WO2021176636A1 - Porte-aiguille pour endoscope, et procédé de suture endoscopique - Google Patents

Porte-aiguille pour endoscope, et procédé de suture endoscopique Download PDF

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Publication number
WO2021176636A1
WO2021176636A1 PCT/JP2020/009326 JP2020009326W WO2021176636A1 WO 2021176636 A1 WO2021176636 A1 WO 2021176636A1 JP 2020009326 W JP2020009326 W JP 2020009326W WO 2021176636 A1 WO2021176636 A1 WO 2021176636A1
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WO
WIPO (PCT)
Prior art keywords
needle
needle holder
tip
pair
suture
Prior art date
Application number
PCT/JP2020/009326
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English (en)
Japanese (ja)
Inventor
悠太 林
伸子 松尾
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to JP2022504873A priority Critical patent/JP7349553B2/ja
Priority to PCT/JP2020/009326 priority patent/WO2021176636A1/fr
Priority to CN202080097830.4A priority patent/CN115209817A/zh
Publication of WO2021176636A1 publication Critical patent/WO2021176636A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets 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

Definitions

  • the present invention relates to a needle holder for an endoscope and an endoscopic suturing method.
  • the needle tip of the suture needle is passed through the tissue and protrudes from the tissue by the operation of the needle holder that grips the suture needle, and then the needle holder that grips the needle tip. It is necessary to pull out the entire suture needle from the tissue by the movement of the vessel. That is, when suturing tissue using a single needle holder, it is necessary to change the gripping position of the suture needle gripped by the needle holder.
  • the present invention has been made in view of the above circumstances, and provides a needle holder for an endoscope and an endoscopic suture method capable of smoothly delivering a suture needle to another needle holder.
  • the purpose is.
  • One aspect of the present invention includes a flexible long flexible tube and a first gripping member and a second gripping member that are connected to the tip of the flexible tube and can be opened and closed with each other.
  • the 1 grip member and the second grip member have a first inner surface and a second inner surface that face each other in a closed state in which the first grip member and the second grip member are closed, respectively, and the first inner surface is It has a pair of receiving portions that are parallel to each other and a groove formed between the pair of receiving portions, and the pair of receiving portions and the groove are in a direction along the longitudinal axis of the flexible tube in the closed state.
  • the second inner surface has a protrusion facing the groove in the closed state and extending in a direction along the longitudinal axis, and at least a part of the top surface of the protrusion has a protrusion with respect to the longitudinal axis.
  • the inclined surface has a tip end side portion facing the base end side of the groove and a tip end side portion facing the tip end side of the groove, and the pair of receiving portions.
  • the suture needle is gripped between the pair of receiving portions and the protrusions by closing the first gripping member and the second gripping member with each other.
  • the suture needle is a directional curved needle, it is located between a pair of receiving portions that support the radial outer surface of the suture needle and a pair of receiving portions in the circumferential direction of the suture needle, and is within the radial direction of the suture needle.
  • the protrusions that support the sides allow the suture needle to be held in a plane along a plane that is orthogonal or substantially orthogonal to the longitudinal axis of the flexible tube.
  • the suture needle gripped by the pair of receiving portions and the protrusions can be positioned at a position where the tip end side portion and the proximal end side portion of the protrusions simultaneously contact the suture needle in the direction along the longitudinal axis. ..
  • the posture and position of the suture needle gripped by the first gripping member and the second gripping member are stable, so that the suture needle gripped by the needle holder for endoscope of this embodiment can be replaced with another needle holder. It can be delivered smoothly to the vessel.
  • At least one tip of the first inner surface and the second inner surface has a concavo-convex surface having a plurality of convex portions or a plurality of concave portions, and the pair of receiving portions, the groove and the protruding portion are formed. , May be provided on the base end side of the uneven surface.
  • the convex or concave portion of the uneven surface functions as a non-slip to the surface of the suture needle.
  • the tip end portion of the first inner surface may have the uneven surface
  • the pair of receiving portions may be offset to the side opposite to the second inner surface with respect to the uneven surface.
  • the tip portion of the side surface of the first grip member and the side surface of the second grip member is a tapered surface inclined with respect to the longitudinal axis, and the tapered surface is the tapered surface toward the tip side.
