JP5314756B2 - Suture device - Google Patents

Description

  The present invention relates to a suturing device for suturing a biological tissue that has been cut and separated in a crater shape with a suture, for example, by excising a tumor, a polyp, or the like.

  2. Description of the Related Art Conventionally, tumors and polyps formed on the inner wall of the stomach, large intestine, and the like have been removed at the same time as examination with an endoscope. That is, after the endoscope reaches the front of the target tumor or polyp, a knife or snare is inserted into the body through the lumen of the endoscope and is visually confirmed with the endoscope. The tumor or polyp is removed. Thus, excision of a tumor, a polyp, or the like can be performed without performing a large body incision operation, and the burden on the patient can be remarkably reduced.

  In addition, living tissue after excision of tumor, polyp, etc. is in a state in which the peripheral wall is separated by crater-like depressions or excision traces, resulting in slow healing of the tissue or tissue hyperplasia May be more likely to occur. Therefore, it is desirable to accelerate the healing of the excised portion by suturing the separated wall portions with a suture after the excision work of the polyp or the like. This suturing can be performed, for example, by piercing through the separated wall portions of the suture needle with the suture thread hooked on the tip, inserting the suture thread into both wall portions, and then binding the suture thread appropriately. .

  The following Patent Document 1 discloses a cylindrical needle assembly, a piercing tip that is fixed to the tip, is cylindrical and curved in a bow shape, and has a sharp shape with a tip cut obliquely and the needle. A suturing apparatus comprising a long cylindrical knot disposition assembly slidably disposed on the outer periphery of the assembly, and a hoop member disposed inside the needle assembly and protruding and retracting from the tip of the piercing tip and holding the suture Is disclosed. The hoop member has a structure that expands in a pantograph shape when protruding from the tip of the puncture tip, and is folded and accommodated when drawn into the puncture tip.

  When suturing the separated walls using the suturing device, first, a hoop member holding a suture is housed in the needle assembly. Then, after moving the distal end portion of the insertion tube of the endoscope to the vicinity of the target tissue, the suturing device is inserted through the lumen of the endoscope, and the puncture tip at the distal end of the needle assembly is inserted into the distal end of the lumen of the endoscope. And a puncture tip is pierced into a predetermined location on one wall of the tissue. Thereafter, the needle assembly is pushed in so that the puncture tip penetrates through one wall. Next, by projecting and expanding the hoop member from the tip of the puncture tip, the suture is released from the hoop member and the suture is inserted into one wall portion.

  Then, the hoop member is pulled into the needle assembly, the needle assembly is pulled out from the wall portion, and the suture thread inserted through the wall portion is again captured by the expanded hoop member, and the hoop member is retracted to move inside the needle assembly. In this state, the puncture tip is pierced into the other wall portion of the tissue. After that, the tissue is sutured by inserting a suture thread into the other wall portion in the same procedure as described above and appropriately binding the suture thread inserted through both wall portions.

Special table 2004-508128 gazette

  In Patent Document 1, the puncture tip at the tip of the needle assembly is pierced directly into the tissue wall. However, since the puncture tip has a thin needle shape so that it can pierce the tissue, there is a possibility that the tip may be bent or bent when piercing the tissue, and it may not be able to pierce the target location accurately was there. For this reason, there is a problem that the suturing operation is troublesome and it is difficult to sew at an appropriate position.

  Accordingly, an object of the present invention is to provide a suturing device that can reliably pierce a suture needle at a target position of a tissue.

In order to achieve the above object, a first aspect of the present invention is a suturing apparatus for suturing tissue with a suture.
The shape is made of a shape memory alloy, the tip has a pointed shape, the needle having a needle hole through which the suture thread can be inserted at the tip, and the base end of the needle is connected via a connection portion, A suture needle having an operation line for moving the needle portion in a predetermined direction;
A tubular member that slidably accommodates the suture needle,
The needle portion of the suturing needle is shaped so that at least a part of the portion that pierces the tissue has a curved shape,
The distal end of the tubular member forms a pointed puncture portion by being cut obliquely with respect to the axial direction of the tubular member, and the needle portion of the suture needle is inserted through the inner peripheral edge of the puncture portion. And being pulled into the tubular member while being stretched against the elastic force, and being protruded while being guided to the opening peripheral edge of the proximal end side of the puncture portion, and the inner periphery of the puncture portion The suturing apparatus is characterized in that the suturing needle is projected and retracted.

  In using this suturing device, first, a suture needle having a suture thread passed through a needle hole is accommodated in a tube-shaped member, and then inserted into the body through an endoscope lumen or the like. For example, a tumor or a polyp is excised. The puncture portion at the distal end of the tubular member is made to reach before the tissue to be sutured that has been depressed or separated in a crater shape.

  And a target is set in the predetermined position of one wall part in the cut | disconnected tissue, the puncture part of a tubular member is stabbed, and a tubular member is positioned in a predetermined position.

  After that, by pushing out the suture needle, the suture needle protrudes from the puncture part and sticks into a predetermined position of the tissue, and further pushes the suture needle and pushes out the suture needle from the other wall part of the separated tissue. A suture needle and a suture thread are inserted into both wall portions of the separated tissue.

  In this state, while holding one end of the suture with forceps or the like, the suture needle is pulled out from both the wall portions of the tissue, so that the suture is left inserted in the both wall portions of the tissue. By appropriately tying together, the separated wall portions of the tissue can be sewn together.

  In this suturing device, before the suture needle is pierced into a predetermined position of the tissue, the puncture portion of the tubular member is pierced into the predetermined position of the tissue. At this time, since the tubular member that accommodates the suture needle is larger than the suture needle, the tubular member can be reliably positioned and punctured at a predetermined position of the tissue without being displaced or shaken. Thereafter, the suture needle can be reliably pierced at the target position of the tissue by causing the suture needle to protrude from the puncture portion.

  Thus, in this suturing device, before the suture needle is pierced into the tissue, the tubular member can be positioned and fixed by being pierced in advance at a predetermined position of the tissue at the puncture portion of the thicker tubular member. Therefore, the suture needle can be pierced stably and reliably at the target position.

  According to a second aspect of the present invention, in the first aspect of the invention, the tubular member includes a puncture tube having a predetermined length extending linearly and having the puncture portion formed at a distal end thereof, and a proximal end side of the puncture tube. It has a connected operation cylinder, and this operation cylinder provides a suturing device constituted by winding a wire in a coil shape.

  According to the above invention, the puncture tube extending linearly can be accommodated by extending linearly even if the suture needle is bent. In addition, since the puncture tube extends linearly, it is easy to aim at a predetermined position of the tissue, and the puncture portion can be reliably pierced at the predetermined position of the tissue. Furthermore, since an operation tube formed by winding a wire rod in a coil shape is connected to the base side of the puncture tube, it can be inserted while flexibly bending along a bent path of an endoscope or the like.

