 1 to the endoscope 2 is performed. That is, according to the outer diameter of the distal end portion (tip portion) of the shaft of the endoscope 2 used for the procedure, the

endoscope mounting portion

34b or 34c having an inner diameter suitable for this is selected. Here, it is assumed that the endoscope 2 having a relatively small diameter is used, and the endoscope mounting portion 34c having an inner diameter suitable for the endoscope 2 is selected. Next, the endoscope mounting part 34b other than the selected endoscope mounting part 34c is cut and removed by using a cutter or the like or by tearing.

Next, a lubricant is applied to the distal end portion of the endoscope 2 and / or the lumen of the endoscope mounting portion 34c, and the distal end portion of the endoscope 2 is applied to the lumen of the endoscope mounting portion 34c. The distal end portion of the case tube 33 of the suturing device 1 is fixed to the distal end portion of the endoscope 2 via the mounting adapter 34 (endoscope mounting portion 34c) by inserting (press-fitting). Thereafter, the case tube 33 is fixed along the shaft by winding a mounting tape (not shown) at a plurality of locations at appropriate intervals around the shaft of the endoscope 2. Thereby, the mounting | wearing with respect to the shaft of the endoscope 2 of the suturing device 1 is completed.

When performing the suturing step, first, the ligature tool 7 is attached to the needle-like member 52a of the suturing device 1, the shaft of the endoscope 2 to which the suturing device 1 is attached is inserted into the stomach, and suturing is performed. The suture part 5 of the device 1 is arranged near the incision part to be sutured. Next, the operation unit 4 is operated to bring the rear arm 52 away from the front arm 51 (see FIG. 1B).

In this state, the first step shown in FIG. 3A is performed. In the first step shown in FIG. 3A, first, the operating portion 4 is pushed into the distal end side as a whole with respect to the case tube 33 and rotated as necessary, as shown in FIG. Only the front arm 51 that is spaced apart from the rear arm 52 is inserted into the incision SH. Before and after this, the rear arm 52 is rotated with respect to the front arm 51, and one lip of the incision SH is formed by one thread support portion 51a of the front arm 51 and the needle-shaped member 52a. The front arm 51 and the rear arm 52 are arranged so that the portion Sa is sandwiched.

Next, when the front arm 51 is brought close to the rear arm 52, as shown in FIG. 3B, the needle-like member 52a pierces one of the mouth edge portions Sa, penetrates the mouth edge portion Sa, Further, the twisting portion of the needle-like member 52a passes through the through hole of the engaging member 6a accommodated (supported) in the accommodation space of the one thread support portion 51a. Thereby, the through hole of the engagement member 6a reaches the tissue penetration part of the needle-like member 52a, and the engagement member 6a is engaged with the needle-like member 52a.

Next, when the operation unit 4 is operated so that the front arm 51 is separated from the rear arm 52 in the stitching unit 5, the engagement member 6a is engaged as shown in FIG. 3C. The needle-like member 52a thus made is inserted into one of the mouth edge portions Sa to reverse the hole (hereinafter referred to as the first perforation) and return to the stomach. As a result, a part of the suture thread 6 (a part on the engagement member 6a side) is in a state of penetrating the one edge portion Sa.

Thereafter, as shown in FIG. 3D, the front arm 51a is so held that the other rim portion Sb of the incision SH is sandwiched between the other thread support portion 51a of the front arm 51 and the needle-like member 52a. 51 and the rear arm 52 are arranged.

From this state, when the operation unit 4 is operated to bring the rear arm 52 closer to the front arm 51, the needle-like member 52a pierces the other mouth edge Sb as shown in FIG. 3E. The penetrating part of the needle-like member 52a passes through the through hole of the engaging member 6b accommodated (supported) in the accommodation space of the other thread support part 51a. Thereby, the through hole of the engagement member 6b reaches the tissue penetration part of the needle-like member 52a, and the engagement member 6b is engaged with the needle-like member 52a.

Next, when the operation unit 4 is operated so that the front arm 51 is separated from the rear arm 52, as shown in FIG. 3F, the needle-like member with which the engagement member 6b is engaged is obtained. A hole formed when 52a is inserted through the other mouth edge Sb (hereinafter referred to as a second perforation) returns to the stomach. As a result, a part of the suture thread 6 (a part on the engagement member 6b side) enters the other mouth edge Sb.

As a result, the pair of engaging

members

6a and 6b, to which both ends of the suture thread 6 are fixed, are both engaged with the single needle-like member 52a, and the needle-like member 52a (that is, the stomach) is engaged by the suture thread 6. A ring is formed that penetrates the first perforation from the inner side to the outside of the stomach and returns from the outer surface of the stomach to the needle-like member 52a (that is, the stomach) through the second perforation.

Next, the operation unit 4 is operated to move the front arm 51 (thread support unit 51a) into the stomach through the incision SH as shown in FIG. 3G. When the front arm 51 (thread support part 51a) enters the stomach, the needle-like member 52a moves away from the incision part SH, and both ends of the suture thread 6 move away from the incision part SH. The portion that penetrates the first perforation and the portion that penetrates the second perforation are drawn, and the end surfaces of the pair of mouth edge portions Sa and Sb of the incision SH are brought into contact with each other and joined.

When the suturing operation of the incision SH with the suturing device 1 is completed, the suture 6 is subsequently ligated. For this work, the ligating apparatus 8 shown in FIG. 3H is used. The ligation device 8 includes, for example, a sheath introduced into a lumen via a treatment instrument guide tube of an endoscope, and an operation wire slidably inserted in the sheath, and the distal end of the operation wire At the end, a connecting hook that protrudes from the distal end of the sheath into a substantially V shape by its own elasticity and closes by being pulled into the distal end of the sheath is provided. Can be used.

