WO2021079461A1 - 内視鏡用持針器および縫合針の操作方法 - Google Patents

内視鏡用持針器および縫合針の操作方法 Download PDF

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Publication number
WO2021079461A1
WO2021079461A1 PCT/JP2019/041694 JP2019041694W WO2021079461A1 WO 2021079461 A1 WO2021079461 A1 WO 2021079461A1 JP 2019041694 W JP2019041694 W JP 2019041694W WO 2021079461 A1 WO2021079461 A1 WO 2021079461A1
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WO
WIPO (PCT)
Prior art keywords
suture needle
slider
gripping
grip
main body
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2019/041694
Other languages
English (en)
French (fr)
Japanese (ja)
Inventor
洸佑 岡
正敏 外村
梶　国英
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Corp
Original Assignee
Olympus Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Corp filed Critical Olympus Corp
Priority to CN201980099896.4A priority Critical patent/CN114302683B/zh
Priority to PCT/JP2019/041694 priority patent/WO2021079461A1/ja
Priority to JP2021553231A priority patent/JP7233562B2/ja
Publication of WO2021079461A1 publication Critical patent/WO2021079461A1/ja
Priority to US17/683,771 priority patent/US12357300B2/en
Anticipated expiration legal-status Critical
Priority to US19/232,961 priority patent/US20250302470A1/en
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062—Needle manipulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00862—Material properties elastic or resilient

Definitions

  • the present invention relates to a needle holder for an endoscope and a method of operating a suture needle.
  • Patent Document 1 describes a surgical gripper that grips a suture needle.
  • the surgical gripper described in Patent Document 1 has a grip portion at the tip of a rigid shaft, the grip portion can adjust the force for gripping the object to be gripped, and the suture needle is gripped again on the grip portion.
  • the orientation and position of the suture needle can be changed to a desired orientation and position without any need.
  • the adjustment mechanism of the force for gripping the object to be gripped provided by the surgical gripper described in Patent Document 1 is an operation wire for operating the grip portion due to a change in the insertion path or the like when used under a flexible endoscope. Since the tension of the grip changes, it is difficult to make the force of the grip portion gripping the object to be gripped constant.
  • the present invention can easily change the direction and position of the suture needle to a desired direction and position by adjusting the force for gripping the object to be gripped in the suturing work under a flexible endoscope. It is an object of the present invention to provide a method of operating a needle holder for an endoscope and a suture needle.
  • the needle holder for an endoscope has a sheath having a longitudinal axis, a grip portion attached to the tip end portion of the sheath and capable of gripping a suture needle, and a base end portion of the sheath.
  • the grip portion is attached to an operating portion capable of opening and closing the grip portion, and an operating wire extending along the longitudinal axis of the sheath.
  • the operating portion includes a main body fixed to a base end portion of the sheath.
  • a member, the tip of the operating wire is connected to the grip, the base end of the operating wire is connected to the slider, and the grip resists the restoring force of the elastic member.
  • the grip of the suture needle is released, and the slider is seconded with respect to the main body against the restoring force of the elastic member.
  • the slider When the suture needle is gripped by the first gripping force and the slider is positioned between the first position and the second position in response to the operation of retracting to the position of, the restoring force of the elastic member is obtained.
  • the slider is positioned by balancing the tension of the operating wire with the operating wire, and grips the suture needle with a second gripping force smaller than the first gripping force.
  • the method of operating the suture needle according to the second aspect of the present invention includes a step of spontaneously introducing the suture needle into the lumen organ and a part of the suture needle located inside the lumen organ. It has a step of changing the direction of the needle tip of the suture needle while pressing it against the tube wall.
  • the method of operating the suture needle according to the third aspect of the present invention is attached to a sheath having a longitudinal axis, a grip portion attached to the tip end portion of the sheath and capable of gripping the suture needle, and a base end portion of the sheath.
  • a method of operating a suture needle gripped by a needle holder for an endoscope comprising an operating portion capable of opening and closing the grip portion and an operating wire extending along a longitudinal axis of the sheath.
