JP6905532B2 - Medical bidirectional suturing device - Google Patents

Description

The present invention relates to a medical bidirectional suturing device capable of suturing an object with a thread in both directions from the proximal side to the distal side and from the distal side to the proximal side, and a method for operating the same.

Transsphenoidal surgery (TSS) is often performed to remove the tumor in the pituitary gland. TSS is generally performed by the following procedure. First, the surgeon progresses along the patient's nasal septum, peeling off the nasal mucosa, fenestrating the sphenoid bone and opening the dura to reach the pituitary gland. Next, the pituitary tumor is removed. Finally, the dura mater is sutured to reconstruct the sphenoid bone and nasal mucosa.

Conventionally, in TSS, the dura mater is sutured by threading one thread on each side of the incised dura mater, closing the dura mater while pulling both ends of the thread, and then tying and fixing a knot. Was there. The method of passing the suture through the dura is as follows. First, a suture needle with a suture is passed through one dura from the proximal side to the distal side of the dura, that is, from the nasal cavity side to the pituitary side, and then the dura mater is passed through the other dura mater. A suture needle with a suture is passed from the distal side to the proximal side, that is, from the pituitary side to the nasal cavity side. At this time, the suture enters from the nasal cavity side to the pituitary side and comes out to the nasal cavity side again.

The dura mater is sutured by TSS by the operator manually holding a curved suture needle having a curved shape having a diameter of about 3 mm to 10 mm by a needle holder having a forceps-like tip. However, the distance from the operator's hand to the actual sutured part is more than ten cm, and the size of the incision is 5 mm to 20 mm at the most, so it is very small. Therefore, the surgeon has to perform the suturing work under a microscope or an endoscopic image, which causes a problem that the operation takes a long time. Therefore, a suture device capable of passing sutures in two directions, from the distal side to the proximal side and from the proximal side to the distal side of the dura mater, has been proposed.

For example, in Patent Document 1 and the corresponding Patent Document 2, a needle having a notch for catching the suture is moved on the side surface, and when the notch and the groove of the boom arm housing are lined up, the needle is caught by the notch. A threading device capable of bidirectionally suturing a living tissue by moving the suture to the groove of the boom arm housing is described.

In Patent Document 3 and the corresponding Patent Document 4, a suture in which a knot or the like is prepared in advance is detachably connected to the distal side of the suture holder to realize bidirectional suture of living tissue. A suture cage is described.

Patent Document 5 and the corresponding Patent Document 6 describe a suture tool capable of suturing a tissue by connecting a suture to a needle having sharp ends and reciprocating the needle.

Patent Document 7 describes a suture tool capable of suturing a tissue by connecting a suture to a ferrule and reciprocating the ferrule.

Further, although it is not a suturing device capable of suturing in two directions, the following suturing devices have also been proposed. Patent Document 8 describes an endoscopic suturing machine in which a looper grips a thread ring formed by a needle and a looper shaft carrying the looper is rotatably arranged in a case.

Patent Document 9 describes a suture device in which a suture clasp arm is pivotally connected to a distal mount and the arm is pivoted around the distal or proximal end of the arm. ..

Special Table 2012-515636A International Publication No. 2010/085793 Special Table 2014-528768 International Publication No. 2013/024466 Japanese Patent Application Laid-Open No. 2011-509121 International Publication No. 2009/089101 Japanese Unexamined Patent Publication No. 2011-72790 Special Table 2004-591299 Japanese Unexamined Patent Publication No. 2014-236995

However, in the threading device described in Patent Documents 1 and 2, it is physically difficult to move the suture thread from the notch of the needle into the groove of the distal boom arm housing. In addition, since it is necessary to move the suture needle while keeping it in close contact with the boom arm housing, there is a risk that the suture will break or deform due to the suture rubbing against the boom arm housing during movement.

In the devices described in Patent Documents 3 and 4 and Patent Document 7, it is necessary to make a knot on the suture or to tie it to a ferrule, so that these operations require time.

In order to reciprocate the needle in both directions in the suture thread cage described in Patent Documents 5 and 6, it is necessary to re-grip the needle and change the gripping position each time. Inadvertent damage to the tissue or the hassle of searching for a missing needle can occur.

The end-scope type suturing machine described in Patent Document 8 manually feeds the sutured object while rotating the looper along a multidimensional motion trajectory in order to reciprocate the thread ring formed by the needle. Need to be done. In addition, since the purpose is to superimpose two pieces of biological tissue and sew the edges over, it is not possible to perform dural suture in TSS.

Since the suture device described in Patent Document 9 needs to grip the tissue portion to be sutured by the suture clasp arm when suturing, there is a possibility of damaging the tissue portion. Since suturing cannot be performed unless the two living tissues are in a position where they can be grasped by the clasp arm, it is necessary to place the living tissues in appropriate positions before suturing.

Therefore, an object of the present invention is to provide a medical bidirectional suturing device that can easily perform a suturing operation and that operates safely with minimal invasiveness to the human body.

The medical bidirectional suture device of the present invention that solves the above problems is a medical bidirectional suture device having a perspective direction, and has a needle mechanism extending in the perspective direction and having a tip on the distal side. The needle mechanism has a thread-like material holding member provided on the distal side of the medical bidirectional suture device, and a needle mechanism includes a passage through which the thread-like material passes, an entrance / exit portion provided on one side of the passage, and a passage. The gist is that it has a terminal portion provided on the other side.

The passage penetrates in one direction perpendicular to the axial direction of the needle mechanism, and the thread-like object holding member has a third direction other than the direction perpendicular to the two directions of the axial direction of the needle mechanism and the penetrating direction of the passage. It is preferable to rotate around one direction.

The first direction may be perpendicular to the axial direction of the needle mechanism or may be the penetrating direction of the passage. Further, the first direction may be parallel to the axial direction of the needle mechanism.

Further, the medical bidirectional suturing device has an operation portion on the proximal side, and the filamentous material holding member is provided on one side of the rotation shaft with the first direction as the axis and the rotation shaft is sandwiched between the rotation shafts. It is preferable to have a fixing portion that is directly or indirectly connected to the portion and a pressing portion that is provided on the other side of the rotating shaft and presses the thread-like object.