  • the width of the first gripping member and the second gripping member may be inclined in a direction in which the width gradually decreases.
  • the opening regulation mechanism for preventing the first gripping member and the second gripping member from opening may be provided.
  • the opening regulation mechanism prevents the first gripping member and the second gripping member from opening against the intention of the operator. Therefore, the operator can take his / her hand off the needle holder for the endoscope while keeping the first gripping member and the second gripping member that grip the suture needle in a closed state. Thereby, for example, one operator can operate the needle holder for the endoscope and other instruments.
  • Another aspect of the present invention is a suturing method in which the first needle holder and the second needle holder are inserted into the body via the inside of the endoscope, and the tissue in the body is sutured under the endoscope.
  • the suture needle is passed through the tissue and the needle tip portion of the suture needle is projected from the tissue, and the needle tip portion protruding from the tissue is referred to as the first needle holder.
  • 2 Gripping with a needle holder, pulling out the suture needle from the tissue by the operation of the second needle holder, and operating a part of the suture needle pulled out from the tissue by the operation of the second needle holder.
  • It is an endoscopic suturing method including arranging the first needle holder on the orbit of the needle holder.
  • the needle tip portion of the suture needle is grasped with the second needle holder and the suture needle is pulled out from the tissue. Then, a part of the suture needle is arranged on the trajectory of the first needle holder by the operation of the second needle holder.
  • the movement of the first needle holder inserted into the body via the endoscope is limited to movement along the longitudinal axis of the first needle holder and rotation around the longitudinal axis.
  • the suture needle can be smoothly delivered from the second needle holder to such a first needle holder.
  • the first needle holder is separated from the suture needle and the first needle holder is retracted in the longitudinal direction, and the trajectory. It may further include gripping a portion of the suture needle placed above by the first needle holder.
  • the first needle holder can be made to stand by at a position where it does not interfere with the suture needle. This configuration may further include advancing the first needle holder after placing a portion of the suture needle in orbit of the first needle holder.
  • arranging a part of the suture needle on the orbit by the operation of the second needle holder causes the second needle holder to rotate around the longitudinal axis of the second needle holder. It may be included. According to this configuration, when the suture needle is a curved needle, a part of the suture needle held by the second needle holder is made of the first needle holder by rotation around the longitudinal axis of the second needle holder. It can be placed in orbit.
  • the suture needle gripped by the second needle holder is positioned so as not to interfere with the tissue.
  • the suture needle may be further retracted. According to this configuration, it is possible to prevent the suture needle from interfering with the tissue when the second needle holder is rotated to arrange a part of the suture needle on the orbit.
  • the tip of the second needle holder is provided with a pair of gripping members that can be opened and closed with each other, and the needle tip protruding from the tissue is gripped by the tip of the pair of gripping members.
  • the position where the suture needle is gripped is set from the tip of the pair of gripping members. It may further include changing to the base end portion of the gripping member of.
  • the suture needle can be gripped in a predetermined posture by the base end portions of the pair of gripping members, and the suture needle can be arranged on the track in the predetermined posture.
  • the tissue in the body may be the tissue of a luminal organ.
  • the suture needle can be easily delivered to another needle holder.
  • FIG. 2A is an end view of the tip of the needle holder for an endoscope in FIG. 2A in line II-II. It is an end view seen from the tip side of a pair of receiving portions and protrusions in a state where the suture needle is gripped. It is a partial vertical cross-sectional view which cut
  • FIG. 8A It is a figure which shows the other structural example of the opening regulation mechanism provided in the operation part. It is a figure which shows an example of the attachment used in the endoscopic suture method. It is a figure which shows the modification of the 2nd needle holder used in the endoscopic suture method. It is a figure which shows the state which holds the suture needle by the 2nd needle holder of FIG. 8A.
  • the needle holder 1 for an endoscope and the method of suturing under an endoscope according to an embodiment of the present invention will be described with reference to the drawings.
  • the tissue S in the body is sutured under the endoscope using the suture needle 22 and the suture thread 23.
  • the endoscope is a flexible endoscope having a long, flexible insertion part and has a treatment tool channel that penetrates the insertion part in the longitudinal direction.