  • the direction and position of the suture needle are desired by adjusting the force for gripping the object to be grasped in the suturing work under a flexible endoscope. Can be easily changed to the orientation and position of.
  • FIG. 6 is a cross-sectional view taken along the line AA of FIG. It is sectional drawing in BB line of FIG.
  • FIG. 1 is an overall view of a treatment system 300 including a needle holder 100 according to the present embodiment.
  • the treatment system 300 includes a flexible endoscope 200 and a needle holder 100, as shown in FIG.
  • the needle holder 100 is used by being inserted into the flexible endoscope 200.
  • the flexible endoscope 200 includes an insertion portion 202 inserted into the body from the tip end and an operation portion 207 attached to the base end of the insertion portion 202.
  • the insertion portion 202 has an imaging portion 203, an active bending portion 204, and a soft portion 205. From the tip of the insertion portion 202, the imaging portion 203, the active bending portion 204, and the soft portion 205 are arranged in this order.
  • a channel 206 for inserting the needle holder 100 is provided inside the insertion portion 202.
  • a tip opening 206a of the channel 206 is provided at the tip of the insertion portion 202.
  • the imaging unit 203 includes, for example, a CCD or CMOS, and can image a portion to be treated.
  • the imaging unit 203 can image the grip portion 3 of the needle holder 100, which will be described later, in a state where the needle holder 100 projects from the tip opening 206a of the channel 206.
  • the active bending portion 204 can be positively bent according to the operation of the operating portion 207 by the operator.
  • the flexible portion 205 is a tubular portion having flexibility.
  • the operation unit 207 is connected to the soft unit 205.
  • the operation unit 207 has a grip 208, an input unit 209, a base end opening 206b of the channel 206, and a universal cord 210.
  • the grip 208 is a portion gripped by the operator.
  • the input unit 209 receives an operation input for bending the active bending unit 204.
  • the universal code 210 outputs the image captured by the imaging unit 203 to the outside.
  • the universal cord 210 can be connected to a display device such as a liquid crystal display via an image processing device such as a processor.
  • FIG. 2 is an overall view showing the needle holder 100.
  • the needle holder 100 has a sheath 1, a hard portion 2, a grip portion 3, an operation portion 4, and an operation wire 5 through which the sheath 1 is inserted.
  • Sheath 1 is a long member that has flexibility and extends from the tip end 1a to the base end 1b. As shown in FIG. 1, the sheath 1 has an outer diameter that can be inserted into channel 206 of the flexible endoscope 200. With the sheath 1 inserted into the channel 206, the tip 1a of the sheath 1 can be recessed from the tip opening 206a of the channel 206. The tip 1a of the sheath 1 can enter the imaging field of view of the imaging unit 203 of the flexible endoscope 200, and is imaged by the imaging unit 203.
  • a hard portion 2 is provided at the tip 1a of the sheath 1.
  • the hard portion 2 is formed of a hard material such as stainless steel (SUS).
  • SUS stainless steel
  • the hard portion 2 is provided with a grip portion 3.
  • An operation unit 4 is provided at the base end 1b of the sheath 1.
  • FIG. 3 is a cross-sectional view of the tip 1a of the sheath 1.
  • the sheath 1 is a member that is inserted into the body cavity endoscopically, and has a first coil sheath 11 through which the operation wire 5 is inserted and a second coil sheath 12 through which the first coil sheath 11 is inserted.
  • the first coil sheath 11 is not limited to the coil sheath, and may be a resin tube having excellent compression resistance such as PEEK.
  • the first coil sheath 11 is a so-called single-row coil sheath formed by tightly winding one metal wire in a loop shape, and has compression resistance to the inserted operation wire 5 for operation.
  • the opening / closing operation of the grip portion 3 via the portion 4 is preferably transmitted to the grip portion 3.