It is preferable that the thread-like object holding member slides in a direction perpendicular to the axial direction of the needle mechanism to hook the middle portion of the thread-like object.

The needle mechanism preferably has a catching portion that narrows the passage or entrance / exit portion.

A needle mechanism is provided on the hollow member and inside the hollow member; has an interpolating member that can advance and retreat axially with respect to the hollow member; passages, entrances and exits, and terminations are formed in the hollow member. It is provided; the doorway is at the distal end of the hollow member; the trap is preferably at the proximal end of the passage.

The needle mechanism is provided in a hollow member having an inclined portion at the distal end and inside the hollow member, and at least the rotational operation around the axis of the hollow member and the axial movement operation of the hollow member. It is preferable to have an interpolating member capable of operating either one, and the entrance / exit portion is provided on the proximal side of the inclined portion.

It is preferable that the catching portion is composed of a hollow member and an interpolating member.

The needle mechanism is hollow, has a needle member having an entrance / exit portion provided at the distal end of the needle member, and an inner cylinder having a catching portion provided inside the needle member and rotating with respect to the needle member. It is a member, and the inner cylinder member preferably has an opening extending to its distal end.

The catching portion may be a protrusion protruding inward in the radial direction of the needle mechanism.

It is preferable that the needle mechanism is provided with a terminal portion proximal to the entrance / exit portion.

It is preferable that the passage penetrates in the direction perpendicular to the axial direction of the needle mechanism.

It is preferable that the passage extends along the axial direction of the needle mechanism.

Further, the method of operating the medical bidirectional sewing device of the present invention that solves the above problems is a medical bidirectional sewing device having a perspective direction, which extends in the perspective direction and has a tip on the distal side. It has a needle mechanism and a thread-like material holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism has a passage through which the thread-like material passes and an entrance / exit portion provided on one side of the passage. A step of preparing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage and a catching portion for narrowing the passage or the entrance / exit, and a step of holding the filament by the catching portion of the needle mechanism. , The step of moving the needle mechanism to the distal side to move the filament to the distal side of the object to be sewn, the step of releasing the holding of the filament by the trapping part of the needle mechanism, and the distal of the needle mechanism. The gist is that it has a step of moving the end to the proximal side of the object to be sewn and a step of holding the thread by the thread-like object holding member on the distal side of the object to be sewn.

Further, the method of operating the medical bidirectional sewing device of the present invention that solves the above problems is a medical bidirectional sewing device having a perspective direction, which extends in the perspective direction and has a tip on the distal side. It has a needle mechanism and a thread-like material holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism has a passage through which the thread-like material passes and an entrance / exit portion provided on one side of the passage. A step of preparing a medical bidirectional sewing device having a terminal portion provided on the other side of the passage and a catching portion for narrowing the passage or the entrance / exit portion, and a state in which the filamentous material is not held by the filamentous material holding member. Then, the step of moving the needle mechanism to the distal side of the stitched object, the step of holding the thread-like object by the catching part of the needle mechanism, and the step of moving the distal end of the needle mechanism to the proximal side of the stitched object. It has a gist in that it has a step to make it.

The method of operating the medical bidirectional suture device of the present invention that solves the above problems is a medical bidirectional suture device having a perspective direction, extending in the perspective direction, and a needle mechanism having a tip on the distal side. And a thread-like material holding member provided on the distal side of the medical bidirectional suture device, and the needle mechanism includes a passage through which the thread-like material passes, and an entrance / exit portion provided on one side of the passage. A step of preparing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage and a catching portion for narrowing the passage or the entrance / exit portion, and a step of exchanging the needle mechanism with another needle mechanism. It has a gist in what it has.

In the medical bidirectional suturing device of the present invention, a folded portion of the thread-like object can be formed on the distal side of the suture object by a simple operation of passing the thread-like object through the passage of the needle mechanism, and the suture object can be sutured. It is possible to facilitate the holding of the thread on the distal side. In addition, it is safe because it is not necessary to change the gripping position of the needle or move the needle while bringing the members into close contact with each other as in the conventional suturing device. Furthermore, since it is not necessary to directly grip the sutured object, it is minimally invasive to the human body.
Further, according to the operating method of the medical bidirectional suturing device of the present invention, a folded-back portion that easily holds the thread-like object can be arranged on the distal side of the suture object, so that the suture object is distal. The filamentous material can be easily held even on the side.

