WO2020084891A1

WO2020084891A1 - Medical bidirectional suturing system

Info

Publication number: WO2020084891A1
Application number: PCT/JP2019/033414
Authority: WO
Inventors: 祥平鈴木
Original assignee: 株式会社カネカ
Priority date: 2018-10-24
Filing date: 2019-08-27
Publication date: 2020-04-30
Also published as: JP7320523B2; JPWO2020084891A1

Abstract

A medical bidirectional suturing system having: a shaft (12) that extends in the lengthwise direction; a first needle member (16) that is capable of moving in the lengthwise direction and has a distal end facing the distal side; a second needle member (17) that is capable of moving in the lengthwise direction, is arranged further to the distal side than the first needle member (16), and has a distal end facing the proximal side; and an objective lens group including a first objective lens (18) and a second objective lens (19), wherein the first objective lens (18) is arranged further to the proximal side than the most distal end of the movable section of the distal end of the first needle member (16) and faces the distal side, and the second objective lens (19) is arranged further to the distal side than the most proximal end of the movable section of the distal end of the second needle member (17) and faces the proximal side.

Description

Two-way medical suturing system

The present invention relates to a medical bidirectional suturing system including a suturing mechanism capable of suturing an object with a thread bidirectionally from the proximal side to the distal side and from the distal side to the proximal side.

Trans-Sphenoidal Surgery (TSS) is often performed to remove the tumor formed in the pituitary gland. TSS is generally performed in the following procedure. First, the operator advances along the nasal septum of the patient while peeling off the nasal mucosa, and opens the sphenoid bone to open the dura to reach the pituitary gland. Next, the pituitary tumor is excised, and finally the dura is sutured to reconstruct the sphenoid bone and nasal mucosa. As a device for suturing the dura, a suturing device has been proposed in which a suture is passed bidirectionally from the distal side of the dura to the proximal side and from the proximal side to the distal side (for example, Patent Document 1). ~ 7). In such a bidirectional suturing device, it is desired to pass the suture through an appropriate position on the object to be sutured such as the dura. For example, Patent Documents 1 and 2 disclose a suturing device equipped with an endoscope. According to the suturing device, a suturing operation can be performed while viewing an image obtained by the endoscope. On the other hand, an endoscope in which a plurality of objective lenses are arranged in a direction perpendicular to the perspective direction is known (for example, Patent Documents 8 to 10).

Special table 2011-509121 publication International Publication No. 2009/089101 Japanese Patent Publication No. 2014-528768 International Publication No. 2013/024466 JP, 2011-72790, A JP 2012-515636 International Publication No. 2010/085793 JP, 2014-230788, A JP, 2013-253797, A Japanese Patent Publication No. 11-503844

When suturing the dura using a bidirectional suturing device, it is desirable to grasp the shape of the object to be sutured such as the dura more accurately and pass the suture at an appropriate position on the object to be sutured. For example, while the suturing devices disclosed in Patent Documents 1 and 2 can grasp the object to be sutured only two-dimensionally, as disclosed in Patent Documents 8 to 10, a direction perpendicular to the perspective direction. When an endoscope in which a plurality of objective lenses are arranged is used, a three-dimensional image can be grasped. However, when a plurality of objective lenses are arranged in the direction perpendicular to the perspective direction, the size in the direction perpendicular to the perspective direction, that is, the radial direction becomes large, so it can be said that this is a preferable mode for the bidirectional suturing device. Absent.

The present invention has been made in view of the above circumstances, and an object thereof is to be able to grasp an object to be sewn three-dimensionally and to form a size of a treatment portion to be sewn in a radial direction compactly. It is to provide a medical bidirectional suturing system capable of performing the above.

A bidirectional medical suturing system of the present invention that has been able to solve the above-mentioned problems, a shaft extending in the perspective direction, and a first needle that is movable in the perspective direction and has a distal end facing the distal side. A second needle member that is movable in a perspective direction, is disposed distally of the first needle member, and has a tip facing the proximal side; and a first objective lens and a second objective lens. A bidirectional medical suturing system having an objective lens group, wherein the first objective lens is disposed closer to a distal side than a most distal end of a movable section of the tip of the first needle member, and the distal side is positioned at a distal side. The second objective lens is characterized in that the second objective lens is arranged distally of the most distal end of the movable section of the tip of the second needle member and faces the proximal side.

According to the medical bidirectional suturing system of the present invention, it is possible to recognize the image of the object to be sutured by the first objective lens and the second objective lens, and to sandwich the object to be sutured, the first objective lens and the second objective lens. The position of the suturing target object can be grasped three-dimensionally because the position of the suturing target object in the perspective direction can be grasped according to the degree of defocusing of the image by the first objective lens and the second objective lens. It becomes possible. Further, since the first objective lens and the second objective lens are arranged side by side in the perspective direction, stitching is performed as compared with the case where the first objective lens and the second objective lens are arranged side by side in the direction perpendicular to the perspective direction. The size of the treatment portion in the radial direction can be made compact.

The first objective lens is disposed closer to the proximal end than the proximal end of the movable section of the tip of the first needle member, and the second objective lens is the most distal end of the movable section of the tip of the second needle member. It may be arranged on the distal side. Further, the first objective lens and the second objective lens may be arranged so that at least some of them overlap each other when viewed from the perspective direction of the shaft.

Illuminator may be provided in the medical bidirectional suturing system. This makes it possible to obtain a clearer image through the first objective lens and / or the second objective lens. The illuminator can be arranged, for example, on at least one of the proximal side of the first objective lens and the distal side of the second objective lens. Further, an illuminator is arranged on the distal side of the first objective lens and on the proximal side of the second objective lens, and the emitted light of the illuminator does not directly enter the first objective lens or the second objective lens. It may be shielded.

It is preferable that the optical axis of the first objective lens and the optical axis of the second objective lens are parallel to the perspective direction. The first objective lens may be movable in the perspective direction with respect to the shaft. The numerical aperture of the first objective lens is preferably larger than the numerical aperture of the second objective lens.

The bidirectional medical suturing system includes a storage unit that holds information for specifying the position of the first needle to the suture target, and the tip of the first needle member near the suture target via the first needle position. It may further include a control unit that controls the first needle member so as to move from the proximal side to the distal side. The medical bidirectional suturing system also includes a storage unit that holds information for identifying the position of the second puncture needle on the object to be sewn, and the tip of the second needle member via the second puncture position to sew the object to be sutured. It may further include a control unit that controls the second needle member so as to move from the distal side to the proximal side.

The bidirectional medical suturing system further includes a display device for displaying an image obtained through the first objective lens or an image obtained through the second objective lens, and the display device has a first needle position or a second needle position. The mark may be displayed at the position corresponding to. The medical bidirectional suturing system may also generate three-dimensional image data of the suture target based on the image obtained through the first objective lens and the image obtained through the second objective lens.

The bidirectional medical suturing system may have a mechanism for moving the shaft in a direction different from the perspective direction.