  • the second coil sheath 12 is a so-called multi-row coil sheath formed by arranging a plurality of metal strands in the radial direction and tightly winding them in a loop shape, and preferably grips an operation for rotating the grip portion 3. Communicate to part 3.
  • the number of metal strands of the second coil sheath 12 may be appropriately determined.
  • the first coil sheath 11 is formed of a metal wire having a rectangular cross section
  • the second coil sheath 12 is formed of a metal wire having a circular cross section.
  • the shape of the cross section of the metal wire is not limited to this, and may be appropriately selected according to the design value of the sheath 1 and the like.
  • a region having a predetermined length from the tip 12A of the second coil sheath 12 is processed so as to have a flat inner peripheral surface 12B by cutting or the like.
  • the base end side of the hard portion 2 is formed in a tubular shape, and the outer surface thereof is provided with an outer surface 2A which is connected and fixed to the inner peripheral surface 12B of the second coil sheath 12.
  • the inner peripheral surface 12B of the second coil sheath 12 and the outer surface 2A on the base end side of the hard portion 2 are fixed by laser welding, brazing, or the like.
  • the tip 11A of the first coil sheath 11 is fixed to the base end of the hard portion 2 by laser welding, brazing, or the like.
  • the tip 12A of the second coil sheath 12 fixed to the outer surface 2A of the hard portion 2 cannot rotate around its own axis with respect to the hard portion 2, and cannot move relative to the first coil sheath 11 in the axial direction. ..
  • connection mode between the hard portion 2 and the sheath 1 is not particularly limited to that described above.
  • the second coil sheath 12 may be fixed to the outer surface and the first coil sheath 11 may be fixed to the inner surface.
  • the shape of the portion of the hard portion 2 to which the sheath 1 is fixed does not have to be tubular.
  • FIG. 4 and 5 are perspective views showing the grip portion 3 of the needle holder 100.
  • the grip portion 3 has a first grip member 31, a second grip member 32, and a link mechanism 36.
  • the first gripping member 31 and the second gripping member 32 are configured to be openable and closable.
  • FIG. 4 shows a state in which the first gripping member 31 and the second gripping member 32 are closed
  • FIG. 5 shows a state in which the first gripping member 31 and the second gripping member 32 are opened.
  • the first gripping member 31 is a part of the tip portion of the hard portion 2.
  • the first gripping member 31 extends along the longitudinal axis Y1 of the sheath 1.
  • the first gripping member 31 and the hard portion 2 are integrally molded.
  • the second gripping member 32 is connected to the hard portion 2 so as to be openable and closable with respect to the first gripping member 31.
  • the second gripping member 32 is hardened by inserting the connecting shaft 37 into the through hole 38 formed in the second gripping member 32 and the through hole 39 formed in the hard portion 2. It is rotatably connected to the portion 2.
  • the second gripping member 32 is rotatable around the longitudinal axis Y2 of the connecting shaft 37.
  • the first gripping member 31 has a first protrusion 311 and a second protrusion 312.
  • the first protrusion 311 and the second protrusion 312 are provided at the tip of the first gripping member 31 and project in a direction intersecting the longitudinal axis (central axis) Y1.
  • the first protrusion 311 and the second protrusion 312 are provided in pairs with the longitudinal axis Y1 of the sheath 1 interposed therebetween, and in a state where the first grip member 31 and the second grip member 32 are closed, the first The tip of the second gripping member 32 is located between the protrusion 311 and the second protrusion 312.
  • the link mechanism 36 is composed of a first link member 36a, a first joint member 36b, a second link member 36c, and a second joint member 36d.
  • the first link member 36a is connected to the second link member 36c by the first joint member 36b.
  • the second link member 36c is connected to the second gripping member 32 by the second joint member 36d.
  • FIG. 6 is an enlarged cross-sectional view of a connecting portion between the operating portion (handle) 4 and the sheath 1.
  • the operation unit 4 includes a main body 40, a slider 41, a fixing mechanism 42, a release button 43, a sliding member (key) 44, a locking member (disk) 45, and an elastic member 46. ing.