  • the needle holder 1 for an endoscope is inserted into the body via a treatment tool channel.
  • the needle holder 1 for an endoscope has a long flexible tube 2 and a pair of grips connected to the tip of the flexible tube 2 to grip the suture needle 22.
  • the members 3 and 4 are provided with an operation unit 5 connected to the base end of the flexible tube 2 and operated by an operator.
  • the vertical direction is a direction orthogonal to the longitudinal axis A of the flexible tube 2
  • the left-right direction is a direction orthogonal to the longitudinal axis A and the vertical direction.
  • the flexible pipe 2 is provided with, for example, a coil sheath, and has rigidity capable of transmitting the movement and force applied to the base end portion of the flexible pipe 2 by the operator to the tip end portion of the flexible pipe 2.
  • the movement is, for example, a movement in a direction along the longitudinal axis A and a movement in a rotational direction around the longitudinal axis A. Therefore, in a state where the flexible tube 2 penetrates the treatment tool channel and the gripping members 3 and 4 project from the tip surface of the endoscope, the operator moves the base end portion of the flexible tube 2 along the longitudinal axis A.
  • the pair of gripping members 3 and 4 can be moved forward or backward by moving forward or backward in the direction, and the pair of gripping members 3 and 4 can be moved forward or backward by rotating the base end portion of the flexible tube 2 around the longitudinal axis A. It can be rotated around the longitudinal axis A.
  • the pair of gripping members 3 and 4 are arranged in the vertical direction, and the base ends of the pair of gripping members 3 and 4 are oscillatingly connected to each other around a swinging axis extending in the left-right direction.
  • the pair of gripping members 3 and 4 can be opened and closed in the vertical direction.
  • the pair of gripping members 3 and 4 are of a single-sided opening type in which the lower first gripping member 3 is fixed to the flexible pipe 2 and the upper second gripping member 4 swings.
  • Both the first gripping member 3 and the second gripping member 4 may be of a double-door type that swings.
  • the operation unit 5 is connected to the first gripping member 3 by a long power transmission member such as a wire passing through the inside of the flexible tube 2.
  • the force applied by the operator to the operation unit 5 is transmitted to the first gripping member 3 by the power transmission member, and the first gripping member 3 swings, so that the gripping members 3 and 4 open and close.
  • the operating unit 5 has a shaft 5a extending along the longitudinal axis A and a slider 5b slidable along the shaft 5a. The operator can close the gripping members 3 and 4 by pulling the slider 5b toward the proximal end side, and can open the gripping members 3 and 4 by pressing the slider 5b toward the distal end side.
  • the first gripping member 3 and the second gripping member 4 face each other in the vertical direction in a closed state in which the first gripping member 3 and the second gripping member 4 are closed. It has an inner surface 3a and a second inner surface 4a, respectively.
  • the first gripping member 3 and the second gripping member 4 grip the suture needle 22 by the uneven surfaces 6 and 7 at the tip portion, and grip the suture needle 22 by the pair of receiving portions 8 and the protrusions 9 at the base end portion.
  • the suture needle 22 can be gripped by two methods.
  • the tip of the first inner surface 3a has an uneven surface 6, and the tip of the second inner surface 4a has an uneven surface 7.
  • the uneven surfaces 6 and 7 have a plurality of convex portions or a plurality of concave portions that function as non-slip with respect to the surface of the suture needle 22.
  • the uneven surfaces 6 and 7 have a large number of convex portions 6a and 7a formed by cutting a flat surface, and the convex portions 6a and 7a are formed in a quadrangular pyramid shape by, for example, diamond cutting. There is.
  • the base end portion of the first inner surface 3a has a pair of receiving portions 8 and a groove 10
  • the base end portion of the second inner surface 4a has a protrusion 9.
  • the pair of receiving portions 8 and the grooves 10 are provided on the base end side of the first gripping member 3 with respect to the uneven surface 6, and the protrusions 9 are provided on the base end side of the second gripping member 4 with respect to the uneven surface 7. ..
  • the groove 10 is formed between the pair of receiving portions 8.