The side view of the medical bidirectional suturing apparatus of this invention is shown. The side view of the medical bidirectional suturing apparatus of this invention is shown. The distal side view of the medical bidirectional suturing device of the present invention is shown. A side view of the needle mechanism according to the first embodiment is shown. An enlarged perspective view of the distal side of the needle mechanism shown in FIG. 4 is shown. FIG. 4 shows an enlarged side view of the distal side of the needle mechanism shown in FIG. A front view of the needle mechanism shown in FIG. 4 as viewed from the distal side is shown. A side view of the inner cylinder member according to the first embodiment is shown. FIG. 8 shows an enlarged perspective view of the distal side of the inner cylinder member shown in FIG. The perspective view on the distal side of the needle mechanism which concerns on Embodiment 1 is shown. A side view (partial cross-sectional view) of the distal side of the needle mechanism according to the first embodiment is shown. A side view (partial cross-sectional view) of the distal side of the needle mechanism according to the first embodiment is shown. A side view (partial cross-sectional view) of the distal side of the needle mechanism according to the first embodiment is shown. FIG. 6 shows an enlarged side view of the distal side of the needle mechanism according to the second embodiment. FIG. 14 shows an enlarged side view of the distal side showing a modified example of the needle mechanism shown in FIG. FIG. 6 shows an enlarged side view of the distal side of the needle mechanism according to the third embodiment. FIG. 6 shows an enlarged perspective view of the distal side of the needle mechanism according to the fourth embodiment. FIG. 17 shows an enlarged side view of the distal side of the needle mechanism shown in FIG. FIG. 6 shows an enlarged perspective view of the distal side of the needle mechanism according to the fifth embodiment. A front view of the needle mechanism shown in FIG. 19 as viewed from the distal side is shown. A side view of the needle mechanism shown in FIG. 19 as viewed from the first side surface is shown. A side view of the needle mechanism shown in FIG. 19 as viewed from the second side surface is shown. FIG. 6 shows an enlarged side view of the distal side of the hollow member according to the sixth embodiment. FIG. 23 shows an enlarged perspective view of the distal side of the hollow member shown in FIG. 23. FIG. 6 shows an enlarged side view of the distal side of the interpolation member according to the sixth embodiment. FIG. 25 shows an enlarged perspective view of the distal side of the interpolation member shown in FIG. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the sixth embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the sixth embodiment. FIG. 6 shows an enlarged side view of the distal side of the hollow member according to the seventh embodiment. FIG. 29 shows an enlarged perspective view of the distal side of the hollow member shown in FIG. 29. FIG. 6 shows an enlarged side view of the distal side of the interpolation member according to the seventh embodiment. FIG. 31 shows an enlarged perspective view of the distal side of the interpolation member shown in FIG. 31. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the seventh embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the seventh embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the seventh embodiment. FIG. 6 shows an enlarged side view of the distal side of the hollow member according to the eighth embodiment. FIG. 36 shows an enlarged perspective view of the distal side of the hollow member shown in FIG. FIG. 6 shows an enlarged side view of the distal side of the interpolation member according to the eighth embodiment. FIG. 38 shows an enlarged perspective view of the distal side of the interpolation member shown in FIG. 38. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the eighth embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the eighth embodiment. FIG. 6 shows an enlarged side view of the distal side of the hollow member according to the ninth embodiment. FIG. 42 shows an enlarged perspective view of the distal side of the hollow member shown in FIG. 42. FIG. 6 shows an enlarged perspective view of the distal side of the interpolation member according to the ninth embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the ninth embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the ninth embodiment. FIG. 6 shows an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism according to the ninth embodiment. The perspective view of the thread-like material holding member which concerns on this invention is shown. FIG. 6 shows an enlarged perspective view of the distal side of the medical bidirectional suturing device of the present invention. FIG. 6 shows an enlarged perspective view of the distal side of the medical bidirectional suturing device of the present invention. A perspective view showing a direction perpendicular to the virtual plane entering the passage of the needle mechanism is shown. FIG. 6 shows an enlarged perspective view of the distal side of a medical bidirectional suturing device using another thread-like material holding member according to the present invention. FIG. 6 shows an enlarged perspective view of the distal side of a medical bidirectional suturing device using another thread-like material holding member according to the present invention. FIG. 6 shows an enlarged perspective view of the distal side of a medical bidirectional suturing device using another thread-like material holding member according to the present invention. FIG. 6 shows an enlarged perspective view of the distal side of a medical bidirectional suturing device using another thread-like material holding member according to the present invention. FIG. 5 is an enlarged perspective view of the distal side of a medical bidirectional suturing device using still another thread-like material holding member according to the present invention. FIG. 5 is an enlarged perspective view of the distal side of a medical bidirectional suturing device using still another thread-like material holding member according to the present invention. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. The explanatory view of the operation method of the medical bidirectional suturing apparatus of this invention is shown. An explanatory diagram of a method of suturing a living tissue of the present invention is shown.

Hereinafter, the present invention will be described in more detail based on the following embodiments, but the present invention is not limited by the following embodiments as well as the present invention, and appropriate changes are made to the extent that it can be adapted to the purpose of the above and the following. In addition, it is of course possible to carry out, and all of them are included in the technical scope of the present invention. In each drawing, hatching, member reference numerals, and the like may be omitted for convenience, but in such cases, the specification and other drawings shall be referred to. In addition, the dimensions of various members in the drawings may differ from the actual dimensions because priority is given to contributing to the understanding of the features of the present invention.

1. 1. Medical bidirectional suture device The medical bidirectional suture device is, for example, visually, under a microscope, and under an endoscopic image, on a suture object such as a living tissue, from one side to the other side and from the other side to one side. It is a treatment tool that can thread sutures in both directions. In the present specification, it may be referred to simply as "device" or "suture device".

The thread-like material is a suture used for medical purposes, and may be a single thread or a knitted thread, and the outer diameter can be appropriately selected as long as it is a diameter used in a general suture. Further, the filamentous material may be formed of a decomposable material. The length of the filament is preferably long enough so as not to interfere with the operation, and is preferably 20 cm or more and 200 cm or less. For example, in TSS, a length that allows the suture to reciprocate from outside the body to the dura is preferred plus a length sufficient for the physician to make a knot in the suture outside the patient's body, which is preferred in TSS. Specifically, the length of the filament is 70 cm or more and 150 cm or less.

First, the overall configuration of the apparatus will be described with reference to FIGS. 1 to 3. 1 and 2 are side views and a side view showing the inside of the suturing device of the present invention, respectively, and FIG. 3 shows an enlarged side view of the distal side. As shown in FIGS. 1 to 3, the suturing device 1 of the present invention has a perspective direction. In the present invention, the proximal side of the device 1 refers to the direction toward the user's hand side, and the distal side refers to the direction opposite to the proximal side (that is, the direction toward the treatment target side). Further, the upper side of the device 1 refers to the upper side of FIG. 1, and the lower side refers to the opposite side of the upper side (that is, the lower side of FIG. 1).

The suturing device 1 of the present invention has a needle mechanism 2 extending in the perspective direction and having a tip on the distal side. A puncture portion 11 for puncturing the sutured object is preferably provided on the distal side of the needle mechanism 2. The suturing device 1 has a needle mechanism 2 and a thread-like material holding member 30 provided on the distal side of the device 1. In FIGS. 1 to 3, the needle mechanism 2 and the thread-like object holding member 30 are held in a hollow housing 50. 1 to 3 show an example in which the needle mechanism 2 has a hollow needle member 10, but the present invention is not limited to this aspect. It is preferable that the device 1 is provided with an operation unit on the proximal side. In FIG. 1, a first operation unit 61 and a third operation unit 63 for operating the needle mechanism 2 and the thread-like object holding member 30, respectively, are provided. When the device 1 is used, the suture object 100 is positioned between the needle mechanism 2 and the thread-like object holding member 30 in a state where the needle mechanism 2 is moved to the proximal side as shown in FIG. By operating the operation unit, the needle mechanism 2 on which the thread-like object 70 is hung is moved in the perspective direction to penetrate the suture object 100, or the thread-like object holding member 30 holds the thread-like object 70 in an appropriate combination. conduct. As a result, the suture object 100 can be sutured from the proximal side to the distal side, or from the distal side to the proximal side.