  • the base end 12C of the second coil sheath 12 is fixed to the sliding member 44 inside the main body 40.
  • the base end 11B of the first coil sheath 11 extending from the second coil sheath 12 is fixed to the locking member 45.
  • the operation wire 5 extending from the first coil sheath 11 passes through the inside of the main body 40 and is connected to the slider 41.
  • the slider 41 is connected to the main body 40 so as to be able to move forward and backward, and can move forward and backward along the axial direction of the main body 40.
  • the fixing mechanism 42 is a ratchet mechanism provided on the slider 41, and has a spring 42S and an engaging portion (claw) 42E.
  • the slider 41 allows the main body 40 to move backward along the axial direction of the main body 40, but does not allow the main body 40 to move forward.
  • the engaging portion 42E of the fixing mechanism 42 engages with the engaged portion (ratchet tooth) 40E provided on the main body 40 by the restoring force of the spring 42S.
  • the slider 41 cannot advance with respect to the main body 40.
  • the slider 41 can be retracted with respect to the main body 40.
  • the release button 43 is a button that releases the engagement between the engaging portion 42E and the engaged portion 40E when pressed.
  • the operator can advance the slider 41 with respect to the main body 40 along the axial direction of the main body 40 only when the release button 43 is pressed. That is, by pushing the release button 43, the engaging portion 42E and the engaged portion 40E are disengaged (hooked), so that the slider 41 can be advanced with respect to the main body 40 along the axial direction of the main body 40. become able to.
  • FIG. 7 is a cross-sectional view taken along the line AA of FIG.
  • the sliding member 44 is a member that slides inside the main body 40, and has a through hole through which the first coil sheath 11 is inserted. Since the cross-sectional shape of the sliding member 44 in the width direction of the main body 40 is substantially rectangular, when the main body 40 is rotated around the axis, the sliding member 44 is caught in the sliding groove 40g, so that the sliding member 44 and the second The coil sheath 12 also rotates about the axis along with the main body 40.
  • the sliding member 44 can slide inside the sliding groove 40g provided so as to extend in the longitudinal direction inside the main body 40. That is, the base end 12C of the second coil sheath 12 is attached so as not to rotate about the axis with respect to the main body 40 and to be relatively movable in the axial direction with respect to the main body 40 and the first coil sheath 11.
  • FIG. 8 is a cross-sectional view taken along the line BB of FIG.
  • the locking member 45 has a substantially cylindrical shape or a ring shape, and has an outer diameter larger than that of the first coil sheath 11.
  • the base end 11B of the first coil sheath 11 fixed to the locking member 45 is attached to the main body 40 so as to be rotatable about the axis and not relatively movable in the axis direction.
  • FIG. 9 is a diagram showing operations when the operation unit 4 and the sheath 1 are used.
  • the long insertion portion 202 of the flexible endoscope 200 and the sheath 1 of the needle holder 100 inserted through the insertion portion 202 may meander or bend. There is.
  • the base end 12C of the second coil sheath 12 is connected as shown in FIG.
  • the sliding member 44 slides in the sliding groove 40g inside the main body 40 toward the tip end side in the axial direction (direction indicated by the arrow shown in FIG.
  • the end face of the sliding member 44 in the longitudinal direction of the sliding groove 40g so that the sheath 1 does not bend even when the sheath 1 is bent to the maximum. It is preferable that it is set so as not to always touch the.
  • the elastic member 46 is a compression spring arranged along the axial direction of the main body 40 that advances and retreats to the slider 41, and has a tip attached to the main body 40 and a base end attached to the slider 41.
  • the expansion / contraction direction of the elastic member 46 is the axial direction of the main body 40.
  • the operation wire 5 is arranged inside the sheath 1 along the longitudinal axis Y1 of the sheath 1.
  • the operation wire 5 is a flexible wire and can transmit the amount of operation force from the operation unit 4.
  • the tip of the operation wire 5 is fixed to the first link member 36a of the link mechanism 36.