  According to a third aspect of the present invention, in the first aspect, the tubular member includes a puncture tube having a predetermined length extending linearly and having the puncture portion formed at a distal end portion, and a proximal end side of the puncture tube. And a stitching device provided with a plurality of slits extending along the circumferential direction at a predetermined length along the axial direction at predetermined intervals. It is.

  According to the above invention, like the second invention, the bent suture needle can be linearly extended and accommodated by the linearly extending puncture tube, and the puncture portion can be reliably pierced at a predetermined position of the tissue. it can. Further, the operation tube integrally connected to the proximal end side of the puncture tube is formed with a plurality of slits extending at a predetermined length along the circumferential direction at predetermined intervals along the axial direction. It can be made to penetrate while flexibly bending along a bent path. Furthermore, since the puncture tube and the operation tube are integrally formed, it becomes difficult to kink at the boundary between the puncture tube and the operation tube, and workability can be improved.

  A fourth aspect of the present invention provides the suturing apparatus according to any one of the first to third aspects, wherein a transfer tube is slidably disposed on an outer periphery of the tubular member.

  According to the above invention, since the transfer tube is slidably disposed on the outer periphery of the tubular member, the tubular member containing the suture needle is further accommodated in the transfer tube, and the tubular member is sharply punctured. Even if the part is inserted into the endoscope lumen or the like while being accommodated in the transfer tube, the inner circumference of the endoscope lumen or the like can be prevented from being damaged.

  According to a fifth aspect of the present invention, in any one of the first to fourth aspects, the needle portion of the suturing needle is formed with a flat line or a triangular line having a triangular cross section, It is an object of the present invention to provide a suturing device in which at least a part of a piercing portion is shaped so as to have a curved shape with a flat line or a triangular line facing the plane side outward.

  According to the above invention, when the suture needle is moved in the tube by pushing and pulling the operation line, such as when the suture needle is accommodated in the tubular member or when the suture needle protrudes from the tubular member. In addition, since the needle part is formed of a flat line or a triangular line having a triangular cross section, the flat part of the flat line or the triangular line is less likely to contact the inner periphery of the tubular member. That is, since both sides of the flat wire or the corners of the triangular line are in contact with the inner periphery of the tubular member, the sliding resistance of the needle portion with respect to the inner periphery of the tubular member can be reduced, and as a result, the suture needle The pushing and pulling operation becomes easy, and the suture needle can be moved smoothly with respect to the tubular member.

  Further, since the needle portion is a flat line or a triangular line, the cross-sectional area can be reduced while sufficiently securing the width necessary for providing the needle hole, and the needle hole is formed in a round line or the like. Since the cross-sectional area is remarkably small compared to the case where the thickness is necessary for this, the tissue can be easily inserted, and the hole formed in the tissue can be reduced to reduce the tissue damage.

  According to a sixth aspect of the present invention, in any one of the first to fifth aspects, the needle portion of the suturing needle has a linear portion extending linearly from the distal end portion with a predetermined length. A suturing device having a curved shape from the base side is provided.

  According to the above invention, even if the distance between the one wall portion of the tissue to be sutured and the other wall portion is long, the straight portion extending linearly of the suturing needle is reliably pierced by them, and both of the tissues are A suture thread can be inserted through the wall portion, and the sewing operation can be easily performed.

  According to a seventh aspect of the present invention, in any one of the first to sixth aspects, the needle portion of the suturing needle is defined as A at a position where the needle portion starts to bend from the straight portion of the proximal end portion thereof, and the bent portion of the needle portion A position that is farthest from the axis of the operation line is B, a tip position of the needle portion is C, an intermediate point between the position A and the position B is a center O, and a line connecting the position A and the center O On the other hand, when the angle at which the line connecting the position C and the center O rotates with respect to the center O is defined as the bending angle θ, the bending angle θ is bent so as to be 190 to 540 degrees. A suturing device is provided.

  According to the above invention, since the distal end portion of the needle portion is bent at an angle that exceeds the bending angle θ of 190 degrees, the needle portion gradually increases as the distal end portion of the needle portion protrudes from the puncture portion of the tubular member. It will be curved. For this reason, after the needle portion is pierced into at least a pair of wall portions to be sutured, the tip of the needle portion can be bent and the suture thread can be protruded so as to be largely separated from the affected portion. It is possible to make it easier to hold the suture thread pierced by a forceps or the like. In addition, since it becomes difficult for the needle portion to come out of the tissue pierced during the operation, the suturing operation can be facilitated.

  In an eighth aspect of the present invention, in any one of the first to seventh aspects, the needle portion of the suturing needle has a shape with a small curvature and a portion with a large curvature in a shape curved from the distal end toward the base side. A suturing device having the above is provided.

  According to the above invention, since the needle portion has a portion with a small curvature and a portion with a large curvature, the tip portion of the needle portion is gradually pushed out from the puncture portion of the tubular member, and the portion with a large curvature is When protruding, the needle part will bend in a sharp curve, so the needle tip protruding from the tissue will bend and move away from the tissue, preventing the needle tip that has been pierced from coming off In addition, the suture thread passed through the needle hole can be easily grasped with forceps or the like away from the tissue, and the suturing operation can be facilitated.

  According to the present invention, before the suture needle is inserted into the tissue, the tube-shaped member is thicker than the suture needle, and the tube-shaped member is positioned and fixed at the predetermined position of the tissue in advance. Thus, the suture needle can be pierced stably and reliably at the target position.