(1) Needle mechanism The needle mechanism is a mechanism used to pass a thread-like object through a living tissue such as a dura mater, which is an object to be sutured. The needle mechanism may be composed of one member or may be composed of a combination of a plurality of members. The needle mechanism according to the present invention has a passage through which a thread-like object passes, an entrance / exit portion provided on one side of the passage, and a terminal portion provided on the other side of the passage. Therefore, by inserting the middle portion of the filamentous material into the passage from the entrance / exit portion of the needle mechanism and hanging it on the passage or the terminal portion, the filamentous material can be kept in the passage in a state of being folded back in the axial direction of the needle mechanism. .. In addition, the needle mechanism and the thread-like object are moved to the distal side of the object to be sutured while the mid part of the thread-like object is retained in the passage, and then only the needle mechanism is moved to the proximal side to suture. The folded portion of the thread-like object can be arranged on the distal side of the object. By forming the folded portion of such a thread-like object, it becomes easy to hold the thread-like object on the distal side of the suture object.

The suturing device of the present invention can form a folded portion of the sutured object on the distal side of the sutured object by a simple operation of passing the threaded object through the passage of the needle mechanism, and on the distal side of the sutured object. It is possible to facilitate the holding of the thread-like material. In addition, it is safe because it is not necessary to change the gripping position of the needle or move the needle while bringing the members into close contact with each other as in the conventional suturing device. Furthermore, since it is not necessary to directly grip the sutured object, it is minimally invasive to the human body.

When the object to be sutured is a living tissue, the range of motion of the device is limited. For example, when suturing the dura mater under an endoscope, it is necessary to perform the work while observing only the proximal side of the dura mater due to the insertion direction of the endoscope. Therefore, the tip of the needle mechanism is provided on the distal side so that the suture position can be confirmed. It is preferable that the puncture portion is provided on the distal side of the needle mechanism, and it is preferable that the puncture portion is provided on the distal end portion of the needle mechanism. The puncture site may be formed so as to have one or more sharp tips pointed toward the distal side, for example, even if the puncture portion is formed so as to decrease the cross-sectional area toward the distal side. It may be formed in a tapered shape. Further, the puncture portion may have a constant outer diameter. The needle mechanism may be provided with one distal end or may be provided with a plurality of distal ends. When the needle mechanism is composed of a plurality of members, the puncture portion may be provided on only one member, or the puncture portion may be provided on the plurality of members.

The needle mechanism is arranged so as to be movable in the perspective direction of the device. By moving the needle mechanism from the proximal side to the distal side, the needle mechanism can be pierced into a suture object located distal to the needle mechanism. By moving the needle mechanism puncturing the suture object to the proximal side, the needle mechanism can be pulled out from the suture object. The needle mechanism extends in the perspective direction, and it is preferable that at least the distal end portion extends in the perspective direction, and it is more preferable that the needle mechanism extends in the perspective direction as a whole.

The length of the needle mechanism can be set to about 2 cm or more and 30 cm or less, which is the distance from the nasal cavity to the pituitary gland when used for TSS, for example.

The needle mechanism may be linear or curved, and may have a combination thereof or a bent portion. Further, the members constituting the needle mechanism may be hollow or solid.

The outer diameter of the needle mechanism is not particularly limited as long as it is a diameter used in a general suture needle, but is preferably 0.05 mm or more and 1.5 mm or less, for example. When the needle mechanism is a hollow needle member, the wall thickness of the needle member is preferably 0.01 mm or more and 0.5 mm or less, for example.

The material of the needle mechanism preferably has biocompatibility and strength capable of puncturing an object such as a biological tissue. For example, a metal material such as stainless steel or a resin material is preferable, and rust resistance and processing are particularly preferable. From the viewpoint of ease, stainless steel is preferable.

The needle mechanism may be connected to a first operation unit 61 (described later) provided on the hand side of the operator, for example, via a needle support member 65 connected to the proximal side of the needle mechanism. 1 It may be connected to the operation unit 61. Further, it may be connected to the first operation unit 61 via one or a plurality of other members.

The passage is a part that appears when viewed from the side surface of the needle mechanism, and is a part through which a thread-like object passes. Therefore, for example, a cavity that does not appear on the side surface of the hollow needle mechanism is not defined as a passage in the present invention. The shape of the passage may be, for example, a straight line, a curved line, or a combination thereof.

The doorway portion is a part that functions as a doorway for passing a thread-like object through the passage of the needle mechanism. The doorway is provided on one side of the passage. When working while observing only the proximal side of the suture object, the doorway is at the distal end of the needle mechanism (more preferably) to facilitate holding the thread on the distal side of the suture object. It is preferably provided at the distal end).

The end portion is a portion provided on the other side of the passage, for example, a filament can be fastened in the passage when the needle mechanism is moved to the distal or proximal side.

The size of the passage may be constant, and a wide portion or a narrow portion may be provided. In the axial direction of the needle mechanism, the length of the passage can be set, for example, in the range of 0.1 mm or more and 100 mm or less. The size of the passage may be formed so as to increase toward the distal side in the puncture portion of the needle mechanism. Here, the size of the passage means the maximum diameter in the cross section perpendicular to the extending direction of the passage, and the length of the passage means the length in the extending direction of the passage.

The size of the doorway and the passage is not particularly limited as long as it has a size that allows the thread-like object to pass through. For example, in order to prevent excessive deformation and cutting of the thread-like object, the entrance / exit portion of the needle mechanism And the size of the passage is preferably larger than the outer diameter of the thread-like material. Here, the size of the entrance / exit means the maximum diameter in the cross section perpendicular to the extending direction of the passage. Further, the size of the entrance / exit portion is not particularly limited, and may be larger or smaller than the length of the passage.