  • the pair of receiving portions 8 and the grooves 10 extend in the direction along the longitudinal axis A and are parallel to each other in the left-right direction of the first inner surface 3a.
  • the protrusion 9 faces the groove 10 in the closed state and extends in the direction along the longitudinal axis A. In the closed state, the vertical distance between the protrusion 9 and each receiving portion 8 is less than the diameter of the suture needle 22. Therefore, as shown in FIG. 3A, the suture needle 22 can be gripped between the pair of receiving portions 8 and the protrusions 9.
  • the suture needle 22 is a curved needle that curves in one direction, and the radial outer surface 22b of the suture needle 22 is supported by a pair of receiving portions 8 at two positions spaced apart from each other in the circumferential direction of the suture needle 22.
  • the radial inner surface 22c of the suture needle 22 is supported by the protrusion 9 at a position between the two positions in the circumferential direction.
  • the posture of the suture needle 22 is fixed to a posture along a plane orthogonal to or substantially orthogonal to the longitudinal axis A.
  • the protrusion 9 is formed in a protruding shape toward the first gripping member 3 when viewed from the front along the longitudinal axis A. Further, the protrusion 9 has a top surface 9c facing the first inner surface 3a and extending along the ridgeline of the protrusion 9. The top surface 9c bends at an intermediate position in the longitudinal direction of the protrusion 9 in a side view viewed from a direction orthogonal to the opening / closing direction of the longitudinal axis A and the gripping members 3 and 4, and is opposite to the first inner surface 3a in the closed state. It extends in an arch shape that projects upward on the side.
  • the top surface 9c of the protrusion 9 has an inclined surface that is inclined with respect to the longitudinal axis A, and the inclined surface is the proximal end side of the groove 10. It has a tip end side portion 9a facing toward the tip end side and a base end side portion 9b facing the tip end side of the groove 10.
  • the distal end side portion 9a and the proximal end side portion 9b are inclined in opposite directions with respect to the longitudinal axis A.
  • the distance from the groove 10 to the distal end side portion 9a gradually increases from the distal end toward the proximal end
  • the distance from the groove 10 to the proximal end side portion 9b gradually decreases from the distal end toward the proximal end. ..
  • the suture needle 22 is gripped between the distal end side portion 9a, the proximal end side portion 9b, and the pair of receiving portions 8.
  • the gripped suture needle 22 is restricted from moving to the distal end side by the distal end side portion 9a, and is restricted from moving to the proximal end side by the proximal end side portion 9b.
  • the suture needle 22 is positioned at a position where the distal end side portion 9a and the proximal end side portion 9b come into contact with the outer surface of the suture needle 22 at the same time in the direction along the longitudinal axis A.
  • the cross-sectional shape of the suture needle 22 is preferably an oval shape having sides parallel to each other on the inner side in the radial direction and the outer side in the radial direction.
  • the pair of receiving portions 8 are offset downward with respect to the uneven surface 6, and a step in the vertical direction is formed between the pair of receiving portions 8 and the uneven surface 6. ..
  • the suture needles 22 placed on the pair of receiving portions 8 stay stably on the pair of receiving portions 8, and the suture needles 22 move from the pair of receiving portions 8 to the uneven surface 6 against the intention of the operator. It is possible to prevent it from slipping out.
  • an endoscopic suturing method for suturing the tissue S in the body using the needle holder 1 for an endoscope will be described with reference to FIGS. 4A to 4E.
  • one endoscope having two treatment tool channels and two needle holders 1 and 21 are used, and the tissue S is observed by the endoscope.
  • Tissue S is, for example, tissue of a luminal organ such as the esophagus, stomach, small intestine or large intestine.
  • the first needle holder 21 is an arbitrary needle holder generally used for suturing the tissue S under an endoscope
  • the second needle holder (needle holder for an endoscope) 1 is an endoscopic needle holder. It is a needle holder 1 for a mirror.
  • the first needle holder 21 and the second needle holder 1 are inserted into the body via separate treatment tool channels.
  • the two treatment tool channels do not necessarily have to be provided inside the endoscope, for example, one treatment tool channel may be attached to the outside of the endoscope.