It is a perspective view which shows 1st Embodiment of the suturing device of this invention. It is a principal part expansion perspective view of the suturing device. 1 shows a suturing needle of the suturing device, wherein (a) is an enlarged perspective view of the main part, (b) is an enlarged side view of the main part, and (c) is an enlarged side view of the main part showing another structure of the suturing needle. is there. The front-end | tip shape of the suturing needle of the suturing device is shown, (a) is an enlarged perspective view, (b) is an enlarged plan view, and (c) is a sectional view taken along the line GG in FIG. The front-end | tip shape of the tubular member of the suturing device is shown, (a) is an enlarged perspective view, (b) is an enlarged side view. The use state of the suturing device is shown, (a) is a cross-sectional view in the first use state, (b) is a cross-sectional view in the second use state, (c) is a cross-sectional view in the third use state, (D) is sectional drawing in the 4th use condition. The use state of the suturing device is shown, (a) is an explanatory view in the first use state, (b) is an explanatory view in the second use state, and (c) is an explanatory view in the third use state. is there. The use state of the suture needle is shown. (A) is an explanatory view in the fourth use state, (b) is an explanatory view in the fifth use state, and (c) is an explanatory view in the sixth use state. is there. It is a principal part expanded side view which shows 2nd Embodiment of the suturing device of this invention. The 3rd Embodiment of the suturing device of this invention is shown, (a) is a principal part expansion perspective view, (b) is a principal part expansion side view. The 4th Embodiment of the suture needle | hook of this invention is shown, (a) is the principal part explanatory drawing, (b) is explanatory drawing in a 1st use state, (c) is explanatory drawing in a 2nd use state. (D) is explanatory drawing in a 3rd use condition, (e) is explanatory drawing in a 4th use condition. The 5th Embodiment of the suture needle | hook of this invention is shown, (a) is the principal part explanatory drawing, (b) is explanatory drawing in a 1st use condition, (c) is explanatory drawing in a 2nd use condition. (D) is explanatory drawing in a 3rd use condition, (e) is explanatory drawing in a 4th use condition. The 6th Embodiment of the suture needle | hook of this invention is shown, (a) is the principal part explanatory drawing, (b) is explanatory drawing in a 1st use state, (c) is explanatory drawing in a 2nd use state. (D) is explanatory drawing in a 3rd use condition, (e) is explanatory drawing in a 4th use condition. 7 shows a seventh embodiment of the suturing needle of the present invention, wherein (a) is an explanatory view of the main part, (b) is an explanatory view in the first use state, and (c) is an explanatory view in the second use state. (D) is explanatory drawing in a 3rd use condition, (e) is explanatory drawing in a 4th use condition. The 8th Embodiment of the suture needle | hook of this invention is shown, (a) is the principal part expansion perspective view, (b) is sectional drawing in the FF arrow line of (a), (c) is the same embodiment. It is a principal part expansion perspective view which shows the other shape of the needle part in FIG. It is a perspective view which shows 9th Embodiment of the suturing device of this invention.

  Hereinafter, with reference to FIGS. 1-8, 1st Embodiment of the suturing device of this invention is described. The suturing device 10 of the present invention is for reclosing the tissue P by suturing the separated wall portions V of the tissue P after excising a tumor or polyp generated on the inner wall of the stomach or large intestine. (See FIGS. 7 and 8).

  As shown in FIG. 1, a suturing device 10 in this embodiment includes a suturing needle 20 that can sew a suture T (see FIGS. 6 to 8) and sews walls V, and the suturing needle 20. A tubular member 30 slidably accommodated, a transfer tube 40 slidably disposed outside the tubular member 30, and the suture needle 20, the tubular member 30, and the transfer tube 40 for operating And an operation device 50.

  First, the suture needle 20 will be described with reference to FIGS. The suture needle 20 has a needle portion 21 and an operation line 28 connected to the proximal end portion of the needle portion 21 via a connection portion 27.

  The operation line 28 moves the needle portion 21 connected to the tip thereof in a predetermined direction. In this embodiment, the operation line 28 is composed of a linear wire extending at a predetermined length. Examples of the material of the operation wire 28 include stainless steel, Ni, W, piano wire, phosphor bronze, Ni—Ti, Ni—Ti—X (X = Fe, Cu, V, Co, etc.), Cu—Al, and the like. Superelastic alloys such as -Ni-based, Cu-Zn-X (X = Si, Al, Sn, Fe, etc.), and synthetic resins such as nylon and polyester can be used. Further, a stranded wire formed by appropriately twisting a plurality of wires may be used as the operation line 28, and the form of the operation line 28 is not particularly limited.

  On the other hand, the needle portion 21 is formed of a shape memory alloy, has a sharp tip 22a, and has a needle hole 23 through which the suture thread T can be inserted. The needle portion 21 in this embodiment is formed by shaping a flat wire extending in a band shape with a predetermined length into a predetermined shape.

  As shown in FIGS. 4 (a) and 4 (b), both side edges 22b and 22b of the distal end portion 22 of the needle portion 21 have a tapered shape in which the distal end portion 22 is gradually narrowed toward the forefront, And it inclines so that it may become gradually wide toward the other plane side from the one plane side of the front-end | tip part 22 (refer FIG.4 (c)). As a result, the distal end portion 22 of the needle portion 21 has a trapezoidal cross section, and the distal end 22a is sharp. The tip 22a forms a portion that pierces the tissue P in the present invention.

  The flat line that forms the needle portion 21 has a rectangular cross section having a predetermined plate width W (see FIG. 3A) and a plate thickness t smaller than that (see FIG. 3B). As for the dimensions, those having a plate width W of 0.5 to 2.0 mm and a plate thickness t of 0.1 to 0.4 mm are preferably used. Further, the needle hole 23 formed at the tip of the needle part has a long hole shape extending long along the extending direction of the needle part 21, and the major axis is 0.5 to 2.0 mm and the minor axis is 0.5 to 0.5. It is 1.5 mm. The needle hole 23 may be circular, square, polygonal or the like, and is not particularly limited.

  The needle portion 21 formed by a flat wire is shaped in a shape curved with the one flat surface side of the tip portion 22 facing outward. In this embodiment, the distal end portion 22 of the needle portion 21 is curved toward the proximal end portion 26 side, and the distal end portion 22 is further curved and rotated once in an annular shape so that the distal end portion 22 becomes the proximal end portion 26. On the other hand, they are shaped so as to be opposite to each other (see FIGS. 3A and 3B). As shown in FIGS. 3A and 3B, the needle portion 21 has a linear portion 24 that linearly extends with a predetermined length from the distal end portion 22 toward the proximal end portion 26. From the base end of the straight line portion 24, a bent portion 25 shaped so as to rotate once in an annular shape is extended.

  As shown in FIG. 3B, the position where the bending starts from the straight line portion of the proximal end portion 26 of the needle portion 21 is A, and the furthest away from the axis of the operation line 28 of the bending portion 25 of the needle portion 21. The position is B, the tip position of the needle portion 21 is C, the middle point between the position A and the position B is the center O, and the position C and the center O are connected to the line connecting the position A and the center O. When the angle at which the line is rotated with respect to the center O is defined as the bending angle θ, the bending angle θ is formed to be 190 to 540 degrees. The bending angle θ in this embodiment is about 425 degrees (360 degrees + 65 degrees). When the bending angle θ is less than 190 degrees, it is difficult to pierce the wall portion V of the tissue P, and when it exceeds 450 degrees, the operability from the hand is lowered.