The medical bidirectional suturing system is a positioning marker that indicates a specific position of two-dimensional coordinates that is perpendicular to the perspective direction, and is at least one of an image captured by the first objective lens and an image captured by the second objective lens. It may have a positioning marker displayed on.

FIG. 2 is an example of a side view of a suturing device included in a bidirectional medical suturing system. FIG. An example of a cross-sectional view of the treatment portion on the distal side of the suturing device is shown. FIG. 3 is a cross-sectional view showing a state in which a suture target is punctured by a needle member in the treatment section of the suturing device shown in FIG. Another example of a cross-sectional view of the treatment section on the distal side of the suturing device is shown, and a configuration example of the treatment section provided with a fixing member for the suture target is shown. FIG. 5 is a cross-sectional view of a state in which a suturing target object is sandwiched by fixing members in the treatment section of the suturing device shown in FIG. 4. FIG. 6B is another example of a cross-sectional view of the treatment section on the distal side of the suturing device, showing the treatment section in which a regulation member is provided and in which the regulation member is in a position not hindering the movement of the needle member. A configuration example is shown. FIG. 7 is a cross-sectional view showing a state in which the regulation member is in a position that impedes movement of the needle member in the treatment portion of the suturing device shown in FIG. An example of a cross-sectional view of the treatment section on the distal side of the suture instrument is shown, and a configuration example of the treatment section in which a spacer member is provided below the regulating member is shown. An example of a cross-sectional view of the treatment section on the distal side of the suturing device is shown, and a configuration example of the treatment section provided with a fixing member and a regulating member for the suture target is shown. 1 shows an example of a block configuration diagram of a medical bidirectional suturing system.

The present invention relates to a medical bidirectional suturing system including a bidirectional suturing mechanism capable of threading a suture target such as a biological membrane from one side to the other side and from the other side to both sides bidirectionally. It is a thing. The bidirectional medical suturing system of the present invention includes a first needle member for sending a thread from a proximal side to a distal side, a second needle member for sending a thread from a distal side to a proximal side, and a first needle member side. And a second objective lens provided on the second needle member side and directed to the proximal side. According to the bidirectional medical suturing system of the present invention, the object to be sutured can be image-recognized by the first objective lens and the second objective lens, and whether or not the position of the object to be sutured in the perspective direction is appropriate is grasped. Therefore, the position of the needle to be sewn by the first needle member and the second needle member can be appropriately set.

Hereinafter, the medical bidirectional suturing system of the present invention will be specifically described based on the following embodiments, but the present invention is not limited by the following embodiments and may be adapted to the gist of the above and the following. It is of course possible to carry out appropriate modifications within the scope, and all of them are included in the technical scope of the present invention. In addition, in each drawing, for convenience, hatching and member reference numerals may be omitted, but in such a case, the specification and other drawings are referred to. Further, the dimensions of various members in the drawings may be different from the actual dimensions because priority is given to contributing to the understanding of the features of the present invention.

FIG. 1 shows an example of a side view of a suturing device included in a medical bidirectional suturing system, and FIGS. 2 and 3 show an example of a cross-sectional view of a treatment portion provided on the distal side of the suturing device. It was FIG. 2 shows a state before the needle member is punctured by the suturing target object, and FIG. 3 shows a state in which the needle member is punctured by the suturing target object. In this specification, the "medical bidirectional suturing system" may be simply referred to as "suture system".

The suturing system has a suturing device 11 having a suturing mechanism including a first needle member 16 and a second needle member 17. The suturing device 11 has a shaft 12 extending in the perspective direction, and a treatment portion 13 for suturing an object to be sutured such as a biological membrane is provided at a distal portion of the shaft 12. The treatment section 13 includes a first needle member 16 and a second needle member 17, and a suture target can be sutured by operating these members.

A handle portion 15 is preferably provided on the proximal side of the shaft 12. The handle portion 15 may simply hold or fix the shaft 12 during an operation, or may be provided with an operation portion for operating the treatment portion 13. The operation portion 13 may be operated by an operator holding the handle portion 15 in his / her hand, or may be remotely operated by the operator while looking at a monitor or the like from a place away from the handle portion 15. . In the latter case, the suturing system preferably has an operating section in addition to the suturing device, and the operating section includes, for example, an input section for operating the first needle member and the second needle member. Further, the treatment section 13 may be mechanically operated by a predetermined protocol without the intervention of the operator.

In the present invention, the perspective direction is determined based on the extending direction of the shaft 12. The proximal side of the shaft 12 refers to the handle portion 15 side, and the distal side refers to the opposite direction of the proximal side, that is, the treatment target side. 1 to 3, the left side of the drawings is the distal side, and the right side of the drawings is the proximal side. The direction from one of the proximal side and the distal side to the other is referred to as the perspective direction.

The size of the suturing device 11 in the perspective direction may be set based on the distance from the operator's hand to the object to be sutured, and may be, for example, 5 cm or more and 80 cm or less. In TSS (transsphenoidal pituitary tumor resection), the distance may be set with reference to the distance from the pituitary to the nostril, and for example, 20 cm or more and 50 cm or less is preferable.

Each part of the suturing device 11 is preferably made of a biocompatible material. Examples of such a material include a metal material such as stainless steel and a resin material. In particular, the part to be inserted into the body is preferably made of a biocompatible material or provided with a biocompatible coating layer.

As shown in FIGS. 2 and 3, the tip of the first needle member 16 faces the distal side and is movable in the perspective direction. The 2nd needle member 17 is arrange | positioned rather than the 1st needle member 16 at the distal side, a front end faces a proximal side, and is movable in a perspective direction. As shown in FIG. 3, arranging the suture object 31 between the tip of the first needle member 16 and the tip of the second needle member 17, and threading the first needle member 16 to move it to the distal side. Thus, the first needle member 16 can penetrate the object 31 to be sewn, and the thread can be passed through the object 31 to be sewn from the proximal side to the distal side. In addition, by threading the second needle member 17 and moving it to the proximal side, it is possible to thread the suture target object 31 from the distal side to the proximal side in the same manner. At this time, the thread sent from the proximal side through the suturing target object 31 to the distal side by the first needle member 16 moves to the second needle member 17 side, and the second needle member 17 moves from the distal side to the distal side. The thread that has passed through the suture target 31 and is sent to the proximal side moves to the first needle member 16 side. As a result, the yarn can be moved in the perspective direction, and the sewing target object 31 can be sewn. For suturing, for example, a thread is passed from a proximal side to a distal side by a first needle member 16 in a portion on one side sandwiching an incision line of an incision portion such as a biological membrane, and a second needle member 17 in a portion on the other side. Can be performed by threading the thread from the distal side to the proximal side.

It is preferable that the shaft 12 has a lumen, and the first needle member 16 and the second needle member 17 are arranged in the lumen of the shaft 12. It is preferable that the shaft 12 is also provided with a notch portion 14 in which the suturing target object 31 is placed during the operation. The notch portion 14 may be provided at least at a part between the tip of the first needle member 16 and the tip of the second needle member 17. Specifically, the cutout portion 14 has a distal end of the first needle member 16 of the shaft 12 in a state where the first needle member 16 is positioned most proximally and the second needle member 17 is positioned most distally. It suffices if it is provided at least at a part of the portion on the more distal side and on the proximal side of the tip of the second needle member 17. The notch 14 may be formed to extend proximally from the tip of the first needle member 16 and / or distally from the tip of the second needle member 17.