  • the endoscopic suture method uses the first step of passing the suture needle 22 through the tissue S using the first needle holder 21 and projecting the needle tip 22a from the tissue S, and the second needle holder 1.
  • the second step of pulling out the suture needle 22 from the tissue S and the third step of delivering the suture needle 22 from the second needle holder 1 to the first needle holder 21 are included.
  • the operator uses the pair of gripping members 21a and 21b of the first needle holder 21 protruding from the tip surface of the endoscope to make the suture needle 22 the first needle holder.
  • the suture needle 22 is gripped in a posture arranged along a plane orthogonal to or substantially orthogonal to the longitudinal axis of the vessel 21.
  • the operator pierces the needle tip portion 22a into the tissue S by rotating the first needle holder 21 around the longitudinal axis of the first needle holder 21, until the needle tip portion 22a protrudes from the tissue S. 1 Rotate the needle holder 21.
  • the second needle holder 1 is retracted to a position where it does not interfere with the needle tip portion 22a protruding from the tissue S.
  • the operator advances the second needle holder 1 and grips the needle tip portion 22a protruding from the tissue S into a pair of the second needle holder 1. It is gripped by the tips of the members 3 and 4. Since the inner surfaces of the tips of the gripping members 3 and 4 are uneven surfaces 6 and 7, even when the thin needle tip 22a slightly protrudes from the structure S, the tips of the pair of gripping members 3 and 4 can be used. The needle tip portion 22a can be firmly gripped.
  • the operator separates the first needle holder 21 from the suture needle 22 and retracts it. Then, the operator pulls out the entire suture needle 22 from the tissue S by rotating the second needle holder 1 around the longitudinal axis A.
  • the curved portion of the endoscope may be curved in the direction in which the suture needle 22 is pulled out from the tissue S (leftward in the endoscopic image in the examples of FIGS. 4B and 4C). By the bending operation of the curved portion, the pair of gripping members 3 and 4 and the suture needle 22 gripped by the pair of gripping members 3 and 4 can be moved to easily pull out the suture needle 22 from the tissue S.
  • the suture needle gripped by the second needle holder 1 when the second needle holder 1 is rotated if necessary.
  • the suture needle 22 may be retracted from the tissue S by operating the endoscope at a position where the 22 does not interfere with the tissue S.
  • the second needle holder 1 holding the suture needle 22 may be moved to a position away from the suture portion of the tissue S by bending the curved portion of the endoscope. Thereby, in the subsequent third step, it is possible to prevent the suture needle 22 from interfering with the tissue S due to the rotational operation of the second needle holder 1.
  • the gripping position of the suture needle 22 gripped by the second needle holder 1 is changed from the needle tip portion 22a to the position closer to the proximal end side than the needle tip portion 22a, if necessary. You may. At that time, the gripping position of the suture needle 22 in the second needle holder 1 is changed from between the uneven surfaces 6 and 7 of the tip portion to between the pair of receiving portions 8 and the protrusion 9 of the base end portion.
  • the operator turns the second needle holder 1 around the longitudinal axis A in a direction opposite to the rotation direction of the second needle holder 1 in the second step.
  • a part of the suture needle 22 suitable for being gripped by the first needle holder 21 is arranged on the trajectory B of the first needle holder 21 by rotating the needle holder 21.
  • the trajectory B is a path for the first needle holder 21 to move forward and backward, and coincides with or substantially coincides with the extension line of the longitudinal axis of the treatment tool channel into which the first needle holder 21 is inserted.
  • the operator sets the position for gripping the suture needle 22 from the tips of the pair of gripping members 3 and 4 to the pair of gripping members 3 and 4 prior to the rotation of the second needle holder 1.
  • Change to the base end That is, the state in which the suture needle 22 is gripped by the uneven surfaces 6 and 7 is switched to the state in which the suture needle 22 is gripped by the pair of receiving portions 8 and the protrusions 9 (tip side portion 9a and proximal end side portion 9b).
  • the suture needle 22 is held in a posture along a plane orthogonal to or substantially orthogonal to the longitudinal axis A by the pair of receiving portions 8 and the protrusions 9.
  • the suture needle 22 is positioned along the longitudinal axis A with respect to the pair of gripping members 3 and 4, and the direction along the longitudinal axis A. The rattling of the suture needle 22 is prevented.