  When the maximum diameter of the bent portion 25 of the needle portion 21 is R (distance between the position A and the position B), the maximum diameter R is preferably 5 to 20 mm. If the maximum diameter R is smaller than 5 mm, the elastic restoring force of the needle portion 21 increases, so that the resistance when the needle portion 21 is accommodated in the tubular member 30 increases and is difficult to accommodate, whereas the maximum diameter R Is larger than 20 mm, the elastic restoring force of the needle portion 21 is small, so that it is difficult to pierce the wall portion V of the target tissue P.

  Examples of the shape memory alloy used for the needle portion 21 include Ni—Ti, Ni—Ti—X (X = Fe, Cu, V, Co, etc.), Cu—Al—Ni, Cu—Zn—X (X = Si, Al, Sn, Fe, etc.) can be used. The shape memory alloy used for the needle portion 21 has a transformation point of room temperature or lower, and when the suture needle 21 is stored in the tubular member 30 and the transfer tube 40 or used in the human body. In addition, the shape is maintained and superelasticity is exhibited. As another means, the transformation point may be set so as to be equal to or higher than the temperature of the human body, and the original shape may be restored by appropriate heating means.

  Then, as shown in FIG. 3B, the base end portion 26 of the needle portion 21 is superposed on a strip-like connecting piece 28a connected to the distal end portion of the operation line 28, and they are brazed, soldered or bonded. The operation line 28 is connected to the proximal end portion 26 of the needle portion 21 via the connection portion 27 by joining at the connection portion 27 made of the agent.

  In addition, the structure shown in FIG.3 (c) may be sufficient as the needle part 21 of the said suture needle 20, The shaping shape is not limited to a special hand. The needle part 21 shown in FIG. 3 (c) is formed as a flat line and extends linearly from the tip part 22 in the same manner as the needle part 21 shown in FIGS. 3 (a) and 3 (b). have. Further, the straight portion 24 is shaped so as to be substantially parallel to the base end portion 26 via the bent portion 25, and the entire needle portion 21 is bent in a substantially U shape. Further, the bending angle θ defined in the above description is about 245 degrees (180 degrees +65 degrees).

  The suturing needle 20 having the above structure is slidably accommodated in a tubular tubular member 30. Referring to FIGS. 2, 5, and 6, the tubular member 30 of this embodiment includes a puncture tube 31 that extends linearly at a predetermined length, and an operation tube 35 that is connected to the proximal end side of the puncture tube 31. have.

  The puncture tube 31 has a puncture portion 33 having a sharp shape at the tip. The puncture portion 33 is a portion that pierces the wall portion V of the target tissue P (see FIG. 7), and the suturing needle 20 protrudes from the inner periphery thereof (see FIG. 6). The needle portion 21 of the shaped suturing needle 20 is also extended and accommodated.

  As shown in FIG. 5, the tip of the puncture tube 31 is sharply cut at a predetermined angle with respect to the line segment S along the axial direction of the puncture tube 31, so that the tip of the puncture tube 31 is sharp. The puncture portion 33 is formed.

  The length L from the distal end to the proximal end of the puncture portion 33 shown in FIG. 5B is preferably 2 to 5 mm. When the length L of the puncture part 33 is smaller than 2 mm, the puncture depth of the tissue P with respect to the wall part V is insufficient, and it becomes difficult to stably position the tubular member 30 with respect to the wall part V. On the other hand, when the length L is greater than 5 mm, the puncture portion 33 is pierced deeper than necessary into the wall portion V of the tissue P, and the invasiveness to the tissue P increases.

  The operation tube 35 connected to the proximal end portion of the puncture portion 33 is formed by winding a flat wire in a coil shape at a predetermined pitch in order to increase the flexibility of the operation tube 35. In this embodiment, the operation tube 35 is formed by tightly winding a flat wire. The operation tube 35 is connected to the puncture tube 31 by disposing the distal end portion of the operation tube 35 on the outer periphery of the proximal end portion of the puncture tube 31 and bonding it with solder or an adhesive. ing.

  Examples of the material of the puncture tube 31 and the operation tube 35 include stainless steel, Ni, W, phosphor bronze, Ni—Ti, Ni—Ti—X (X = Fe, Cu, V, Co, etc.), Cu, and the like. Shape memory alloys such as Al—Ni and Cu—Zn—X (X = Si, Al, Sn, Fe, etc.) can be used. The puncture tube 31 is preferably made of stainless steel that is highly rigid and easy to pierce the wall portion V of the tissue P. The operation cylinder 35 is also preferably made of high-rigidity stainless steel in consideration of pushability and torque transmission.

  A transfer tube 40 that is slidable with respect to the tubular member 30 is disposed on the outer periphery of the tubular member 30. The transfer tube 40 is made of a synthetic resin such as nylon elastomer, polyethylene, polyurethane, polyether block amide, polyvinyl chloride, vinyl acetate, or a fluorine resin. The transfer tube 40 serves to prevent the outer periphery of the tubular member 30 from directly touching the lumen inner periphery of an endoscope (not shown).

  The suturing needle 20, the tubular member 30, and the transfer tube 40 are operated by the operation device 50.

  As shown in FIG. 1, the operation device 50 includes a cylindrical transfer tube operation unit 51, a cylindrical tube-shaped member operation unit 53 slidably accommodated in the transfer tube operation unit 51, and the tube And a suture needle operation unit 55 that is arranged on the outer periphery of the tube-like member operation unit 53 and is slidable relative to the tube-like member operation unit 53. The tubular member operating portion 53 has an insertion cylinder 53a on the distal end side and a guide cylinder 53b in which a guide groove is formed on the proximal end side. The insertion tube 53a is inserted into the transfer tube operation unit 51, and the suture needle operation unit 55 is slidably mounted on the outer periphery of the guide tube 53b.

  The proximal end portion of the transfer tube 40 is connected to the distal end portion 51 a of the transfer tube operation portion 51. A proximal end portion of the operation tube 35 of the tubular member 30 is connected to a distal end portion (not shown) of the insertion tube 53a of the tube-shaped member operation portion 53. Further, the proximal end of the operation line 28 of the suture needle 20 is connected to the center of the distal end of the suture needle operation unit 55.

  By operating the operation device 50 having the above structure, the suture needle 20, the tubular member 30, and the transfer tube 40 operate as follows. That is, when the transfer tube operation unit 51 of the operation device 50 is moved, the transfer tube 40 is moved accordingly. Further, when the tubular member operation portion 53 is slid back and forth in the axial direction with respect to the transfer tube operation portion 51, the tubular member 30 moves back and forth with respect to the transfer tube 40.