The needle mechanism preferably has a catching portion that narrows at least one of an entrance / exit portion, a passage, and an end portion. More preferably, the needle mechanism has a trap that narrows the passage or doorway. Since the catching portion makes it easier to hold the thread-like object, it is possible to prevent the thread-like object from coming off the needle mechanism while the needle mechanism is moving.

(Embodiment 1 of Needle Mechanism)
An example of the needle member 10 (10A) in which the needle mechanism 2 (2A) is hollow and the entrance / exit portion is provided at the distal end will be described with reference to FIGS. 4 to 7. The needle member 10A is provided with two distal ends. FIG. 4 shows a side view of the needle mechanism 2A, FIG. 5 shows an enlarged perspective view of the distal side of the needle mechanism 2A shown in FIG. 4, and FIG. 6 shows a distance of the needle mechanism 2A shown in FIG. An enlarged side view of the position side is shown, and FIG. 7 shows a front view of the needle mechanism 2A shown in FIG. 4 as viewed from the distal side.

In FIGS. 4 to 7, since the needle mechanism 2A is composed of the needle member 10A, the passage 13 is formed in the needle member 10A. It is preferable that the passage 13 extends along the axial direction of the needle mechanism 2A. The passage 13 shown in FIGS. 4 to 7 extends along the axial direction of the needle member 10. Therefore, by moving the needle member 10 in the axial direction, the thread-like object 70 located in the passage 13 can be moved in the perspective direction of the needle member 10. As shown in FIG. 6, it is preferable that the passage 13 passes through the axis C of the needle member 10. As a result, the filamentous material 70 is stably held. Since the entrance / exit portion 12 is provided at the distal end of the needle member 10, it is easy to guide the thread-like object 70 into the passage 13 of the needle member 10 even when the distal side cannot be seen under the endoscope.

When the needle member 10 is hollow, it is preferable that a plurality of distal ends are provided, and it is preferable that two of them are provided. In this case, it is more preferable that the distal end portion has a shape that tapers toward the distal side (so-called twin peak shape). As shown in FIGS. 4 to 6, the outer diameter of the needle member 10 may be constant. In that case, in order to facilitate the insertion of the filament 70 into the passage 13, it is preferable that the size of the passage 13 of the needle member 10 increases toward the distal side.

It is preferable that the passage 13 penetrates in the direction perpendicular to the axial direction of the needle mechanism 2A. As shown in FIGS. 5 to 7, it is more preferable that the passage 13 penetrates in the direction perpendicular to the axial direction of the needle member 10. It is more preferable that the passage 13 penetrates in the direction perpendicular to the axial direction of the needle member 10 when viewed from the distal side of the needle member 10. As a result, the folded-back portion 71 of the thread-like object 70 is likely to be formed on the distal side of the suture object, so that the thread-like object 70 can be easily held by the needle member 10 or the thread-like object holding member.

A passage 13 is formed in the needle member 10, and an opening is provided on the side surface of the needle member 10. When the passage 13 is formed so that the distal ends of the needle member 10 are two and two openings are provided on the side surface of the needle member 10, one opening and the other are provided in the circumferential direction of the needle member 10. It is preferable that the openings face each other with the axial center C of the needle member 10 interposed therebetween. The openings provided on the side surface of the needle member 10 may be arranged rotationally symmetrically with the major axis direction of the needle member 10 as the central axis. As a result, the folded-back portion 71 of the thread-like object 70 can be formed in a symmetrical shape, so that the thread-like object 70 can be easily held on the distal side of the suture object.

The needle mechanism 2A may be provided with a terminal portion 14 proximal to the entrance / exit portion 12. The needle member 10 may be provided with a terminal portion 14 proximal to the entrance / exit portion 12. As a result, when the needle member 10 is moved from the proximal side to the distal side, the thread-like object 70 is caught by the terminal portion 14, so that the thread-like object 70 easily stays in the passage 13.

The holding and releasing of the thread-like object 70 by the needle member 10 is preferably performed by combining with the inner cylinder member described below. That is, it is preferable that the needle mechanism 2A has a needle member 10A and an inner cylinder member 20 provided inside the needle member.

8 and 9 show a side view and an enlarged perspective view of the distal side of the inner cylinder member 20 according to the present invention, respectively, and FIG. 10 shows a perspective view of the needle mechanism 2A according to the present invention on the distal side. 11 to 13 show side views (partial cross-sectional views) of the needle mechanism 2A according to the present invention.

As shown in FIG. 10, the needle mechanism 2A is hollow, the entrance / exit portion 12 has a needle member 10 provided at the distal end, and the catching portion 15 is provided inside the needle member 10 to provide a needle. It is preferable that the inner cylinder member 20 rotates with respect to the member 10. As the inner cylinder member 20 rotates with respect to the needle member 10, the entrance / exit portion 12 or the passage 13 of the needle member 10 is covered with the inner cylinder member 20 and becomes narrower. As a result, the filamentous material 70 can be held in the narrowed entrance / exit portion 12 or the passage 13.

The outer diameter of the inner cylinder member 20 may be smaller than the inner diameter of the needle member 10, and can be set to, for example, 0.02 mm or more and 1.5 mm or less.

The wall thickness of the inner cylinder member 20 can be set to, for example, 0.01 mm or more and 0.5 mm or less.

Like the needle member 10, the inner cylinder member 20 is preferably made of a metal material such as stainless steel or a resin material, and is particularly preferably stainless steel from the viewpoint of rust resistance and ease of processing.

The inner cylinder member 20 preferably has an opening 21 extending to the distal end. In FIG. 10, an opening 21 is provided on the side of the inner cylinder member 20. As a result, the filamentous material 70 can be hung from the distal end of the inner cylinder member 20 to the opening 21.