  • the operator advances the first needle holder 21 toward a part of the suture needle 22 arranged on the track B, and the suture needle 22 is moved by the first needle holder 21. Grasp a part of.
  • the suture needle 22 gripped by the base ends of the pair of gripping members 3 and 4 is The needle holder 21 is held in a posture along a plane orthogonal to or substantially orthogonal to the longitudinal axis of the needle holder 21.
  • the base end portions of the pair of gripping members 3 and 4, that is, the suture needle 22 gripped by the pair of receiving portions 8 and the protrusions 9, are stably held at a fixed position without rattling in the direction along the longitudinal axis A. Will be done. Therefore, the suture needle 22 can be easily grasped in an appropriate posture by the first needle holder 21.
  • the movement of the first needle holder 21 inserted into the body via the treatment tool channel is limited to advancing and retreating in the direction along the longitudinal axis and rotation around the longitudinal axis.
  • the movement of the second needle holder 1 inserted into the body via the other treatment tool channel is limited to advancing and retreating along the longitudinal axis A and rotating around the longitudinal axis A. Therefore, when the suture needle 22 is handed over from the second needle holder 1 to the first needle holder 21, only the advance / retreat and rotation of the second needle holder 1 with respect to the first needle holder 21 with respect to the first needle holder 21.
  • the position and orientation of the suture needle 22 must be adjusted.
  • the suture needle 22 is made of the first needle holder by the pair of receiving portions 8 and the protrusions 9 provided at the base ends of the pair of gripping members 3 and 4 of the second needle holder 1. It is stably held at a fixed position in a posture along a plane orthogonal to or substantially orthogonal to the longitudinal axis of 21. Further, a part of the suture needle 22 is arranged on the trajectory B of the first needle holder 21 by the rotation of the second needle holder 1. As a result, the suture needle 22 can be smoothly delivered from the second needle holder 1 to the first needle holder 21.
  • At least the tip end portion of the right side surface of each of the gripping members 3 and 4 may be tapered surfaces 3b and 4b inclined with respect to the longitudinal axis A.
  • the tapered surfaces 3b and 4b are inclined so that the widths of the gripping members 3 and 4 in the left-right direction gradually decrease toward the tip end side.
  • the tapered surfaces 3b and 4b may be provided over the entire length of the gripping members 3 and 4 in the longitudinal direction.
  • the tapered surfaces 3b and 4b may be a flat surface or a convex curved surface.
  • the left side surface of each of the gripping members 3 and 4 is parallel to or substantially parallel to the longitudinal axis A. Therefore, the gripping members 3 and 4 have an asymmetrical shape with respect to the longitudinal axis A when viewed from above or below.
  • the tissue S is pulled by the needle tip portion 22a and swells.
  • the tapered surfaces 3b and 4b on the right side surfaces of the gripping members 3 and 4 are used. Advances along the surface of the raised tissue S. Further, the tip of the flexible tube 2 bends to the left side opposite to the structure S due to the force received by the tapered surfaces 3b and 4b from the structure S. As a result, in the endoscopic image, the suture needle 22 protruding to the left side can be gripped by the second needle holder 1, and the gripping members 3 and 4 come into strong contact with the raised tissue S. Can be prevented.
  • the needle holder 1 for an endoscope may further include an opening regulation mechanism that prevents the pair of gripping members 3 and 4 from opening each other.
  • an opening regulation mechanism that prevents the pair of gripping members 3 and 4 from opening each other.
  • one doctor operates the endoscope and two caregivers operate the two needle holders. It is common to operate 1, 21.
  • the second needle holder 1 With an opening regulation mechanism, it becomes easy for one doctor to operate the endoscope and the second needle holder 1. That is, the doctor can release the hand from the operation unit 5 of the needle holder 1 and operate the endoscope while keeping the pair of gripping members 3 and 4 that grip the suture needle 22 in a closed state by the opening regulation mechanism. can.
  • one caregiver can easily operate the two needle holders 1 and 21 at the same time. Thereby, one doctor and one caregiver can carry out the endoscopic suturing method of the present embodiment.