It is preferable that an insertion passage through which the first needle member 16 passes and / or an insertion passage through which the second needle member 17 passes are provided inside the shaft 12. By providing these insertion passages, it becomes easy to stably move the first needle member 16 and the second needle member 17 in the perspective direction.

The first needle member 16 is preferably movable to a position closer to the proximal side than the tip of the second needle member 17 in a state where the second needle member 17 is located on the most distal side. It is preferable not to reach the distal side of the tip of 17. That is, the most distal end of the movable section of the distal end of the first needle member 16 is located closer to the proximal side than the distal end of the second needle member 17 with the second needle member 17 located at the most distal side. Preferably. It is preferable that the tip of the second needle member 17 is movable to a position distal to the tip of the first needle member 16 in a state where the first needle member 16 is located on the most proximal side. It is preferable that the needle member 16 does not reach the proximal side of the tip. That is, the most proximal end of the movable section of the tip of the second needle member 17 is located on the distal side of the tip of the first needle member 16 in a state where the first needle member 16 is located on the most proximal side. It is preferable. Thereby, when the yarn is applied to the first needle member 16 or the second needle member 17 and moved in the perspective direction, the yarn is easily moved between the first needle member 16 and the second needle member 17.

The first needle member 16 and the second needle member 17 are preferably arranged such that at least some of them overlap each other when viewed from the perspective direction of the shaft 12, and the axial center of the first needle member 16 and the second needle member It is more preferable that the axis center of 17 coincides. That the first needle member 16 and the second needle member 17 overlap each other when viewed from the distal side means that the first needle member 16 and the second needle member 17 are substantially on the same straight line in the perspective direction. Means In this case, at least the tip portion of the first needle member 16 and the tip portion of the second needle member 17 are preferably arranged so as to overlap each other when viewed from the distal side. By arranging the first needle member 16 and the second needle member 17 in this manner, the yarn moved to the distal side by the first needle member 16 is easily arranged near the tip of the second needle member 17, and The yarn moved to the proximal side by the needle member 17 is easily arranged near the tip of the first needle member 16. Therefore, it becomes easy to suitably move the yarn between the first needle member 16 and the second needle member 17. Further, when it is difficult to puncture the suturing target object with the one of the first needle member 16 and the second needle member 17 on which the thread is applied, the needle member on which the thread is not applied punctures the suturing target object. By opening the opening, it becomes possible to easily sew the object to be sewn.

The thread is not particularly limited as long as it is a suture thread used for medical purposes, and may be a single thread or a knitting thread. The diameter of the thread can be appropriately selected as long as it is a diameter generally used for sutures. The yarn material may be a degradable material. The length of the thread is preferably long enough not to interfere with the operation, and is preferably 20 cm or more and 200 cm or less. For example, in the TSS, a length that allows the suture to reciprocate from the outside of the body to the dura plus a length sufficient for a doctor to make a knot in the suture outside the patient's body is preferable, which is preferable in the TSS. The length of the thread is 40 cm or more and 150 cm or less.

The first and

second needle members

16 and 17 are preferably made of a material that is biocompatible and has a strength capable of piercing an object to be sewn such as a biological membrane. The first and

second needle members

16 and 17 are preferably made of, for example, a metal material such as stainless steel or a resin material, and more preferably made of stainless steel from the viewpoint of safety and ease of processing.

The first and

second needle members

16 and 17 may be solid or hollow. From the viewpoint of ease of manufacturing and high strength, the first and

second needle members

16 and 17 are preferably solid.

The outer diameter of the first and

second needle members

16 and 17 is not particularly limited as long as it is a diameter used in a general suture needle, but is preferably 0.05 mm or more and 1.5 mm or less, for example. When the first and

second needle members

16 and 17 are hollow, the wall thickness thereof is preferably, for example, 0.01 mm or more and 0.5 mm or less.

The lengths of the first and

second needle members

16 and 17 can be appropriately set in the range of 1.5 mm or more and 40 cm or less, which is the distance from the nasal cavity to the pituitary gland in the case of TSS, for example.

It is preferable that the first needle member 16 and the second needle member 17 are directly or indirectly connected to the handle portion 15. Thereby, the movement of the first needle member 16 and the second needle member 17 in the perspective direction can be performed by operating from the proximal side of the suturing device. When the first needle member 16 or the second needle member 17 is indirectly connected to the handle portion 15, the first needle member 16 or the second needle member 17 is connected to the handle portion 15 via one or more connecting members. If you have.

It is preferable that the tip portions of the first and

second needle members

16 and 17 are formed so that their cross-sectional areas become smaller toward the tips, whereby the first and

second needle members

16 and 17 are sutured. It is easier to insert a needle.

The first and

second needle members

16 and 17 preferably have their tips divided into at least a first end and a second end. The first and

second needle members

16 and 17 may have three or more end portions at their tips. Thereby, when the first needle member 16 is moved to the distal side or the second needle member 17 is moved to the proximal side, the thread is applied to the branched portion of the first needle member 16 or the second needle member 17. be able to. The branched portion of each needle member preferably has a groove shape having a predetermined angle with respect to the traveling direction of the needle member, that is, the perspective direction, and is arranged, for example, perpendicularly to the perspective direction. When the thread is applied to such a branched portion, the thread can be moved along with the movement of the first needle member 16 and the second needle member 17 in the perspective direction, and the thread can be easily passed through the suture target. The tip positions of the branched ends may be the same or different from each other in the perspective direction.

The overall shape of the first and

second needle members

16 and 17 may be linear, curved, or a combination thereof. The first and

second needle members

16 and 17 may have a bent portion. In the drawing, a bent portion is provided on the second needle member 17. By providing the bent portion on the second needle member 17, the distal end of the second needle member 17 is formed to face the proximal side, and the proximal end side of the second needle member 17 is also formed to face the proximal side. Thereby, the second needle member 17 can be connected to the handle portion 15. In addition, the cutout portion 14 in the shaft 12 is provided so that the connecting portion connecting the portion extending in the perspective direction on the distal side of the second needle member 17 and the portion extending in the perspective direction on the proximal side can be moved in the perspective direction. A groove 20 through which the connection portion passes is formed on the distal side of the groove 20. Although not shown in the drawings, the second needle member 17 is not provided with a bent portion, and the distal end portion of the second needle member 17 is provided with a connecting member extending in the perspective direction. The second needle member 17 may be connected to the handle portion 15 via.

Although not shown in the drawing, the shaft 12 may be provided with a protective lid for covering the notch portion 14. Thereby, when the shaft 12 is moved in the body before and after suturing, the tips of the first needle member 16 and the second needle member 17 can be prevented from being exposed from the cutout portion 14. The protective lid is preferably attached so as to be movable in the perspective direction. Further, it is preferable that the opening and closing of the protective lid can be operated by the handle portion 15 on the near side. Thereby, the protective cover can be moved to expose the cutout portion 14 during the suturing operation, and the cutout portion 14 can be covered with the protective cover during the non-suturing operation.