By rotating the inner cylinder member 20 with respect to the needle member 10, the shape and size of the overlapping region of the entrance / exit portion 12 or the passage 13 of the needle member 10 and the opening 21 provided on the side portion of the inner cylinder member 20 are changed. can do. 11, FIG. 12, and FIG. 13 show states in which the inner cylinder member 20 is rotated by 0 degrees, 40 degrees, and 70 degrees with respect to the needle member 10, respectively. As shown in FIG. 11, when the inner cylinder member 20 is not rotated, that is, when the rotation angle is 0 degrees, the entrance / exit portion 12 or the passage 13 of the needle member 10 is formed so that the opening 21 of the inner cylinder member 20 overlaps. It is preferable that it is. The filamentous material 70 can be guided into the passage 13 from the distal side of the region where the entrance / exit portion 12 or the passage 13 and the opening 21 of the inner cylinder member 20 overlap.

As shown in FIG. 12, when the inner cylinder member 20 is rotated with respect to the needle member 10, a part of the entrance / exit portion 12 or the passage 13 of the needle member 10 is covered with the inner cylinder member 20, and the entrance / exit of the needle member 10 A part of the portion 12 and the passage 13 is narrowed. As a result, the thread-like object 70 can be held at the entrance / exit portion 12 of the needle member 10 or the narrowed portion of the passage 13.

As shown in FIG. 13, when the inner cylinder member 20 is further rotated with respect to the needle member 10, the region where the entrance / exit portion 12 or the passage 13 of the needle member 10 and the opening 21 of the inner cylinder member 20 overlap is further reduced. .. Since the entrance / exit portion 12 or the passage 13 of the needle member 10 is narrowed, the thread-like object 70 is sandwiched and held by the needle member 10 and the inner cylinder member 20.

To release the holding of the thread-like object 70, the rotation angle may be reduced by rotating the inner cylinder member 20 in the reverse direction with respect to the needle member 10.

In this example, an example is shown in which the thread-like object 70 is sandwiched between the needle member 10 and the inner cylinder member 20 by rotating the inner cylinder member 20 by 0 to 70 degrees, but the rotation angle is limited to this. Any angle may be used as long as it is larger than 0 degrees and smaller than 180 degrees, and more preferably 30 degrees or more and 90 degrees or less.

The inner cylinder member 20 preferably has an opening 21 as shown in FIG. 9 in order to easily hold and release the filamentous material 70 by rotating the inner cylinder member 20 with respect to the needle member 10. .. That is, the opening 21 of the inner cylinder member 20 has a distal region 21A, a proximal region 21B connected to the distal region 21A and proximal to the distal region 21A, and the inner cylinder member 20. The width of the distal region 21A in the circumferential direction is preferably smaller than the width of the proximal region 21B. As a result, when the inner cylinder member 20 is rotated with respect to the needle member 10, the distal region 21A of the inner cylinder member 20 is entirely covered by the needle member 10 before the proximal region 21B. Therefore, it is possible to prevent the filamentous material 70 existing in the proximal region 21B from passing through the entrance / exit portion 12 of the needle member 10 and coming out during rotation.

The shape of the opening 21 of the inner cylinder member 20 is not particularly limited as long as the thread-like object 70 can be inserted, and the opening 21 is viewed from the side and has a polygonal shape such as a triangle or a quadrangle, a circular shape, an elliptical shape, or a combination thereof. Can be. In FIG. 9, the opening 21 has a shape in which a rectangular distal region 21A and a rectangular proximal region 21B are combined.

The shape of the opening 21 of the inner cylinder member 20 may be a combination of a rectangular distal region 21A and a rectangular proximal region 21B as shown in FIG. 9 from the viewpoint of preventing the filamentous material from falling off. preferable. Further, from the viewpoint of ease of processing, one rectangular shape is preferable.

The number of openings 21 of the inner cylinder member 20 is preferably one or more, and more preferably two or more. In particular, the number of openings 21 of the inner cylinder member 20 is preferably the same as the number of openings of the needle member 10. When the needle member 10 has a twin peak shape, the number of openings 21 of the inner cylinder member 20 may be two in order to provide a region where the openings of the needle member 10 and the openings 21 of the inner cylinder member 20 overlap. preferable.

In order to prevent the filament 70 from being deformed or cut, it is preferable that the minimum diameter of the opening 21 of the inner cylinder member 20 is larger than the outer diameter of the filament 70.

Although not shown, the inner cylinder member 20 may be provided with a fixing portion in order to control the rotation angle of the inner cylinder member 20 with respect to the needle member 10. As the fixing portion, for example, a convex portion may be provided on the outside of the inner cylinder member 20, and a groove that engages with the convex portion of the inner cylinder member 20 may be provided on the inside of the needle member 10.

(Embodiment 2 of the needle mechanism)
The needle mechanism 2 (2B) according to the second embodiment will be described with reference to FIG. FIG. 14 shows a side view of the needle mechanism 2B, and FIG. 15 shows a side view showing a modified example of the needle mechanism 2B shown in FIG.

The needle mechanism 2B has a solid shape and has a needle member 10 (10B) provided with one distal end. The entrance / exit portion 12, the passage 13, and the terminal portion 14 are provided on the needle member 10. The entrance / exit portion 12 of the needle member 10 shown in FIG. 14 is provided on the proximal side of the distal end of the needle member 10. In this case, the entrance / exit portion 12 is preferably provided on the side portion of the needle member 10. As a result, the needle member 10 shown in FIG. 14 is provided with one distal end. The passage 13 extends along the radial direction of the needle member 10.

Even if the needle member 10 is in a solid state and the catching portion 15 is a portion (hereinafter, simply referred to as “protrusion”) that protrudes to narrow the entrance / exit portion 12 or the passage 13 of the needle mechanism 2B (needle member 10). good. In FIG. 14, the protrusion 16 projects toward the proximal side of the needle member 10, but may protrude toward the distal side of the needle member 10. The protrusion 16 preferably protrudes in a direction perpendicular to the extending direction of the passage 13. Since the filament 70 is held at the portion where the protrusion 16 is formed, the filament 70 is prevented from falling off.

The protrusion 16 preferably has a size of one-fifth or more of the size of the passage 13, more preferably one-fourth or more, still more preferably one-third or more.