  • the opening regulation mechanism is provided on the operation unit 5 and prevents the slider 5b from moving toward the tip side corresponding to the opening direction of the pair of gripping members 3 and 4 in a state where the operator does not apply force to the slider 5b. ..
  • the opening regulation mechanism of FIG. 6A includes an urging member 11 that urges the slider 5b in the direction toward the proximal end corresponding to the closing direction of the pair of gripping members 3 and 4.
  • the urging member 11 is, for example, a compression spring that is arranged in the shaft 5a and can be compressed in the direction along the longitudinal axis A.
  • Reference numeral 13 is a power transmission member that connects the slider 5b and the second gripping member 4. The operator can open the pair of gripping members 3 and 4 by moving the slider 5b toward the tip end against the urging force of the urging member 11.
  • the opening regulation mechanism of FIG. 6B is a ratchet mechanism that limits the movement of the slider 5b only to the proximal end side corresponding to the closing direction of the pair of gripping members 3 and 4.
  • This opening regulation mechanism includes a plurality of teeth 12a formed on the outer peripheral surface of the shaft 5a, a button 12b provided on the slider 5b, a movable member 12d fixed to the button 12b and having a claw 12c, and a claw 12c having a tooth 12a. It is provided with an urging member 12e that urges the movable member 12d in the direction of fitting into the groove between them.
  • the plurality of teeth 12a are arranged in a direction along the longitudinal axis A, and have a shape that locks the movement of the claw 12c toward the tip end side while allowing the claw 12c to move toward the proximal end side.
  • the operator can move the slider 5b toward the base end side to close the pair of gripping members 3 and 4. Further, by pressing the button 12b, the operator moves the movable member 12d in the direction in which the claw 12c comes out from between the teeth 12a against the urging force of the urging member 12e, and moves the slider 5b in the longitudinal direction of the shaft 5a. It can be switched to a state where it can be moved in both directions.
  • a C-shaped hook may be used as the attachment 30.
  • the C-shaped hook 30 is attached to the operating portion 5 of the second needle holder 1, for example, to the tip of the shaft 5a.
  • both the first inner surface 3a and the second inner surface 4a have the uneven surfaces 6 and 7, but instead, only one of the first inner surface 3a and the second inner surface 4a has the uneven surface 6 or 7 may have. Since at least one of the inner surfaces 3a and 4a has the uneven surface 6 or 7, the thin needle tip portion 22a can be firmly gripped.
  • a general-purpose needle holder is used as the first needle holder 21, but instead, the needle holder 1 for endoscopy is used. May be good. That is, the endoscopic suturing method may be performed using two needle holders for endoscopy 1.
  • a multi-legged forceps 40 having a plurality of legs may be used as the second needle holder.
  • the multi-legged forceps 40 includes a long tubular sheath 40a and a plurality of legs 40b arranged within the sheath 40a, and the plurality of legs 40b can move forward and backward independently of the sheath 40a. Is.
  • the tip of each leg 40b is curved outward in the radial direction of the sheath 40a, and is elastically deformed into a linear shape inside the sheath 40a. Therefore, by projecting the tip portions of the plurality of legs 40b from the tip end surface of the sheath 40a, the tip portions of the plurality of legs 40b can be expanded radially outward.
  • the needle tip portion 22a protruding from the tissue S can be gripped between the plurality of legs 40b, or between the legs 40b and the tip of the sheath 40a.
  • the suture needle 22 is gripped by the advance / retreat of the leg 40b, the alignment of the second needle holder 1 with respect to the needle tip portion 22a protruding from the tissue S becomes easy.
  • the number of legs 40b does not necessarily have to be a plurality, and may be only one.
  • the needle tip portion 22a can be gripped between only one leg 40b and the tip of the sheath 40a, even when the second needle holder has only one leg 40b, it is the same as the multi-leg forceps 40. , The alignment of the second needle holder with respect to the needle tip portion 22a protruding from the tissue S becomes easy.
  • a curved needle having an oval cross-sectional shape is used as the suture needle 22
  • a curved needle having another shape such as a circular or oval cross-sectional shape is also used for an endoscope. It can be used for the needle holder 1.