The suturing system has an objective lens group including a first objective lens 18 and a second objective lens 19. The first objective lens 18 is disposed closer to the distal side than the most distal end of the movable section of the tip of the first needle member 16 and faces the distal side, and the second objective lens 19 is the second objective lens 18. The distal end of the needle member 17 is located distally of the movable end of the movable section and faces the proximal side. In the suturing system, it is preferable that the first objective lens 18 and the second objective lens 19 are provided with an image pickup device that converts an image obtained through the lens into an electric signal. The first objective lens 18 and the second objective lens 19 can be used for image recognition of the suturing target object 31, and the needle position of the suturing target object 31 by the first needle member 16 and the second needle member 17 can be appropriately set. it can. Further, by disposing the first objective lens 18 and the second objective lens 19 with the suturing target object 31 interposed therebetween, the degree of defocusing of the image by the first objective lens 18 and the second objective lens 19, in other words, out-of-focus blur. Depending on the condition, it is possible to grasp whether or not the position in the perspective direction of the sewing object 31 is appropriate. Furthermore, since the first objective lens 18 and the second objective lens 19 are arranged side by side in the perspective direction, the size of the treatment portion 13 can be reduced, and thus the first objective lens 18 and the second objective lens 19 can be made smaller. It becomes possible to grasp the suturing target 31 three-dimensionally while arranging 19. It is preferable that the first objective lens 18 and the second objective lens 19 are arranged so that at least some of them overlap each other when viewed from the perspective direction of the shaft 12. If the first objective lens 18 and the second objective lens 19 are arranged in this way, the size of the treatment portion 13 in the radial direction of the shaft 12 can be made compact.

The direction in which the first objective lens 18 faces the distal side, that is, the side of the object 31 to be sewn with respect to the first objective lens 18 and the direction in which the optical axis of the first objective lens 18 extends from the first objective lens 18 is , ± 30 ° with respect to the distal direction, preferably ± 20 ° or less, more preferably ± 10 ° or less. The direction in which the second objective lens 19 faces the proximal side, that is, the side closer to the sewing target object 31 than the second objective lens 19, and the direction in which the optical axis of the second objective lens 19 extends from the second objective lens 19 is The angle is preferably within ± 30 ° with respect to the proximal direction, more preferably within ± 20 °, even more preferably within ± 10 °. If the first objective lens 18 and the second objective lens 19 are installed in this manner, when the suturing target object 31 is placed at a position where it can be punctured by the first needle member 16 and the second needle member 17, the suturing target object is The object 31 can be easily and appropriately recognized by the first objective lens 18 and the second objective lens 19. The optical axis of the first objective lens 18 and the optical axis of the second objective lens 19 are parallel to the perspective direction of the shaft 12 in that it is easy to more accurately grasp the perspective position of the sewing object 31. It is preferable. Particularly, it is preferable that the lens surfaces of the first objective lens 18 and the second objective lens 19 are arranged perpendicular to a straight line extending in the perspective direction. Further, it is preferable that the first objective lens 18 and the second objective lens 19 are arranged on the same straight line extending in the perspective direction.

The first objective lens 18 is arranged at or near the proximal end of the cutout portion 14, and the second objective lens 19 is arranged at the distal end of the cutout portion 14 or at the distal side thereof. It is preferable. In this case, the suturing target 31 is arranged in the cutout portion 14, so that the first objective lens 18 and the second objective lens 19 can surely put the suturing target 31 in the image.

Although not shown in the drawings, the first objective lens 18 may be disposed closer to the proximal end than the most proximal end of the movable section of the tip of the first needle member 16, and the second objective lens 19 may be The second needle member 17 may be disposed on the distal side of the movable section of the tip of the second needle member 17 with respect to the most distal end. If the first objective lens 18 and the second objective lens 19 are arranged in this way, it becomes easy to put the tip of the first needle member 16 or the tip of the second needle member 17 together with the sewing target object 31 in the image, It becomes easier to more accurately set the puncture position of the sewing target object 31 by the first needle member 16 and the second needle member 17.

The first objective lens 18 may be provided on the shaft 12 as long as it is arranged closer to the distal end than the most distal end of the movable section of the tip of the first needle member 16, and any member other than the shaft 12 may be provided. May be provided. The second objective lens 19 may be provided on the shaft 12 as long as it is arranged on the distal side of the most distal end of the movable section of the tip of the second needle member 17, and may be provided on any member other than the shaft 12. It may be provided. When the first objective lens 18 or the second objective lens 19 is provided on the shaft 12, the first objective lens 18 or the second objective lens 19 may be disposed inside the shaft 12 or may be disposed outside the shaft 12. Good. In the drawing, a configuration example in which the first objective lens 18 and the second objective lens 19 are provided in the shaft 12 is shown. On the other hand, although not shown in the drawing, when the first objective lens 18 or the second objective lens 19 is provided on a member other than the shaft 12, for example, the suturing system is configured to include an endoscope, The lens provided in the mirror may be the first objective lens 18 or the second objective lens 19. In this case, in particular, it is easy to configure the first objective lens 18 from an endoscope lens. On the other hand, the second objective lens 19 is preferably provided on the shaft 12, which allows the treatment portion 13 to be formed compactly.

The first objective lens 18 and / or the second objective lens 19 may be fixed to the shaft 12 or may be movably provided. For example, the first objective lens 18 and / or the second objective lens 19 may be movable in the perspective direction with respect to the shaft 12, and in particular, the first objective lens 18 may be movable in the perspective direction with respect to the shaft 12. It may be. In this case, a lens driving mechanism can be arranged on the shaft 12 in order to make the first objective lens 18 and / or the second objective lens 19 arranged on the shaft 12 movable. By moving the first objective lens 18 and / or the second objective lens 19 in the perspective direction, the focal position of the lens can be adjusted. When the first objective lens 18 is composed of an endoscope lens, the first objective lens 18 is formed so as to be movable in the perspective direction with respect to the shaft 12. The first objective lens 18 and / or the second objective lens 19 may be rotatable about a direction perpendicular to the shaft 12 as an axis. A wider area can be observed by rotating the first objective lens 18 and / or the second objective lens 19.

The numerical aperture of the first objective lens 18 is preferably larger than that of the second objective lens 19. The numerical aperture is one of the indexes showing the resolution of a lens, and the larger the numerical value of the numerical aperture, the more brightness can be captured. When suturing the object 31 to be sutured, as a first step, a thread is passed from the proximal side to the distal side of the object 31 to be sutured by the first needle member 16, so that the numerical aperture of the first objective lens 18 is set to the second value. If the numerical aperture is larger than that of the objective lens 19, the needle position by the first needle member 16 can be more accurately determined based on the image acquired through the first objective lens 18.