The shape of the protrusion 16 can be formed, for example, into a polygonal columnar shape, a pyramid shape such as a cone shape or a pyramid shape, a truncated cone shape such as a truncated cone shape or a truncated cone shape, a hemispherical shape or a semi-elliptical spherical shape.

The protrusion 16 is formed in a rounded shape such as a truncated cone shape, a hemispherical shape, or a semi-elliptical spherical shape in order to prevent the filamentous object 70 from being damaged by contact with the filamentous object 70. preferable.

In FIG. 15, instead of the protrusion 16, a narrow portion 17 in which the passage 13 is narrowed is provided as the capture portion 15. In FIG. 15, the narrow portion 17 is provided on the end portion 14 side and the end portion 14 of the passage 13, but the narrow portion 17 is provided on at least one of the entrance / exit portion 12, the passage 13, and the end portion 14. It suffices if it is done.

The narrow portion 17 is formed in a staircase shape in FIG. 15, and the size of the passage 13 is sharply reduced, but the size is not limited to this, and a tapered shape that gradually shrinks may be adopted. ..

The size of the passage in the narrow portion 17 is preferably smaller than the outer diameter of the filamentous material 70. As a result, the thread-like object 70 can be sandwiched between the narrow portions 17 and firmly held, and the thread-like object 70 can be prevented from falling out of the passage 13.

As described above, by providing the needle member 10 with the protrusion 16 or the narrow portion 17 as the capturing portion 15, the needle member 10 alone does not need to be combined with other members as described in the first embodiment of the needle mechanism. The filamentous material 70 can be held and released.

(Embodiment 3 of the needle mechanism)
The needle mechanism 2 (2C) according to the third embodiment will be described with reference to FIG. FIG. 16 shows a side view of the needle mechanism 2C. The needle mechanism 2C is formed in a solid state and has a needle member 10 (10C) provided with two distal ends. In the solid needle member 10 shown in FIG. 16, the entrance / exit portion 12 is provided at the distal end of the needle member 10. The passage 13 extends along the axial direction of the needle member 10. Since the passage 13 can take a longer distance as compared with the second embodiment of the needle mechanism, the filamentous material 70 is less likely to fall off from the passage 13. The outer diameter of the distal end portion (puncture portion 11) of the needle member 10 decreases toward the distal end. The passage 13 is formed so as to pass through the axis C of the needle member 10, and the needle member 10 is provided with two distal ends.

In FIG. 16, the capturing portion 15 is a protrusion 16 (16A, 16B) protruding inward in the radial direction of the needle mechanism 2B (needle member 10). The protrusion 16A provided on the entrance / exit portion 12 side protrudes toward the lower side of the device 1, and the protrusion 16B provided on the terminal portion 14 side protrudes toward the upper side of the device 1. When a plurality of protrusions 16 are provided, it is preferable that the protrusions 16 are formed in opposite directions. As a result, the filamentous material 70 can be firmly held. In order to prevent the thread-like object 70 from falling out of the passage 13 unintentionally, at least one protrusion 16 may be provided in each of the entrance / exit portion 12 and the passage 13. Although not shown, a narrow portion may be provided instead of the protrusion.

(Embodiment 4 of the needle mechanism)
The needle mechanism 2 (2D) according to the fourth embodiment will be described with reference to FIGS. 17 to 18. FIG. 17 shows an enlarged perspective view of the distal side of the needle mechanism 2D, and FIG. 18 shows a side view of the needle mechanism 2D shown in FIG. The needle mechanism 2D has a needle member 10 (10D) in which a plurality of passages 13 having a shape extending in different directions are formed.

The passage 13 is a combination of a section 13A extending along the axial direction of the needle member 10 and a section 13B extending along the direction perpendicular to the axial direction of the needle member 10. By connecting the section 13B to the proximal end of the section 13A, the sections 13A and 13B communicate with each other. An entrance / exit portion 12 is provided on one side of the section 13B, and the other side of the section 13B is connected to one side of the section 13A. A terminal portion 14 is provided on the other side of the section 13A.

The thread-like object 70 can be held by moving the thread-like object 70 from the section 13B of the passage 13 of the needle member 10 to the section 13A. Further, by moving the thread-like object 70 from the section 13A to the section 13B of the passage 13 of the needle member 10, the holding of the thread-like object 70 can be released.

When the needle member 10 on which the filament 70 is hung is moved to the distal side, the filament 70 can be hooked on the connecting portion between the section 13A and the section 13B. On the other hand, when the needle member 10 is moved to the proximal side, the filamentous material 70 can be hooked on the distal end portion (that is, the end portion 14) of the section 13A. In FIGS. 17 to 18, one section 13A and one section 13B are provided, but the section 13A and the section 13B may be provided alone or in a plurality, respectively. Further, although the example in which the section 13B is connected to the proximal end of the section 13A is shown, the section 13B may be connected to the distal end of the section 13A.

The needle member 10 of the fourth embodiment of the needle mechanism may also be provided with protrusions and narrow portions as in the second and third embodiments of the needle mechanism. In particular, the section 13B in which the entrance / exit portion 12 is provided has a risk of the filamentous material 70 falling off as compared with the section 13A in which the terminal portion 14 is provided, so that the protrusion or the narrow portion may be provided in the section 13B. preferable. On the other hand, in order to smoothly guide the filamentous material 70 to the passage 13, the catching portion 15 may be provided in the section where the terminal portion 14 is provided.

(Embodiment 5 of the needle mechanism)
The needle mechanism 2 (2E) according to the fifth embodiment will be described with reference to FIGS. 19 to 22. FIG. 19 shows an enlarged perspective view of the distal side of the needle mechanism 2E according to the present invention, and FIG. 20 shows a front view of the needle mechanism 2E shown in FIG. 19 as viewed from the distal side. FIG. 22 shows a side view of the needle mechanism 2E shown in FIG. 19 as viewed from the first side surface and the second side surface, respectively. The needle mechanism 2 (2E) is solid and has a needle member 10 (10E) provided with four distal ends. The distal end of the needle member 10 has a larger passage toward the distal side. The passage 13 for fastening the filamentous material 70 is formed with four openings 18 when viewed from the side surface. As shown in FIG. 21, when viewed from the first side surface, the passage 13 of the needle member 10 has a constant size on the proximal side of the puncture portion 11. On the other hand, as shown in FIG. 22, when viewed from the second side surface, there is a narrow portion 17 in which the passage 13 is narrowed.