  • the base end of the operation wire 5 is connected to the slider 41 of the operation unit 4. That is, the tip of the operation wire 5 and the second gripping member 32 are connected to each other via the link mechanism 36. Therefore, the amount of operating force for operating the opening / closing operation of the second gripping member 32 with respect to the first gripping member 31 is transmitted from the operating unit 4 to the second gripping member 32 via the operating wire 5 and the link mechanism 36.
  • the wire is the wire.
  • the operation wire 5 By moving the slider 41 forward and backward along the main body 40, the operation wire 5 can be moved forward and backward along the longitudinal axis Y1 of the sheath 1. In the present embodiment, the operation wire 5 can be pulled toward the operation unit 4 by moving the slider 41 toward the base end side along the main body 40.
  • the operating wire 5 can be maintained in the pulled state.
  • the second grip member 32 moves in the closing direction with respect to the first grip member 31.
  • the second grip member 32 moves in the opening direction with respect to the first grip member 31.
  • FIGS. 10 to 12 are views showing the needle holder 100 when the slider 41 is moved forward and backward.
  • FIG. 10 is a diagram showing a needle holder 100 in which the grip portion 3 does not grip the suture needle N.
  • the operator keeps pressing the release button 43 and advances the slider 41 with respect to the main body 40 along the axial direction of the main body 40.
  • the second gripping member 32 moves in the opening direction with respect to the first gripping member 31.
  • the operation wire 5 is pushed in as the slider 41 advances.
  • the elastic member 46 receives a compressive force, so that the elastic force generated in the elastic member 46 becomes larger than the tension of the operation wire 5.
  • the elastic member 46 is in a contracted state in the expansion / contraction direction from the initial state.
  • the position of the slider 41 in which the gripping portion 3 grips the suture needle N in the open state is referred to as "first position P1".
  • FIG. 11 is a diagram showing a needle holder 100 in which the gripping portion 3 grips the suture needle N.
  • the operator retracts the slider 41 with respect to the main body 40 along the axial direction of the main body 40.
  • the second gripping member 32 moves in the closing direction with respect to the first gripping member 31.
  • the suture needle N is gripped by the second gripping member 32 and the first gripping member 31 and fixed so that the orientation and position cannot be changed.
  • the suture needle N is held non-rotatably around the longitudinal axis of the suture needle N.
  • the gripping force of the gripping portion 3 at this time is referred to as a "first gripping force".
  • surgeon may or may not maintain the state in which the release button 43 is pressed when retracting the slider 41, or may not maintain the state in which the release button 43 is pressed.
  • the operator can retract the slider 41 with respect to the main body 40 along the axial direction of the main body 40 regardless of the state of the release button 43.
  • a state in which the grip portion 3 grips the suture needle N with the first gripping force, and the suture needle N is fixed so as not to rotate around the longitudinal axis of the suture needle N (hereinafter, “the first”.
  • the operation wire 5 is pulled by a force larger than the restoring force generated in the elastic member 46.
  • the elastic member 46 is in a state of being stretched in the expansion / contraction direction from the initial state.
  • the position of the slider 41 in which the gripping state of the suture needle N by the gripping portion 3 is in the first gripping state is referred to as "second position P2". The operator needs to move the slider 41 backward against the restoring force of the elastic member 46.
  • FIG. 12 is a diagram showing a needle holder 100 in which the gripping portion 3 grips the suture needle N with a light gripping force.
  • the operator moves the slider 41 to a position between the first position P1 and the second position P2.
  • the slider 41 is positioned by balancing the restoring force of the elastic member 46 with the tension of the operating wire 5.
  • the suture needle N is gripped by the second gripping member 32 and the first gripping member 31 so that its orientation and position can be changed.
  • the suture needle N is rotatably held around the longitudinal axis of the suture needle N.
  • the gripping force of the gripping portion 3 at this time is referred to as a "second gripping force".
  • the second gripping force is smaller than the first gripping force.