  Further, when the suture needle operation portion 55 is slid back and forth with respect to the tubular member operation portion 53, the suture needle 20 moves back and forth with respect to the tubular member 30. That is, as the suture needle operation unit 55 slides, the operation line 28 of the suture needle 20 moves back and forth, so that the needle unit 21 connected to the distal end of the operation line 28 punctures the puncture tube 31 of the tubular member 30. It appears from the inner periphery of the portion 33.

  By appropriately operating the operation device 50 as described above, the slide operation of the tubular member 30 with respect to the transfer tube 40, the slide operation of the operation line 28 with respect to the tube-shaped member 30, and the retracting operation of the needle portion 21 are possible. Yes. In the structure of the operation device 50, the transfer tube operation unit 51 and the tube-shaped member operation unit 53 can be rotated in a predetermined direction. For example, the tube-shaped member 30 is rotated with respect to the transfer tube 40. The leading edge direction of the puncture unit 33 can also be changed.

  Next, operations of the tubular member 30 and the suture needle 20 of the suturing apparatus 10 will be described with reference to FIG. The needle portion 21 of the suturing needle 20 in this embodiment is shaped as shown in FIGS. 1 and 2, but the suturing needle 20 is normally housed in the tubular member 30.

  That is, when the needle portion 21 protruding from the puncture portion 33 and shaped in a predetermined shape is accommodated in the puncture tube 31 against the elastic force, the needle portion 21 is drawn while being gradually extended through the inner peripheral edge of the puncture portion 33. Then, the needle portion 21 is accommodated and held in an extended state on the inner periphery of the puncture tube 31 (see FIG. 6A). Then, the needle portion 21 of the suture needle 20 protrudes from the inner periphery of the puncture portion 33 of the puncture tube 31 of the tubular member 30 as necessary. That is, when the tissue P is sutured by the suture needle 20 from the state shown in FIG. 6A, the needle portion 21 protrudes from the inner periphery of the puncture portion 33 of the puncture tube 31 via the operation line 28 (FIG. 6). 5 (b)). The protruding needle portion 21 is gradually elastically restored by the elastic restoring force of the shape memory alloy (see FIG. 6C), and when the needle portion 21 is protruded to the maximum extent, the needle portion returns to the original shape. 21 is reset (see FIG. 6D).

  At this time, since the needle portion 21 of the suturing needle 20 shaped in a predetermined shape is accommodated in the puncture tube 31 of the tubular member 30, the needle portion 21 has the original shaped shape. The elastic restoring force which tries to return to is always applied. Therefore, when the suture needle 20 moves so as to protrude the needle portion 21 from the inner periphery of the puncture portion 33, the needle portion 21 is closest to the position where the elastic return of the needle portion 21 is possible, that is, the tip 22 a of the needle portion 21. The needle portion 21 protrudes from the opening peripheral edge on the proximal end side of the puncture portion 33 which is the position while returning elastically (see FIGS. 6B and 6C). Therefore, as shown in FIG. 5A, both side edges of the needle portion 21 are projected while being guided by the opening peripheral edge of the proximal end side of the puncture portion 33.

  For this reason, regardless of the angle at which the needle portion 21 is accommodated in the puncture tube 31, when protruding from the puncture portion 33, both side edges of the needle portion 21 are open peripheral edges on the proximal end side of the puncture portion 33. The needle portion 21 protrudes from the puncture portion 33 while the direction of the needle portion 21 is automatically corrected so as to be in sliding contact with the puncture portion 33. As a result, the direction of the needle portion 21 protruding from the puncture tube 31 can be easily predicted.

  Next, a method of using the suturing device 10 of the present invention having the above configuration will be described with reference to FIGS.

  Prior to the operation, as shown in FIG. 2, the needle portion 21 of the suture needle 20 is projected from the inner periphery of the puncture portion 33 of the puncture tube 31 of the tubular member 30, and is inserted into the needle hole 23 of the needle portion 21. A suture thread T made of a wire material such as silk, nylon or fluororesin is inserted and hooked.

  Thereafter, in a state where the transfer tube operation unit 51 of the operation device 50 is held and fixed, the tube-shaped member operation unit 53 and the suture needle operation unit 55 are slid rearward (direction in which the operator pulls toward the hand side). Then, the tubular member 30 is retracted and accommodated in the transfer tube 40, and the suture needle 20 is retracted and accommodated in the tubular member 30. At this time, the shaped needle portion 21 is accommodated and held by the inner peripheral edge of the puncture portion 33 in a state of being stretched to the inner periphery of the puncture tube 31 (see FIG. 6A). In particular, in this embodiment, since the puncture tube 31 that extends linearly is adopted as a member constituting the tubular member 30, even if the needle portion 21 of the suturing needle 20 is bent, it can be linearly extended and securely accommodated. Is possible.

  After the above preparation, the tip of the endoscope (not shown) is made to reach the target tumor and polyp by a well-known method, and a knife or the like is inserted through the lumen formed in the endoscope to remove the tumor. Or by inserting forceps or the like to grasp and peel off the tumor, or by inserting an annular snare through the lumen and pulling it at the root of the tumor, etc. And polyps are excised from the inner wall of the gastrointestinal tract. Thus, the tissue P after excising the tumor, polyp, and the like is in a state in which the walls V and V are separated from each other by a crater-like depression or excision trace (see FIG. 7).

  Next, the suturing device 10 is inserted into the body through the lumen of the endoscope while grasping the transfer tube operation portion 51 of the operation device 50. At this time, in this embodiment, since the transfer tube 40 is disposed on the outer periphery of the tubular member 30 and covers the tubular member 30, a sharp puncture tube 31 of the tubular member 30 or a hard material such as stainless steel is used. The operation tube 35 formed from the above is prevented from coming into contact with the lumen of the endoscope, and damage to the inner periphery of the lumen of the endoscope is prevented. Further, it is possible to prevent the sliding resistance from increasing due to the operation tube 35 formed by being wound in a coil shape being caught on the inner periphery of the lumen of the endoscope. Furthermore, in this embodiment, as the member constituting the tubular member 30, the operation tube 35 formed by winding a wire rod in a coil shape is connected to the base side of the puncture tube 31, so that the lumen of the endoscope is Even if it is bent, it can be inserted while flexibly bending along the bent path.

  Then, the front-end | tip part of the transfer tube 40 is made to reach before the one wall part V of the structure | tissue P which should be sutured. In this state, the transfer tube operation unit 51 of the operation device 50 is gripped and fixed, and the tube-shaped member operation unit 53 is slid forward (in the direction in which the operator pushes in), so that the tube-shaped member 30 is moved from the tip of the transfer tube 40. The puncture tube 31 is protruded.

  Then, a target is set at a predetermined position of the wall portion V, and the puncture portion 33 of the puncture tube 31 is pierced into the wall portion V at a predetermined depth as shown in FIG. It can be positioned at a predetermined position of the part V.