Although not shown in the drawings, the suture system may be provided with an illuminator. Thereby, a clearer image can be acquired by the first objective lens 18 and / or the second objective lens 19. The illuminator is provided so as to illuminate the suturing target 31, and is preferably arranged, for example, on at least one of the proximal side of the first objective lens 18 and the distal side of the second objective lens 19, and the first objective. More preferably, they are arranged on the proximal side of the lens 18 and on the distal side of the second objective lens 19, respectively. By providing the illuminator at such a position, a wide range of the sewing target object 31 can be illuminated.

The illuminator may be arranged on the distal side of the first objective lens 18 and on the proximal side of the second objective lens 19. By providing the illuminator at such a position, the suturing target object 31 can be illuminated more brightly, and the suturing target object 31 can be made less likely to have a shadow. In this case, the illuminator is on the distal side of the first objective lens 18 and on the proximal side of the second objective lens 19, and is on the distal side and the proximal side of the position where the suture object 31 is arranged. It is sufficient to be disposed on at least one of the above, and it is more preferable to be disposed on each of the proximal side and the distal side of the position where the suture target object 31 is disposed.

The illuminator may be provided at the same position as the first objective lens 18 or at the same position as the second objective lens 19 in the perspective direction. Even if the illuminator is provided at such a position, it is possible to prevent the suturing target object 31 from having a shadow. In this case, the illuminator may be arranged on at least one of the distal side and the proximal side with respect to the position where the suturing target object 31 is disposed, and with the illuminator on the proximal side with respect to the position where the suturing target object 31 is disposed. More preferably, they are arranged distally, respectively.

The illuminator is preferably shielded so that the emitted light does not directly enter the first objective lens 18 or the second objective lens 19. Specifically, when the illuminator is arranged on the proximal side of the position where the suturing target 31 is arranged, the light emitted from the illuminator is shielded so as not to directly enter the first objective lens 18. It is preferable that the illuminator is disposed on the distal side of the position where the suturing target object 31 is disposed, and the light emitted from the illuminator is shielded so as not to directly enter the second objective lens 19. Is preferred. As a result, halation hardly occurs in the image obtained by the first objective lens 18 or the second objective lens 19.

The illuminator may be provided on the shaft 12, or may be provided on any member other than the shaft 12. If the shaft 12 is provided with an illuminator, the illuminator may be located within the lumen of the shaft 12 or may be located outside the shaft 12. When the illuminator is provided on any member other than the shaft 12, for example, the suturing system is configured to include an endoscope, and the illuminator provided on the endoscope is provided on the proximal side of the first objective lens 18 or It may be used as an illuminator provided on the distal side or an illuminator provided on the proximal side or the distal side of the second objective lens 19.

As the light source of the illuminator, for example, LED, xenon lamp, organic EL, laser light or the like can be used.

It is preferable that the suturing device is provided with a fixing member for fixing a biological membrane or the like to be sutured. 4 and 5 show an example of the configuration of the treatment portion of the suturing device provided with the fixing member 21. The fixing member 21 is formed to be movable in the perspective direction, and by moving the fixing member 21 in the perspective direction, the suturing target object 31 can be sandwiched and fixed. This facilitates the needle insertion with the first needle member 16 and the second needle member 17.

The fixing member 21 is preferably arranged in the shaft 12 and adjacent to the notch 14 in the perspective direction. In this case, when the fixing member 21 is moved in the perspective direction, the length of the notch portion 14 in the perspective direction can be changed.

FIG. 4 shows the treatment section 13 in a state before the suturing target object 31 is sandwiched, and FIG. 5 shows the treatment section 13 in a state in which the suturing target object 31 is sandwiched. 4 and 5 show a configuration example of the treatment portion 13 that can sandwich the suturing target object 31 when the fixing member 21 is moved to the distal side. The proximal end is a distal side of the tip of the first needle member 16 and the second needle, with the first needle member 16 being positioned most proximally and the second needle member 17 being positioned most distally. It is preferable to be located closer to the tip than the tip of the member 17. In this case, the first objective lens 18 can be provided on the fixing member 21, and the illuminator for the first objective lens 18 can also be provided on the fixing member 21.

Although not shown in the drawing, the fixing member 21 may be capable of sandwiching the sewing target object 31 when moved to the proximal side. In this case, the proximal end of the fixing member 21 is located closer to the proximal side of the first needle member 16 and the distal end of the second needle member 17 than the distal end of the first needle member 16. It is also preferable to be located on the distal side and on the proximal side of the tip of the second needle member 17. In this case, the second objective lens 19 can be provided on the fixed member 21, and an illuminator for the second objective lens 19 can also be provided on the fixed member 21.

The fixing member 21 preferably has a first insertion passage 22 extending in the perspective direction, and the first needle member 16 and / or the second needle member 17 is preferably inserted into the first insertion passage 22. The first insertion passage 22 is provided to penetrate the fixing member 21 in the perspective direction. By providing the first insertion passage 22 in the fixing member 21 in this way, the periphery of the point at which the suturing target 31 is pierced by the first needle member 16 or the second needle member 17 can be fixed by the fixing member 21. The puncture with the first needle member 16 and the second needle member 17 becomes easy. In addition, the trajectory of the first needle member 16 and the second needle member 17 moving in the perspective direction is stabilized.

The fixing member 21 is preferably directly or indirectly connected to the handle portion 15. Thereby, the fixing member 21 can be moved in the perspective direction by operating from the proximal side of the suturing device. When the fixing member 21 is indirectly connected to the handle portion 15, the fixing member 21 may be connected to the handle portion 15 via one or a plurality of connecting members.

In the suturing device, the first needle member 16 is located on the most proximal side and the second needle member 17 is located on the most distal side. It is preferable that the restriction member is provided at a position closer to the needle member 17 than the needle member 17. 6 and 7 show configuration examples in which the regulating member 24 is provided for the treatment portion 13 shown in FIGS. 2 and 3. By providing the regulation member 24, when the yarn is fed from the proximal side of the sewing target object 31 by the first needle member 16 or when the yarn is fed from the distal side of the sewing target object 31 by the second needle member 17, The movement of the thread can be restricted so that the thread does not fall out of the suture device. In FIG. 6 and FIG. 7, a first restricting member 24A and a second restricting member 24B are provided as restricting members 24, and at least a part of the second restricting member 24B is positioned distal to the first restricting member 24A. It is provided to do. The restriction member 24 is preferably arranged in the shaft 12.

The restriction member 24 is formed so as to be movable between a position that hinders the movement of the first needle member 16 and / or the second needle member 17 and a position that does not hinder the movement thereof. Specifically, the regulation member 24 has a holding portion 25, and the holding portion 25 is provided between a position that hinders the movement of the first needle member 16 and / or the second needle member 17 and a position that does not hinder the movement. Formed to move. The position that hinders the movement of the first needle member 16 is on the locus of the first needle member 16 when the first needle member 16 is moved in the perspective direction, and the first needle member 16 is the most proximal position. In the state of being located on the side, it means any position distal to the tip of the first needle member 16. The position that hinders the movement of the second needle member 17 is on the trajectory of the second needle member 17 when the second needle member 17 is moved in the perspective direction, and the second needle member 17 is the most distal position. In the state of being located on the side, it means an arbitrary position on the proximal side from the tip of the second needle member 17.