  • the grip portion 3 grips the suture needle N with a second gripping force and the suture needle N is rotatably held around the longitudinal axis of the suture needle N (hereinafter, “the first”.
  • the elastic force of the elastic member 46 is balanced with the tension of the operating wire 5.
  • the elastic member 46 is hardly expanded or contracted in the expansion and contraction direction from the initial state, and a restoring force is hardly generated.
  • the operator moves the slider 41 to a position between the first position P1 and the second position P2, and grips the suture needle N with a light gripping force by the gripping portion 3 (second gripping state).
  • the direction and position of the suture needle N can be changed.
  • the surgeon changes the direction and position of the suture needle N by pressing the suture needle N gripped in the second gripping state against the tube wall in the digestive tract, for example.
  • the slider 41 is urged to move to a position between the first position P1 and the second position P2.
  • the gripping state of the suture needle N by the gripping portion 3 is the second gripping state. Therefore, it is possible to prevent the suture needle N from unintentionally falling from the grip portion 3.
  • the surgeon changes the direction and position of the suture needle N to the desired direction and position, and then retracts the slider 41 to the second position P2.
  • the gripping state of the suture needle N by the gripping portion 3 becomes the first gripping state, and the suture needle N is fixed in a state in which the orientation and the position cannot be changed.
  • FIGS. 13 to 18 are diagrams showing one process of how to use the needle holder 100.
  • the operator Before inserting the flexible endoscope 200 into the digestive tract, the operator projects the grip portion 3 of the needle holder 100 from the tip opening 206a of the channel 206 of the flexible endoscope 200. The operator grips the suture needle N with the grip portion 3. The surgeon may grip the suture S attached to the suture needle N with the grip portion 3.
  • First step In the first step, the surgeon inserts the flexible endoscope 200 into the gastrointestinal tract through the patient's natural opening.
  • the suture needle N or suture thread S is introduced into the digestive tract in a state of being gripped by the grip portion 3 protruding from the tip opening 206a.
  • the surgeon temporarily places the suture needle N on the tube wall T and holds the suture needle N in the grip portion. Re-grip at 3. Even when the suture thread S is gripped when the suture needle N is introduced into the digestive tract, the suture needle N is temporarily placed on the tube wall T, and the suture needle N is gripped again by the grip portion 3.
  • FIG. 13 is a diagram showing an example of the first step of gripping the suture needle N by the gripping portion 3.
  • the surgeon moved the slider 41 forward to the first position P1 with respect to the main body 40 against the restoring force of the elastic member 46 (see FIG. 10), and the imaging unit 203 moved the imaging unit 203.
  • the grip portion 3 is brought close to the suture needle N arranged on the tube wall, and the suture needle N is gripped by the grip portion 3.
  • FIG. 14 is a diagram showing an example of the first step of gripping the suture needle N.
  • the surgeon pulls the suture needle with the first gripping force while the tip N1 and the rear end N2 of the suture needle N are projected forward from the grip portion 3 on the longitudinal axis Y1 of the sheath 1. To grasp.
  • the operator adjusts the gripping force of the gripping portion 3 that grips the suture needle N located inside the luminal organ (digestive tract). Specifically, the grip portion 3 is seconded by retracting the slider 41 to a position between the first position P1 and the second position P2 with respect to the main body 40 by the restoring force of the elastic member 46. The suture needle is gripped by the gripping force (see FIG. 12). The gripping state of the suture needle N by the gripping portion 3 is the second gripping state. In the second step, the restoring force of the elastic member 46 and the tension of the operation wire 5 are balanced, the slider 41 is positioned, and the suture needle N is gripped by the grip portion 3.
  • the surgeon adjusts the gripping force of the gripping portion 3 that grips the suture needle N to the second gripping force, and then holds the suture needle N by the gripping portion 3, and then one of the suture needles N.
  • the direction of the needle tip of the suture needle N is changed while pressing the portion against the tube wall T.
  • FIG. 15 is a front view of the grip portion 3 showing an example of the third step.