  At this time, in this embodiment, since it has the puncture tube 31 extending linearly, it is easy to aim at a predetermined position of the wall portion V, and the puncture portion 33 is reliably and predetermined depth of the wall portion V. You can stab it.

  With the wall portion V pierced by the puncture portion 33 as described above, the suture needle operation portion 55 is slid forward with respect to the tube-like member operation portion 53 of the operation device 50, whereby the puncture portion 33 The needle portion 21 of the suture needle 20 is projected from the inner periphery, and the tip 22a of the needle portion 21 is pierced into a predetermined position of the wall portion V as shown in FIG.

  Thereafter, the needle portion 21 is caused to protrude from the inner periphery of the puncture portion 33 by further sliding the suture needle operation portion 55 forward. At this time, the needle portion 21 of this embodiment has a linear portion 24 that extends linearly from the distal end portion 22 at a predetermined length (see FIGS. 2 and 3). Therefore, even if the distance between the two wall portions V, V of the tissue P is long, the straight portion 24 that extends linearly sticks into both the wall portions V, V surely, and sutures the both wall portions of the tissue. Can be inserted, and the suturing operation can be easily performed.

  Furthermore, by sliding the suture needle operating portion 55 forward, the needle portion 21 is greatly protruded from the inner periphery of the puncture portion 33, and also on the other wall portion V of the tissue P as shown in FIG. The needle portion 21 is pierced, and the tip 22a of the needle portion 21 protrudes from the other wall portion V.

  Thereafter, when the suture needle operating portion 55 is further slid forward, the needle portion 21 is elastically restored and bent by the bent portion 25 and the needle portion 21 is separated from the wall portion V as shown in FIG. Go.

  Thus, the needle portion 21 is protruded from the puncture portion 33 to such an extent that the needle portion 21 is elastically returned to the U-shaped hook shape. As a result, the suture thread T inserted into the needle hole 23 of the suture needle 20 is also inserted into the both wall portions V and V of the tissue P together with the suture needle 20. The pair of wall portions V and V are gathered together so that the tip portions of the pair of wall portions V and V approach each other by the needle portion 21 that has elastically returned to the U-shaped hook shape.

  At this time, since the needle portion 21 is greatly bent, the suture thread T once inserted into the wall portion V is prevented from being pulled out, and the pair of wall portions V and V of the tissue P are sutured. The state where the thread T is inserted can be maintained.

  In the above state, as shown in FIG. 8B, one end of the suture T passed through the needle hole 23 of the suture needle 20 (inserted from the other wall portion V and supported by the needle hole 23) By grasping and pulling one end of T) with the grasping tool 1 such as forceps, the suture T is extracted from the needle hole 23 of the suture needle 20, and the suture T is paired with the pair of walls V, V of the tissue P. It is pulled out while being inserted into

  Thereafter, the needle portion 21 of the suture needle 20 is extracted from the pair of walls V and V by sliding the suture needle operation portion 55 backward with respect to the tubular member operation portion 53 of the operation device 50. Thereafter, the tube-shaped member operation unit 53 is slid backward with respect to the transfer tube operation unit 51 of the operation device 50, thereby pulling out the puncture unit 33 of the puncture tube 31 from one wall portion V. As a result, as shown in FIG. 8 (c), only the suture thread T is left inserted through the pair of wall portions V and V, and the suture thread T is bound by a known binding tool or the like. The pair of wall portions V, V separated from each other of the tissue P can be sewn together to close the tissue P.

  As described above, in the suturing device 10, the tip 22 a of the needle portion 21 of the suturing needle 20 is pierced into a predetermined position of the wall portion V of the tissue P before the wall portion V is punctured by the puncture portion 33 of the tubular member 30. It stabs at a predetermined position. At this time, the tubular member 30 that accommodates the suturing needle 20 is thicker than the suturing needle 20, so that the wall is not displaced or shaken as compared with the case where the thin suturing needle 20 directly pierces the wall portion V. The part V can be reliably positioned and stabbed at a predetermined position. Thereafter, the needle portion 21 of the suture needle 20 is protruded from the inner periphery of the puncture portion 33, so that the suture needle 20 can be reliably pierced at the target position of the wall portion V.

  Further, in this embodiment, since the needle portion 21 of the suture needle 20 is formed as a flat line, when the operation line 28 is pushed and pulled to accommodate the suture needle 20 in the tubular member 30, When projecting the suture needle 20 from the tubular member 30, both sides of the flat line that mainly forms the needle portion 21 come into contact with the inner periphery of the tubular member 30, and the inner periphery of the tubular member 30 is The sliding resistance of the needle part 21 can be reduced. As a result, the pushing and pulling operation of the suture needle 20 becomes easy, and the suture needle 20 can be smoothly moved with respect to the tubular member 30.

  Further, since the needle portion 21 is a flat line, the width necessary for forming the needle hole 23 is sufficiently secured, and the thickness necessary for forming the needle hole 23 in a round line or the like is used. In comparison, the cross-sectional area can be significantly reduced. As a result, the needle portion 21 can be easily inserted into the wall portion V of the tissue P, and the hole formed in the wall portion V of the tissue P can be reduced to reduce tissue damage.

  Furthermore, in this embodiment, since the bending angle θ of the distal end portion of the needle portion 21 is curved at an angle exceeding 270 degrees, as the distal end portion of the needle portion 21 protrudes from the puncture portion 33 of the tubular member 30, the needle The part 21 is gradually greatly curved. For this reason, after the needle portion 21 is pierced into the wall portions V and V of the tissue P, the distal end portion 22 of the needle portion 21 can be bent so that the suture thread T can be protruded far away from the tissue P. The suture thread T pierced by the pair of wall portions V, V can be easily held by forceps or the like. In addition, since the needle part 21 is less likely to be removed from the stabbed tissue, the suturing operation is further facilitated.

  FIG. 9 shows a second embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  In the suturing device 10a, the structure of the tubular member 30 is different from that in the first embodiment. That is, the tubular member 30 includes a puncture cylinder 31 having a predetermined length and extending linearly and having a puncture portion 33 formed at the distal end, and an operation cylinder 35a integrally connected to the proximal end side of the puncture cylinder 31. And have. In the operation cylinder 35a, a plurality of slits 37 extending at a predetermined length along the circumferential direction are formed at predetermined intervals along the axial direction.