As the regulation member 24, preferably, a first regulation member 24A and a second regulation member 24B are provided, and between the position where the first regulation member 24A hinders the movement of the first needle member 16 and the position where it does not hinder the movement. The second restricting member 24B is movable and is movable between a position that hinders the movement of the second needle member 17 and a position that does not hinder the movement of the second needle member 17. More preferably, both the first restricting member 24A and the second restricting member 24B are formed so as to be movable between a position that hinders the movement of the first needle member 16 and the second needle member 17 and a position that does not hinder the movement thereof. It

The holding portion 25 is a distal side of the first needle member 16 and a second needle member in a state where the first needle member 16 is located on the most proximal side and the second needle member 17 is located on the most distal side. It is preferable to be located on the proximal side of 17. When the first restricting member 24A and the second restricting member 24B are provided as the restricting member 24, the holding portion 25 of the first restricting member 24A is located closer to the proximal side than the retaining portion 25 of the second restricting member 24B. It is preferably provided. In this case, it is preferable that the suturing target object 31 is arranged between the holding portion 25 of the first regulating member 24A and the holding portion 25 of the second regulating member 24B. Therefore, the holding portion 25 of the first regulating member 24A is It is preferable that the shaft 12 is provided on the proximal side of the cutout portion 14, and the holding portion 25 of the second regulating member 24B is provided on the distal side of the cutout portion 14.

By moving in a direction different from the perspective direction, the holding portion 25 can move between a position that hinders the movement of the first needle member 16 and / or the second needle member 17 and a position that does not hinder the movement. preferable. The direction different from the perspective direction is preferably parallel movement in a direction different from the perspective direction. 6 and 7 show a configuration example of the restriction member 24 in which the holding unit 25 moves in a direction perpendicular to the perspective direction as a mode in which the holding unit 25 translates in a direction different from the perspective direction. In FIG. 6, the holding portion 25 is at a position that does not hinder the movement of the first needle member 16 and the second needle member 17, and in FIG. 7, the holding portion 25 moves the first needle member 16 and the second needle member 17. It is in a position that interferes with. By moving the holding portion 25 to a position that hinders the movement of the first needle member 16 and / or the second needle member 17, the yarn to be delivered by the first needle member 16 or the second needle member 17 is easily formed. You can prevent it from falling out. On the other hand, when the holding portion 25 is at a position that does not hinder the movement of the first needle member 16 and / or the second needle member 17, by moving the first needle member 16 or the second needle member 17 in the perspective direction. The yarn can be sent out. The holding portion 25 may prevent the yarn from falling off by directly contacting the yarn, or may prevent the yarn from falling off by moving to a position that is an obstacle when the yarn falls off.

The moving direction of the holding portion 25 is preferably 45 ° or more and 90 ° or less with respect to the perspective direction, more preferably 60 ° or more and 90 ° or less, and further preferably 75 ° or more and 90 ° or less. The holding portion 25 is preferably movable in a direction perpendicular to the perspective direction, so that even if the holding portion 25 comes into contact with the yarn when the holding portion 25 is moved, the yarn is less likely to shift in the perspective direction. Become. In FIG. 6 and FIG. 7, the regulating member 24 is formed in an L shape in a cross section along the perspective direction, and the distal end portion of the distal portion extending perpendicularly to the perspective direction serves as the holding portion 25. Has become. The holding portion 25 is movable in a direction perpendicular to the perspective direction.

It is preferable that an insertion passage through which the holding portion 25 passes is provided inside the shaft 12. The insertion passage through which the holding portion 25 passes preferably extends along the moving direction of the holding portion 25. By providing such an insertion passage, it becomes easy to move the holding portion 25 in parallel in a desired direction and accurately move it to a position that hinders the movement of the first needle member 16 and / or the second needle member 17. . The insertion passage through which the holding portion 25 passes is preferably connected in the middle of the insertion passage through which the first needle member 16 or the second needle member 17 passes. Further, the cutout portion 14 of the shaft 12 is provided on the distal side of the insertion passage through which the holding portion 25 of the first regulation member 24A passes and on the proximal side of the insertion passage through which the holding portion 25 of the second regulation member 24B passes. It is preferable.

The shape of the holding portion 25 is not particularly limited. It should be noted that the holding portion 25 has a rod-like or plate-like shape extending in a direction different from the perspective direction in order to reduce the space in which the holding portion 25 moves within the shaft 12 and to prevent the yarn from falling off by the movement of the holding portion 25. And is movable in the direction.

The restriction member 24 is formed so as to move between a position that hinders the movement of the first needle member 16 and / or the second needle member 17 and a position that does not hinder the movement of the first needle member 16 and / or the second needle member 17 by an operation from the proximal side of the suturing device. Is preferably provided. From this point, it is preferable that the regulation member 24 has the support portion 26 extending in the perspective direction on the proximal side of the holding portion 25. In this case, by operating from the proximal side of the suturing device, the movement of the support portion 26 is directly or indirectly controlled to move the holding portion 25 so as to prevent the movement of the first needle member 16 and / or the second needle member 17. It can be moved between an obstructing position and an unobstructing position.

The holding portion 25 and the support portion 26 of the regulating member 24 may be integrally formed of one member, or may be formed by combining a plurality of members. In FIGS. 6 and 7, the regulation member 24 is formed by bending the wire into an L-shape, and the distal end portion bent into the L-shape is used as the holding portion 25, and the portion on the proximal side is supported. Part 26.

The restricting member 24 is preferably formed so that the holding portion 25 and the supporting portion 26 can move in a direction perpendicular to the perspective direction. If the holding part 25 and the support part 26 can move integrally in the direction perpendicular to the perspective direction, the holding part 25 can be stably moved in the direction perpendicular to the perspective direction. In this case, it is preferable that the regulation member 24 is formed so as to be movable in the direction perpendicular to the perspective direction as follows. That is, the direction perpendicular to the perspective in which the holding portion 25 is movable is defined as the up-down direction, and the holding portion 25 does not interfere from the position where the movement of the first needle member 16 and / or the second needle member 17 is hindered. When the direction of movement to the position is downward and the opposite direction is upward, a spacer member movable in the perspective direction is provided below the support portion 26 of the regulation member 24, and the spacer member is moved to the distal side. It is preferable that the holding portion 25 and the supporting portion 26 move upward when the spacer member is moved, and the holding portion 25 and the supporting portion 26 move downward when the spacer member is moved proximally.

FIG. 8 shows a configuration example in which a spacer member 27 that is movable in the perspective direction is provided below the support portion 26 of the regulation member 24. As shown in FIG. 8, when the spacer member 27 is moved to the distal side, the holding portion 25 and the support portion 26 of the first regulating member 24A move upward, and the holding portion of the second regulating member 24B. 25 and the support portion 26 move upward. On the other hand, the state shown in FIG. 6 can be regarded as a state in which the spacer member 27 is moved to the proximal side, but when the spacer member 27 is moved to the proximal side, the holding portion 25 of the first restriction member 24A is obtained. The support portion 26 moves downward, and the holding portion 25 and the support portion 26 of the second restricting member 24B move downward.