As shown in FIG. 3G, the ligature tool 7 is held in a state where the ligation loop 7c (see FIG. 1B) is inserted into the proximal end portion (ligation tool mounting portion) of the needle-like member 52a. Therefore, the distal end of the ligating device 8 (see FIG. 3H) is disposed in the vicinity of the connecting loop 7b of the ligating device 7, and the connecting loop 7b is grasped by the connecting hook protruding from the ligating device 8 and opened. The ligation tool 7 is connected to the distal end of the sheath of the ligating device 8 by drawing the connecting loop 7 b into the distal end of the sheath of the ligating device 8.

Next, as shown in FIG. 3H, the distal end portion of the sheath of the ligation apparatus 8 to which the ligature tool 7 is connected is moved to the incision SH side (downward in FIG. 3H) to Assume that both ends of the suture thread 6 are inserted inside the ligation loop 7c. As a result, the suture thread 6 is squeezed and both ends of the suture thread 6 are bundled.

When the operation wire is slid from the state where both ends of the suture thread 6 are bundled so that the connecting hook of the ligating device 8 is further pulled into the sheath, as shown in FIG. The ligation loop 7c is drawn together with the suture thread 6, and the ligation loop 7c and the suture thread 6 are accommodated in the tightening tube 7a so as to be in close contact with each other and compressed. That is, since the ligation loop 7c and the suture thread 6 are accommodated in a state of being tightly fitted in the tightening tube 7a, one end of the suture thread 6 and the ligation loop 7c is separated from the tightening tube 7a. It is fixed so that it does not fall out. Thereby, the ligation of the suture thread 6 is completed.

When the ligation of the suture thread 6 is completed, the sheath of the ligation device 8 is moved by sliding the sheath toward the proximal end so as to draw the sheath against the operation wire while keeping the position of the operation wire of the ligation device 8 unchanged. The other end of the connecting hook and the loop member protrudes (exposes) from the distal end, and the connecting hook is opened by its own elasticity to release the grip. As shown in FIG. The ligation apparatus 8 is separated from the ligature tool 7 that has been determined.

Finally, as shown in FIG. 3K, the suture thread 6 between the ligature 7 and the suture part 5 (needle member 52a) is cut with an endoscopic scissors forceps called a loop cutter. Then, the ligature 7 and the stitched portion 5 are separated, and if necessary, the connection loop 7b of the ligature 7 in the ligated state is cut and collected by a loop cutter or the like, and one needle is sutured. A series of procedures is completed.

According to the above-described embodiment, the mounting adapter 34 integrally attached to the distal end portion of the case tube 33 has a plurality of

endoscope mounting portions

34b and 34c having different inner diameters of the portions into which the endoscope is press-fitted. have. For this reason, it is possible to adapt to a plurality of types of endoscopes having different outer diameters at the distal end, and as compared with conventional ones having only a single endoscope mounting part, Can be improved. Therefore, the number of suturing devices to be prepared can be reduced as compared with the conventional one, and both the manufacturer supplying them and the medical institution using them can reduce the economic burden or the storage and storage burden. can do.

In addition, since each of the

endoscope mounting portions

34b and 34c of the mounting adapter 34 can be individually separated from the case tube 33 as needed, an endoscope mounting portion (compatible with the endoscope 2 to be used ( For example, an endoscope mounting part (for example, 34b) other than 34c) can be selectively separated and removed. If the endoscope mounting portion that is not used is left, there is a possibility that the procedure may be hindered, and this can be prevented.

The embodiment described above is described for facilitating understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the above-described embodiment is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

For example, in the above-described embodiment, the mounting adapter 34 includes a pair of

endoscope mounting portions

34b and 34c. However, a single or a plurality of other endoscope mounting portions having different inner diameters from these are provided. Further, it may be provided. In this way, versatility can be further improved.

DESCRIPTION OF SYMBOLS 1 ... Suture apparatus 2 ... Endoscope 3 ... Sheath part 31 ... Front side arm movement wire 32 ... Rear side arm movement tube 33 ... Case tube (tube)
34 ... Attachment adapter 34a ...

Tube attachment part

34b, 34c ... Endoscope attachment part 4 ... Operation part 41 ... Slider part 42 ... Base part 5 ... Suture part 51 ... Front arm 51a ... Yarn support part 52 ... Rear arm 52a ... Needle-like member 52b ... needle support portion 52c ... rear guide portion 53 ... front guide portion 53a ... notch portion 53b ... penetration guide groove 6 ...

suture thread

6a, 6b ... engagement member 7 ... ligature 7a ... tightening tube 7b ... Linking loop 7c ... Ligating loop SH ... Incision part Sa, Sb ... Mouth edge 8 ... Ligating device

Claims

An external tube member for an endoscope that is attached to the outside of an endoscope as needed,
A tube disposed from the proximal end to the distal end of the endoscope;
An external tube member for an endoscope, comprising a plurality of substantially cylindrical endoscope mounting portions, each provided at a distal end portion of the tube and having different diameters of lumens into which endoscopes are inserted.
The external tube member for an endoscope according to claim 1, wherein the endoscope mounting portion can be individually separated from the tube.
The endoscope external tube member according to claim 1 or 2, wherein the lumen of the endoscope mounting portion has a tapered shape whose diameter is increased along a direction in which the endoscope is inserted.