  According to this embodiment, similarly to the first embodiment, the bent suture needle 20 can be accommodated by linearly extending by the puncture tube 31 extending linearly, and the puncture portion 33 can be accommodated by the wall portion V of the tissue P. It is possible to reliably stab at a predetermined position. Furthermore, since a plurality of slits 37 extending at a predetermined length along the circumferential direction are formed at predetermined intervals along the axial direction in the operation cylinder 35a that is integrally connected to the proximal end side of the puncture cylinder 31, The endoscope can be inserted while flexibly bending along the bent path of the endoscope. Furthermore, since the puncture tube 31 and the operation tube 35a are integrally formed, it becomes difficult to kink at the boundary between the puncture tube 31 and the operation tube 35a, and workability can be improved.

  FIG. 10 shows a third embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  In the suturing device 10b, the shape of the suturing needle 20 is different from that of the above embodiment. That is, the suturing needle 20 of the suturing device 10b is composed of a needle portion 21 bent and formed in a substantially U shape, and a stranded wire connected to a proximal end portion of the needle portion 21 via a connecting portion 27. It consists of an operation line 28a. According to this embodiment, since the needle portion 21 has a simple shape, the manufacturing cost can be reduced. Further, in this embodiment, the bending angle θ defined in the description of the first embodiment (the angle at which the line connecting the position C and the center O rotates with respect to the center O) is about 235 °. It has become.

  FIG. 11 shows a fourth embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  In the suturing device 10c of this embodiment, the shape of the needle portion 21 is different from that of the above embodiment. That is, the needle portion 21 of the suturing device 10c has a portion with a small curvature and a portion with a large curvature in a shape curved from the distal end to the base side. Specifically, as shown in FIG. 11 (a), a bent portion 21a (hereinafter referred to as a “first gentle curve portion 21a”) is drawn suddenly from the tip toward the base side, A curved portion 21b (hereinafter referred to as a “first steep curve portion 21b”) and a curved portion 21c (hereinafter referred to as a “second gentle curve portion 21c”). Furthermore, it is shaped so that the angle of the bending angle θ of the pointed tip (the angle at which the line connecting the position C and the center O rotates with respect to the center O) is about 450 °. Has been.

  Then, when the needle portion 21 is pushed out via the operation line 28 in a state where the suture needle 20 is accommodated in the tubular member 30, the tubular member 30 is shown in FIGS. 11 (b) to 11 (e). The needle portion 21 gradually protrudes from the inner periphery of the puncture portion 33 and is elastically restored, and finally returns to the shaped shape shown in FIG.

  In this embodiment, the suture needle 20 has a first gentle curve portion 21a, a first sharp curve portion 21b, and a second gentle curve portion 21c, so that the tissue P is operated to be sutured. As shown in FIGS. 11B and 11C, first, the first gentle curve portion 21 a protrudes from the inner periphery of the puncture portion 33 of the tubular member 30. Since the first gentle curve portion 21a draws a relatively gentle curve, it is easy to pierce the wall portion V of the tissue P.

  Further, when the distal end portion 22 of the needle portion 21 is pushed out from the tubular member 30, the first sharp curve portion 21b protrudes this time as shown in FIG. 11 (d). The first sharp curve portion 21b is curved with a steep curve with respect to the first gentle curve portion 21a. Therefore, the distal end portion 22 of the needle portion 21 is suddenly warped, and the first gentle curve portion 21a is bent. The punctured wall portions V and V are brought to the hand side.

  That is, when the tissue P is stabbed into at least a pair of wall portions V and V, the first sharp curve portion 21b protrudes and the needle portion 21 is bent in a sharp curve (see FIG. 11D). ), It can be prevented that the needle tip is separated from the tissue P and the needle portion 21 is pulled out again, and the suture thread T passed through the needle hole 23 is also separated from the tissue P and easily grasped with forceps or the like. The sewing operation can be facilitated.

  FIG. 12 shows a fifth embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  In the suturing device 10d of this embodiment, the shape of the needle portion 21 is different from that of the above embodiment. That is, as shown in FIG. 12A, the needle portion 21 of the suturing device 10d includes a first gentle curve portion 21a, a first sharp curve portion 21b, a second gentle curve portion 21c, and a second sharp curve. It has a portion 21d and a third gentle curve portion 21e.

  According to this embodiment, when the needle portion 21 is pushed out from the puncture portion 33 of the tubular member 30, as shown in FIGS. 12 (b) to 12 (e), the first gentle curve portion 21a, the first sharp curve The portion 21b, the second gentle curve portion 21c, the second sharp curve portion 21d, and the third gentle curve portion 21e are projected in this order, and the needle portion 21 is pierced into the wall portion V of the tissue P as in the fourth embodiment. In addition to facilitating the removal of the needle portion 21 pierced by the wall portion V.

  FIG. 13 shows a sixth embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  In the suturing device 10e of this embodiment, the shape of the needle portion 21 is different from that of the above embodiment. That is, as shown in FIG. 13A, the needle portion 21 of the suturing device 10e includes a first gentle curve portion 21a, a first sharp curve portion 21b, a second gentle curve portion 21c, and a second sharp curve. It has a portion 21d and a third gentle curve portion 21e.

  Also in this embodiment, as in the fifth embodiment, when the needle portion 21 is pushed out from the inner periphery of the puncture portion 33 of the tubular member 30, as shown in FIGS. 13B to 13E, each curve portion is 21a. , 21b, 21c, 21d, and 21e in this order.

  FIG. 14 shows a seventh embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  In the suturing device 10f of this embodiment, the shape of the needle portion 21 is different from that of the above embodiment. That is, the needle portion 21 of the suturing device 10f has a first gentle curve portion 21a, a first sharp curve portion 21b, and a second gentle curve portion 21c, as shown in FIG. When the needle portion 21 is pushed out from the puncture portion 33 of the tubular member 30, the curved portions protrude in the order of 21a, 21b, and 21c as shown in FIGS. 14 (b) to 14 (e).

  FIG. 15 shows an eighth embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  That is, the needle portion 21 of each suture needle in the first to seventh embodiments is formed from a flat line, whereas the needle portion 21 in the suturing apparatus 10g is formed from a triangular line having a triangular cross section. Are different (see FIGS. 15A and 15B). The needle portion 21 of the suturing device 10g is shaped so that one plane side of the triangular line is curved outward. Further, the triangular line forming the needle portion 21 is thicker on the proximal end side and has a tapered shape that gradually becomes thinner toward the distal end 22a, and is easily pierced into the wall portion V of the tissue P.

  In this embodiment, the needle portion 21 is formed by a triangular line having a triangular cross section, so that the suture needle 20 is accommodated in the tubular member 30 or the inner periphery of the puncture portion 33 of the tubular member 30. When the suture needle 20 protrudes from, the flat portion of the triangular line is less likely to contact the inner periphery of the tubular member 30. That is, since both corners of the triangular line constituting the needle portion 21 are in contact with the inner periphery of the tubular member 30, the sliding resistance of the needle portion 21 with respect to the inner periphery of the tubular member 30 is reduced, and the suture needle 20 is made smooth. Can be moved to.