The spacer member 27 is preferably directly or indirectly connected to the handle portion 15. This allows the spacer member 27 to be moved in the perspective direction by operating from the proximal side of the suturing device, and the restriction member 24 at a position that hinders the movement of the first needle member 16 and / or the second needle member 17. And can be moved between unobtrusive positions. As the spacer member 27, it is preferable to use a rod-shaped or plate-shaped member extending in the perspective direction. By using such a spacer member 27, the spacer member 27 can be arranged and moved in the perspective direction even in a narrow space in the shaft 12.

When the spacer member 27 is provided below the support portion 26 of the regulation member 24, it is preferable that the regulation member 24 exert a downward force when the spacer member 27 is moved to the proximal side. Thereby, when the spacer member 27 is moved to the proximal side, the regulation member 24 is likely to move downward. Therefore, it is preferable that the support portion 26 is in contact with an elastic member such as a spring or rubber. For example, a compression coil spring, a torsion spring, or a leaf spring may be installed on the upper side of the support portion 26, a tension coil spring may be installed on the lower side of the support portion 26, or the support portion 26 may be provided with the shaft 12 and rubber on the lower side. A downward force can be applied to the support portion 26 by connecting with an elastic string or an elastic thread. As yet another example, a rubber, an elastic string, or an elastic thread may be included in the support portion 26 and may circulate the section of the shaft 12 including the cutout portion 14 when viewed from the perspective direction. By providing, a downward force can be applied to the support portion 26. Thereby, when the spacer member 27 is moved to the proximal side, the regulation member 24 is likely to move downward.

The suturing device may include both the fixing member for fixing the suturing target object described above and the restricting member for restricting the movement of the thread so that the thread does not fall out of the suturing apparatus. FIG. 9 shows a configuration example in which the restriction member 24 shown in FIGS. 6 and 7 is provided to the treatment portion 13 provided with the fixing member 21 shown in FIGS. 4 and 5. Note that, regarding the configuration example of FIG. 9, description of the portions overlapping the above description will be omitted.

The fixing member 21 is preferably provided with a second insertion passage 23 extending in a direction different from the perspective direction, and at least a part of the holding portion 25 of the regulation member 24 is inserted into the second insertion passage 23. The second insertion passage 23 is preferably connected in the middle of the first insertion passage 22 through which the first needle member 16 or the second needle member 17 passes. In the treatment portion 13 shown in FIG. 9, the holding portion 25 of the first regulating member 24A is inserted into the second insertion passage 23. The holding portion 25 of the second restriction member 24B may be inserted into the second insertion passage 23, and in this case, the suturing target object 31 may be sandwiched when the fixing member 21 is moved to the proximal side. it can. By providing the second insertion passage 23 in the fixed member 21, the holding portion 25 of the restriction member 24 can be accurately moved in a direction different from the perspective direction. The second insertion passage 23 is preferably formed so as to extend in a direction perpendicular to the perspective direction.

When at least a part of the holding portion 25 of the regulation member 24 is inserted through the second insertion passage 23 of the fixed member 21, for example, as described in FIG. The spacer member 27 movable in the direction is provided, and when the spacer member 27 is moved to the distal side, the holding portion 25 and the support portion 26 are moved upward and the spacer member 27 is moved to the proximal side. At times, the holding portion 25 and the support portion 26 can be configured to move downward.

The suturing system preferably has a display device for displaying an image obtained through the first objective lens 18 or an image obtained through the second objective lens 19. The display device may display both an image obtained through the first objective lens 18 and an image obtained through the second objective lens 19. The surgeon can perform the suturing operation of the suturing target 31 and determine the position of the needle by the first needle member 16 or the second needle member 17 while looking at the image displayed on the display device.

The suturing system may generate three-dimensional image data of the suturing target object 31 based on the image obtained through the first objective lens 18 and the image obtained through the second objective lens 19. The operator can perform the suturing operation of the suturing target 31 and determine the position of the needle by the first needle member 16 or the second needle member 17 while viewing the obtained three-dimensional image data.

The suturing system may have a positioning marker that indicates a specific position of the two-dimensional coordinate that is perpendicular to the perspective direction. The positioning marker is displayed on at least one of the image captured by the first objective lens 18 and the image captured by the second objective lens 19. The positioning marker indicates a position serving as a reference in the surface direction of the suturing target 31, and the operator can appropriately set the puncture position by the first needle member 16 or the second needle member 17 using the positioning marker as a guide. . The positioning marker may be, for example, a marker member attached to the suturing device or a mark displayed on the image of the display device. In the former case, the marker member is provided at a position where it is reflected in the image captured by the first objective lens 18 or the second objective lens 19, and is preferably provided in the notch portion 14 of the shaft 12, for example.

As another method of using the positioning marker, the positioning marker can be used as follows. That is, the positioning marker is displayed on both the image captured by the first objective lens 18 and the image captured by the second objective lens 19, and the image captured by the first objective lens 18 and the image captured by the second objective lens 19 are displayed. When the focus of the displayed image matches the positioning marker, it is possible to determine that both the first objective lens 18 and the second objective lens 19 are observing the same two-dimensional plane perpendicular to the perspective direction. . Further, by using the position of the positioning marker as the origin, the coordinate position of the plane can be matched with the first objective lens 18 and the second objective lens 19, which is advantageous for generating three-dimensional image data of the suture target 31. Become.

The suturing system specifies the position of the suturing target object on the display device that displays the image obtained through the first objective lens 18 or the image obtained through the second objective lens 19, so that the first needle member 16 or the second needle is provided. A puncture position control unit that controls the puncture position of the member 17 may be included. The surgeon looks at the image obtained through the first objective lens 18 or the image obtained through the second objective lens 19, specifies the position to be punctured next, and determines the position on the display device or a separate designation device. You can enter the information. The pricking position control unit to which the positional information is input controls the first needle member 16 or the second needle member 17 to guide or prick the first needle member 16 or the second needle member 17 to the position.

In the suturing system, the operator directly operates the handle portion 15 of the suturing device 11 based on the image information of the suturing target 31 and the position information in the perspective direction acquired through the first objective lens 18 and / or the second objective lens 19. The object 31 to be sutured may be sewn by using the first objective lens 18 and / or the second objective lens 19 to obtain the object to be sewn based on the image information of the object 31 to be sewn and the positional information in the perspective direction. The sewing of the object 31 may be automatically or semi-automatically performed. In the latter case, the suturing system controls the movement of the first needle member 16 and / or the second needle member 17 in the perspective direction and the storage unit that holds information for specifying the position of the needle to be sewn on the suture target 31. It is preferable to have a control unit for controlling. This will be described with reference to FIG. Regarding the position of the needle member to be sewn on the object to be sewn, the puncture position of the first needle member is referred to as a “first puncture position”, and the puncture position of the second needle member is referred to as a “second puncture position”.