  • the surgeon holds the suture needle N with the second gripping force by the gripping portion 3, and presses at least one of the tip N1 and the rear end N2 of the suture needle N against the tube wall T while pressing the tip of the suture needle N. Adjust the direction of.
  • the part of the tube wall T to be pressed is not limited as long as it is the wall of the digestive tract.
  • the intermediate portion of the suture needle N is gripped by the grip portion 3, and the suture needle N is sewn along the tangential direction of the surface of the tube wall T (see FIG. 14). While pressing the tip N1 side and the rear end N2 side of the needle N against the tube wall T, the state is changed so that the tip of the suture needle N is directed in a direction substantially perpendicular to the surface of the tube wall T. ..
  • FIG. 16 is a front view of the grip portion 3 showing another example of the third step.
  • the intermediate portion of the suture needle N is gripped by the grip portion 3, and the suture needle N is pressed against the tube wall T at one point on the rear end N2 side of the suture needle N. The direction of the tip is adjusted.
  • FIG. 17 is a front view of the grip portion 3 showing another example of the third step.
  • the place where the grip portion 3 grips the suture needle N in the third step does not matter.
  • the tube wall T is formed on the tip N1 side of the suture needle N or the intermediate portion between the tip N1 and the rear end N2. Adjust the direction of the tip of the suture needle N while pressing it against.
  • FIG. 18 is a diagram showing an example of the fourth step.
  • the slider 41 After adjusting the direction of the tip of the suture needle N, the slider 41 is retracted to the second position P2 with respect to the main body 40 against the restoring force of the elastic member 46, so that the grip portion 3 provides the first grip force. Grasp the suture needle N with (see FIG. 11). As shown in FIG. 18, the gripping state of the suture needle N by the gripping portion 3 is the first state.
  • the surgeon fixes the direction and position of the suture needle N in the desired direction and position, and then sutures the treatment target. If the operator wants to further change the orientation or position of the suture needle N, the operator repeats the second to fourth steps.
  • the force for gripping the suture needle N is adjusted to adjust the direction and position of the suture needle N to a desired direction. Can be easily changed to or position.
  • the surgeon moves the slider 41 to a position between the first position P1 and the second position P2, and changes the gripping state of the suture needle N by the gripping portion 3 to the second gripping state.
  • the direction and position of N can be easily changed.
  • the operator presses the suture needle N in the second gripped state against the tube wall in the digestive tract and sutures.
  • the orientation and position of the needle N can be easily changed.
  • FIG. 19 is a diagram showing an operation unit 4B which is a modification of the operation unit 4. Even when the operation unit does not have the fixing mechanism 42 as in the operation unit 4B, the slider 41 is urged to move to a position between the first position P1 and the second position P2. Therefore, when the operator releases the hand from the slider 41, the gripping state of the suture needle N by the gripping portion 3 becomes the second gripping state.
  • FIG. 20 is a diagram showing an operation unit 4C which is a modification of the operation unit 4. Like the engaged portion 40EC of the operating portion 4C, the engaged portion is provided in a range where the slider 41 engages with the engaging portion 42E only when the slider 41 is in the first position P1 and the second position P2. You may.
  • the grip portion 3 grips the suture needle N by opening and closing the second grip member 32 with respect to the first grip member 31, but the mode of the grip portion is not limited to this.
  • 21 to 24 are modified examples of the grip portion, (A) shows the grip portion in which the grip state is in the open state, and (B) shows the grip portion in which the grip state is in the second grip state.
  • the grip portion 3B which is a modified example of the grip portion shown in FIG. 21, grips the suture needle N by opening and closing both the first grip member 31B and the second grip member 32B.
  • the grip portion 3C which is a modified example of the grip portion shown in FIG.
  • the grip portion 3D which is a modified example of the grip portion shown in FIG. 23, grips the suture needle N by pantographing the second grip member 32D with respect to the first grip member 31D along the direction perpendicular to the longitudinal axis Y1. To do.