  Further, in the case of the suturing needle 20 of the suturing device 10g shown in FIG. 15A, the needle portion 21 is formed by a continuous triangular line having a triangular cross section, but is not limited thereto. . For example, as shown in FIG. 15C, the distal end side of the needle portion 21 may be formed by a triangular line having a triangular cross section, and the proximal end side may be a round line having a circular cross section. According to this, since the proximal end side of the needle part 21 is formed by a round wire having a larger cross-sectional area than the triangular line on the distal end side, the rigidity on the proximal end side can be increased, and the wall portion of the tissue P V can be easily pierced.

  FIG. 16 shows a ninth embodiment of the suturing device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  The suturing device 10h according to this embodiment has a structure to which a high-frequency current can be applied, like a so-called high-frequency electric knife. Specifically, as shown in FIG. 16, a cylindrical wall 51 b is erected on the outer periphery of the tubular member operating portion 53, and the tubular member 30 is electrically connected to the opening of the distal end of the cylindrical wall 51 b. The connected electrode A protrudes. Further, a cylindrical wall 55a is also provided on the outer periphery of the suture needle operation unit 55, and an electrode B electrically connected to the suture needle 20 protrudes from a distal end opening of the cylindrical wall 55a. Each of the electrodes A and B is connected to a high-frequency oscillator (not shown) connected to the living body via a lead, and the high-frequency current is selectively applied to the suture needle 20 and the tubular member 30 by the high-frequency oscillator. It can be added.

  In addition, the suturing needle 20 and / or the tubular member 30 are insulated from each other in order to prevent short-circuiting due to mutual contact. For example, the inner periphery of the tubular member 30 is coated with an insulating coating made of a fluorine resin or the like, or the tip portion 22 of the needle portion 21 of the suture needle 20 is covered with a heat shrinkable tube made of a synthetic resin. A resin tube different from those may be disposed between the tubular member 30 and the suture needle 20, and the insulating means can be determined as appropriate.

  When using the suturing device 10h, first, one of the conducting wires extended from a high-frequency oscillator (not shown) is connected to the human body, and the other conducting wire is connected to the electrodes A and B of the suturing device 10h.

  As shown in FIG. 7 (a), when the tubular member 30 pierces a predetermined portion of the wall portion V, the tubular member 30 is energized through the electrode A from the high frequency oscillator, and the puncture tube at the tip thereof. A high frequency current is added to 31. Then, Joule heat is generated in the puncture tube 31, the punctured wall portion V is instantaneously heated, and the puncture portion is protein-denatured, so that the puncture tube 31 can be pushed in smoothly and the puncture performance can be improved. it can. In addition, since the blood around the puncture portion coagulates quickly, the hemostatic effect can be enhanced.

  From the above state, as shown in FIGS. 7B and 7C, when protruding the needle portion 21 of the suture needle 20 from the puncture tube 31 of the tubular member 30, the conduction to the electrode A is stopped, By energizing the suture needle 20 through the electrode B and applying a high-frequency current to the needle portion 21 at the tip, Joule heat is generated in the needle portion 21 as in the case of the puncture tube 31, and the needle portion 21 is smoothly smoothed. It is possible to push into the tube, improve the puncture property and enhance the hemostatic effect.

10, 10a, 10b, 10c, 10d, 10e, 10f, 10g, 10h Suture device 20 Suture needle 21 Needle portion 22 Tip portion 22a Tip 23 Needle hole 24 Linear portion 27 Connection portion 28, 28a Operation line 30 Tubular member 31 Puncture Tube 33 Puncture part 35, 35a Operation tube 37 Slit 40 Transfer tube

Claims (8)

In a suturing device for suturing tissue with a suture,
The shape is made of a shape memory alloy, the tip has a pointed shape, the needle having a needle hole through which the suture thread can be inserted at the tip, and the base end of the needle is connected via a connection portion, A suture needle having an operation line for moving the needle portion in a predetermined direction;
A tubular member that slidably accommodates the suture needle,
The needle portion of the suturing needle is shaped so that at least a part of the portion that pierces the tissue has a curved shape,
The distal end of the tubular member forms a pointed puncture portion by being cut obliquely with respect to the axial direction of the tubular member, and the needle portion of the suture needle is inserted through the inner peripheral edge of the puncture portion. And being pulled into the tubular member while being stretched against the elastic force, and being protruded while being guided to the opening peripheral edge of the proximal end side of the puncture portion, and the inner periphery of the puncture portion A suturing device, wherein the suturing needle is projected and retracted.   The tubular member has a puncture tube that extends linearly for a predetermined length and has the puncture portion formed at a distal end portion thereof, and an operation tube that is connected to the proximal end side of the puncture tube, The suturing device according to claim 1, wherein the suturing device is constituted by winding a wire in a coil shape.   The tube-shaped member has a puncture tube that extends linearly for a predetermined length and has the puncture portion formed at a distal end portion thereof, and an operation tube that is integrally connected to a proximal end side of the puncture tube. The suturing device according to claim 1, wherein a plurality of slits extending at a predetermined length along the circumferential direction are formed in the tube at predetermined intervals along the axial direction.   The suturing device according to any one of claims 1 to 3, wherein a transfer tube is slidably disposed on an outer periphery of the tubular member.   The needle portion of the suturing needle has a portion that pierces the tissue formed of a flat line or a triangular triangle with a cross section, and at least a part of the portion that pierces the tissue faces the plane side of the flat line or the triangle line outward. The suturing device according to any one of claims 1 to 4, wherein the suturing device is shaped so as to have a curved shape.   The needle portion of the suturing needle has a straight portion extending linearly from the tip portion with a predetermined length, and has a shape curved from the base side of the straight portion. The suturing device according to one.   The needle portion of the suturing needle has a position where A begins to bend from the straight portion of the base end portion thereof as A, a position farthest from the axis of the operation line of the bent portion of the needle portion as B, and the needle portion , The center point between the position A and the position B is the center O, and the line connecting the position C and the center O rotates around the center O with respect to the line connecting the position A and the center O. The suturing device according to any one of claims 1 to 6, wherein the suturing device is bent so that the bending angle θ is 190 to 540 degrees when the moving angle is defined as the bending angle θ.   The suturing according to any one of claims 1 to 7, wherein a needle portion of the suturing needle has a portion with a small curvature and a portion with a large curvature in a shape curved from the distal end toward the base side. apparatus.

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