Regarding the control of the movement of the first needle member 16 in the perspective direction, the storage unit and the control unit are preferably configured as follows. That is, the storage unit holds information for specifying the position of the first needle to the suture target 31, and the control unit causes the tip of the first needle member 16 to pass through the first needle position and the suture target 31. It is preferable to control the first needle member 16 so as to move from the proximal side to the distal side. The identification of the first needle position is based on the image information obtained through the first objective lens 18 and / or the second objective lens 19, and the operator determines the first needle position while looking at the image information displayed on the display device. Alternatively, the suture system may be provided with an arithmetic unit, and the arithmetic unit may determine the first needle position and input the arithmetic operation to the storage unit. The control unit moves the first needle member 16 from the proximal side to the first puncture position of the suturing target 31 based on the information on the first puncturing position held in the storage unit, and punctures the suturing target 31.

Regarding the control of the movement of the second needle member 17 in the perspective direction, the storage unit and the control unit are preferably configured as follows. That is, the storage unit holds information for specifying the position of the second puncture needle on the suturing target object 31, and the control unit causes the tip of the second needle member 17 to pass through the second puncture position and the suturing target object 31. It is preferable to control the second needle member 17 so as to move from the distal side to the proximal side. The identification of the second needle position is based on the image information obtained through the first objective lens 18 and / or the second objective lens 19, and the operator determines the second needle position while looking at the image information displayed on the display device. Alternatively, it may be input to the storage unit, or an operation unit may be provided in the suturing system, the operation unit may determine the second needle position, and may be input to the storage unit. The control unit moves the second needle member 17 from the distal side to the second puncture position of the suture target 31 based on the information on the second puncture position held in the storage unit, and punctures the suture target 31.

Preferably, the display device displays the marker at a position corresponding to the first needle position or the second needle position. When the suturing system generates three-dimensional image data of the object to be sutured, it is preferable that the marker is displayed at a position corresponding to the first needle position or the second needle position of the three-dimensional image data. The marker may be displayed by the operator inputting the first needle position or the second needle position, or the first needle position or the second needle position determined by the calculation unit may be displayed. May be In either case, it is possible to confirm the first needle stick position or the second needle stick position on the display screen.

The suturing device 11 preferably has a mechanism for moving the shaft 12 in a direction different from the perspective direction. For example, the shaft 12 is preferably formed so that the distal portion of the shaft 12 can move in a direction different from the perspective direction with the proximal portion of the shaft 12 as a fulcrum. Further, it is preferable that the shaft 12 is formed so that the shaft 12 can be rotated about the perspective direction of the shaft 12. Thereby, the tip of the first needle member 16 is moved to the first needle position or the tip of the second needle member 17 is moved to the second needle position based on the information of the first needle position or the second needle position held in the storage unit. It can be moved to the needle position. In this case, the control unit moves the shaft 12 in a direction different from the perspective direction so that the tip of the first needle member 16 faces the first needle position or the tip of the second needle member 17 moves to the second needle position. It is preferable to have a function of controlling the movement of the shaft 12 so as to move the shaft 12 to a position opposite to. Accordingly, it is possible to save labor or automate the suturing operation.

The present application claims the benefit of priority based on Japanese Patent Application No. 2018-200351 filed on October 24, 2018. The entire contents of the specification of Japanese Patent Application No. 2018-200351 filed on October 24, 2018 are incorporated herein by reference.

11: Suture device 12: Shaft 13: Treatment part 14: Notch part 15: Handle part 16: First needle member 17: Second needle member 18: First objective lens 19: Second objective lens 21: Fixing member 22: First insertion passage 23: Second insertion passage 24: Regulation member, 24A: First regulation member, 24B: Second regulation member 25: Holding portion 26: Support portion 27: Spacer member 31: Object to be sewn

Claims

A shaft extending in the perspective direction,
A first needle member that is movable in a perspective direction and has a tip facing distally;
A second needle member that is movable in a perspective direction, is disposed on the distal side of the first needle member, and has a tip facing the proximal side;
A bidirectional medical suturing system having an objective lens group including a first objective lens and a second objective lens,
The first objective lens is arranged closer to the distal side than the most distal end of the movable section of the tip of the first needle member, and faces the distal side,
The second objective lens is disposed on the distal side of the movable section of the distal end of the second needle member, and faces the proximal side, and faces the proximal side. .
The first objective lens is arranged closer to the proximal side than the most proximal end of the movable section of the tip of the first needle member,
The two-way medical suturing system according to claim 1, wherein the second objective lens is arranged more distally than the most distal end of the movable section of the tip of the second needle member.
The bidirectional suturing system for medical use according to claim 1 or 2, wherein the first objective lens and the second objective lens are arranged so that at least some of them overlap each other when viewed from the perspective direction of the shaft.
The medical bidirectional suture according to any one of claims 1 to 3, wherein an illuminator is arranged on at least one of a proximal side of the first objective lens and a distal side of the second objective lens. system.
An illuminator is arranged on the distal side of the first objective lens and on the proximal side of the second objective lens, and the emitted light of the illuminator is the first objective lens or the second objective lens. The bidirectional medical suturing system according to any one of claims 1 to 3, which is shielded so as not to be directly incident on
The medical bidirectional suturing system according to any one of claims 1 to 5, wherein an optical axis of the first objective lens and an optical axis of the second objective lens are parallel to a perspective direction.
The medical bidirectional suturing system according to any one of claims 1 to 6, wherein the first objective lens is movable in a perspective direction with respect to the shaft.
The medical bidirectional suturing system according to any one of claims 1 to 7, wherein the numerical aperture of the first objective lens is larger than the numerical aperture of the second objective lens.
A storage unit that holds information for identifying the position of the first puncture needle on the suture target;
The control unit that further controls the first needle member so that the tip of the first needle member moves from the proximal side to the distal side of the suture target via the first puncture position. 8. The medical bidirectional suturing system according to any one of 8 above.
A storage unit that holds information for specifying the position of the second needle on the object to be sutured;
The control unit that further controls the second needle member such that the tip of the second needle member moves from the distal side to the proximal side of the suture target via the second puncture position. 9. The medical bidirectional suturing system according to any one of 9 above.
A display device for displaying an image obtained through the first objective lens or an image obtained through the second objective lens,
The medical bidirectional suturing system according to claim 9 or 10, wherein a mark is displayed on the display device at a position corresponding to the first needle position or the second needle position.
The two-way medical suturing system according to claim 9 or 10, which generates three-dimensional image data of an object to be sutured based on an image obtained through the first objective lens and an image obtained through the second objective lens.
The medical bidirectional suturing system according to any one of claims 9 to 12, which has a mechanism for moving the shaft in a direction different from the perspective direction.
A positioning marker indicating a specific position of two-dimensional coordinates perpendicular to the perspective direction, the positioning marker being displayed on at least one of an image captured by the first objective lens and an image captured by the second objective lens. The medical bidirectional suturing system according to any one of claims 1 to 13, which has a marker.