  • the grip portion 3E which is a modified example of the grip portion shown in FIG. 24, has a through hole 31H through which the suture needle N can pass through the first grip member 31E. The grip portion 3E grips the suture needle N by moving the second grip member 32E forward and backward along the longitudinal axis Y1 in a state where the suture needle N is passed through the through hole 31H.
  • the operation wire 5 is pulled toward the operation portion 4, so that the second grip member 32 moves in the closing direction with respect to the first grip member 31, but the aspect of the grip portion 3 is this.
  • the grip portion 3F which is a modified example of the grip portion shown in FIG. 25
  • the operation wire 5 is pulled toward the operation portion 4, so that the second grip member 32 moves in the opening direction with respect to the first grip member 31.
  • the link mechanism 36F may be provided.
  • the grip portion 3G which is a modification of the grip portion shown in FIG. 26
  • the operation wire 5 is pulled toward the operation portion 4, so that the second grip member 32 moves in the opening direction with respect to the first grip member 31.
  • the cam mechanism 36G may be provided.
  • FIG. 27 is a diagram showing a needle holder 100K.
  • the needle holder 100K has a sheath 1, a hard portion 2, a grip portion 3, an operation portion 4K, and an operation wire 5 through which the sheath 1 is inserted.
  • the operation unit 4K has a main body 40, a slider 41, a fixing mechanism 42, a release button 43, a sliding member 44, a locking member 45, and an elastic member 46K.
  • the elastic member 46K is a tension spring arranged along the axial direction of the main body 40 that advances and retreats to the slider 41, and the tip is attached to the slider 41 and the base end is attached to the main body 40.
  • the expansion / contraction direction of the elastic member 46K is the axial direction of the main body 40.
  • the elastic member 46K may be a plurality of tension springs. Further, the elastic member 46K does not necessarily have to be a compression spring, and may be an elastic body that generates an elastic force between the slider 41 and the main body 40.
  • the elastic force of the elastic member 46K becomes larger than the tension of the operating wire 5.
  • the gripping portion 3 grips the suture needle N in the first gripping state
  • the operating wire 5 is pulled by a force larger than the restoring force generated in the elastic member 46K by retracting the slider 41.
  • the gripping state of the suture needle N by the gripping portion 3 is the second gripping state
  • the elastic force of the elastic member 46K balances with the tension of the operating wire 5.
  • the force for gripping the suture needle N is adjusted to adjust the suture needle N.
  • the orientation and position of the can be easily changed to the desired orientation and position.
  • the present invention can be applied to a medical device for suturing a tubular part of the human body or the like.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
PCT/JP2019/041694 2019-10-24 2019-10-24 内視鏡用持針器および縫合針の操作方法 Ceased WO2021079461A1 (ja)

Priority Applications (5)

Application Number Priority Date Filing Date Title
CN201980099896.4A CN114302683B (zh) 2019-10-24 2019-10-24 内窥镜用持针器及缝合针的操作方法
PCT/JP2019/041694 WO2021079461A1 (ja) 2019-10-24 2019-10-24 内視鏡用持針器および縫合針の操作方法
JP2021553231A JP7233562B2 (ja) 2019-10-24 2019-10-24 内視鏡用持針器および縫合針の操作方法
US17/683,771 US12357300B2 (en) 2019-10-24 2022-03-01 Needle holder for endoscope and operating method of suture needle
US19/232,961 US20250302470A1 (en) 2019-10-24 2025-06-10 Needle holder for endoscope and operating method of suture needle

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PCT/JP2019/041694 WO2021079461A1 (ja) 2019-10-24 2019-10-24 内視鏡用持針器および縫合針の操作方法

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JPWO2021079461A1 (https=) 2021-04-29
US20250302470A1 (en) 2025-10-02
CN114302683A (zh) 2022-04-08
US12357300B2 (en) 2025-07-15
CN114302683B (zh) 2024-04-26
JP7233562B2 (ja) 2023-03-06

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