  • Needle holder for endoscope 2nd needle holder 2 Flexible tube 3 1st grip member 3a 1st inner surface 3b, 4b Tapered surface 4 2nd grip member 4a 2nd inner surface 5 Operation part 6, 7 Concavo-convex surface 6a , 7a Convex part 8 Receiving part 9 Protruding part 10 Groove 11 Biasing member, Opening regulation mechanism 12a, 12b, 12c, 12d, 12e Opening regulation mechanism 13 Power transmission member 21 First needle holder 22 Suture needle 23 Suture thread 30 Many Leg forceps, second needle holder A Longitudinal axis of flexible tube B Trajectory S Tissue

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  • 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)

Abstract

Ce porte-aiguille pour un endoscope comprend : un tube souple allongé (2) ; et des premier et second éléments de préhension (3, 4) qui sont reliés à la pointe du tube flexible (2) et pouvant s'ouvrir/se fermer ensemble, une première surface intérieure (3a) du premier élément de préhension (3) comprend une paire de parties de réception (8) et une rainure (10) formée entre la paire de parties de réception (8), la paire de parties de réception (8) et la rainure (10) s'étendent dans une direction allant le long de l'axe longitudinal du tube flexible (2), une seconde surface interne (4a) présente une saillie (9) opposée à la rainure (10) et s'étendant dans une direction le long de l'axe longitudinal, une surface supérieure (9c) d'au moins une partie de la saillie (9) présente une section côté pointe (9a) et une section côté base (9b) qui s'inclinent par rapport à l'axe longitudinal et respectivement vers la pointe et la base de la rainure (10), et une aiguille de suture est saisie parmi la paire de parties de réception (8), la section côté pointe (9a) et la section côté base (9b).
PCT/JP2020/009326 2020-03-05 2020-03-05 Porte-aiguille pour endoscope, et procédé de suture endoscopique WO2021176636A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
JP2022504873A JP7349553B2 (ja) 2020-03-05 2020-03-05 内視鏡用持針器
PCT/JP2020/009326 WO2021176636A1 (fr) 2020-03-05 2020-03-05 Porte-aiguille pour endoscope, et procédé de suture endoscopique
CN202080097830.4A CN115209817A (zh) 2020-03-05 2020-03-05 内窥镜用持针器及内窥镜下缝合方法

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PCT/JP2020/009326 WO2021176636A1 (fr) 2020-03-05 2020-03-05 Porte-aiguille pour endoscope, et procédé de suture endoscopique

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH10155807A (ja) * 1996-11-29 1998-06-16 Olympus Optical Co Ltd 内視鏡用処置具
JP2009247888A (ja) * 2008-04-10 2009-10-29 Olympus Medical Systems Corp 治療システム
US20140128890A1 (en) * 2012-11-02 2014-05-08 Boston Scientific Scimed, Inc. Medical device and related methods of use
WO2016002932A1 (fr) * 2014-07-03 2016-01-07 オリンパス株式会社 Porte-aiguille de suture et système d'endoscope
WO2017145337A1 (fr) * 2016-02-25 2017-08-31 オリンパス株式会社 Porte-aiguille et ensemble de suture
WO2019097560A1 (fr) * 2017-11-14 2019-05-23 オリンパス株式会社 Dispositif de préhension médical

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH10155807A (ja) * 1996-11-29 1998-06-16 Olympus Optical Co Ltd 内視鏡用処置具
JP2009247888A (ja) * 2008-04-10 2009-10-29 Olympus Medical Systems Corp 治療システム
US20140128890A1 (en) * 2012-11-02 2014-05-08 Boston Scientific Scimed, Inc. Medical device and related methods of use
WO2016002932A1 (fr) * 2014-07-03 2016-01-07 オリンパス株式会社 Porte-aiguille de suture et système d'endoscope
WO2017145337A1 (fr) * 2016-02-25 2017-08-31 オリンパス株式会社 Porte-aiguille et ensemble de suture
WO2019097560A1 (fr) * 2017-11-14 2019-05-23 オリンパス株式会社 Dispositif de préhension médical

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JPWO2021176636A1 (fr) 2021-09-10
CN115209817A (zh) 2022-10-18
JP7349553B2 (ja) 2023-09-22

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