It is preferable that the first side surface and the second side surface are at positions different by 90 degrees when viewed from a direction perpendicular to the axial direction of the needle member 10.

In the so-called four-peak shape needle member 10 having four distal ends, it is preferable that the shapes of the openings 18 adjacent to each other in the circumferential direction are different. Further, in order to make it easier to hang the thread-like object 70, it is preferable that the shapes of the openings 18 facing each other with the axis C of the needle member 10 interposed therebetween are the same.

It is preferable that the minimum width of the opening 18A seen from the first side surface is larger than the minimum width of the opening 18B seen from the second side surface. By changing the opening 18 on which the filament 70 is hung, the strength of holding the filament 70 can be changed. For example, in suturing from the proximal side to the distal side where the filamentous material 70 is difficult to fall off from the needle member 10, the filamentous material 70 is hung on the opening 18A visible from the first side surface, and the filamentous material 70 falls off from the needle member 10. By using the opening 18B seen from the second side surface in the possible distal-to-proximal suture, it is possible to change the holding strength of the filament 70 according to the suturing direction. That is, as shown in FIG. 20, it is preferable that the passage 13 is formed in a cross shape when the needle member 10 is viewed from the distal side.

The needle member 10 shown in FIG. 21 can hold the thread-like object 70 in the opening 18A and move forward to the distal side by hanging the thread-like object 70 on the opening 18A seen from the first side surface. When the needle member 10 retracts to the proximal side, the holding of the filamentous material 70 is released. In order to wind the filament 70 around the needle member 10 to strengthen the holding, the needle member 10 may be rotated by a predetermined angle about the major axis direction before the needle member 10 is advanced. The needle member 10 shown in FIG. 22 can be retracted while holding the thread-like object 70 in the opening 18B by hanging the thread-like object 70 on the opening 18B on the proximal side when viewed from the second side surface. The filament 70 can be brought into contact with the distal end of the proximal opening 18B as viewed from the second side surface to hold the filament 70. At this time, if the narrow portion 17 is provided in the opening 18B viewed from the second side surface, the thread-like object 70 can be firmly held, so that the opening of the needle member 10 even if the needle member 10 is retracted. It becomes difficult for the filamentous material 70 to come off from 18. The holding of the filament 70 is released by pulling out the filament 70 from the side surface of the opening 18 or moving the filament 70 to the distal side of the opening 18. In order to wind the thread-like object 70 around the needle member 10 to strengthen the holding, the needle member 10 may be rotated by a predetermined angle about the major axis direction of the needle member 10 before the needle member 10 is retracted.

(Embodiment 6 of the needle mechanism)
The needle mechanism 2 (2F) according to the sixth embodiment will be described with reference to FIGS. 23 to 28. The needle mechanism 2F has a hollow member 22 (22F) and an interpolation member 25 (25F) provided inside the hollow member 22F and capable of advancing and retreating in the axial direction with respect to the hollow member 22F. 23 to 24 show a side view and a perspective view of the hollow member 22F on the distal side, respectively. 25 to 26 show a side view and a perspective view showing the distal side of the interpolation member 25F, respectively. 27 to 28 show side views (partially side views) of the needle mechanism 2F according to the sixth embodiment.

The passage 13, the entrance / exit 12 and the end portion 14 are provided in the hollow member 22F, the entrance / exit portion 12 is at the distal end of the hollow member 22F, and the capture portion 15 is the proximal end of the passage 13. Is preferable. By forming the catching portion 15 in this way, the thread-like object 70 can be held by the needle mechanism 2F. Further, by moving the interpolation member 25F forward and backward in the axial direction of the needle mechanism 2F, the holding of the thread-like object 70 can be released.

In the first embodiment, the needle mechanism 2A having the inner cylinder member 20 holds and releases the filamentous material 70 by rotating the inner cylinder member 20, whereas in the sixth embodiment, the passage 13 of the hollow member 22F. The difference is that the thread-like object 70 is held at the proximal end of the above, and the thread-like object 70 is released from the holding by the interpolation member 25F.

The passage 13 of the needle mechanism 2F shown in FIGS. 23 to 24 extends along the axial direction of the hollow member 22F. Therefore, by moving the hollow member 22F in the axial direction, the thread-like object 70 located in the passage 13 can be relatively moved. As shown in FIGS. 23 to 24, it is preferable that the passage 13 passes through the axis C of the hollow member 22F. As a result, the filamentous material 70 is stably held. Since the entrance / exit portion 12 is provided at the distal end of the hollow member 22F, it is easy to guide the thread-like object 70 into the passage 13 of the hollow member 22F even when the distal side cannot be seen under the endoscope.

It is preferable that a plurality of distal ends of the hollow member 22F are provided, and it is preferable that two of them are provided. In this case, it is more preferable that the distal end portion of the hollow member 22F has a shape that tapers toward the distal side (so-called twin peak shape). As shown in FIGS. 23 to 24, the outer diameter of the hollow member 22F may be constant. In that case, in order to facilitate the insertion of the filament 70 into the passage 13, it is preferable that the width of the passage 13 increases toward the distal side. Since the width of the passage 13 narrows toward the proximal side, the filamentous material 70 is held at the proximal end of the passage 13. That is, in the needle mechanism 2F shown in FIG. 27, the capturing portion 15 is composed of the proximal end portion of the passage 13.

As shown in FIG. 23, it is preferable that the passage 13 penetrates in the direction perpendicular to the axial direction of the hollow member 22F. As a result, the folded-back portion of the thread-like object 70 is likely to be formed on the distal side of the suture object, so that the thread-like object 70 can be easily held by the needle member 10 or the thread-like object holding member.

The shape of the passage is not particularly limited, and the passage may be narrowed by inclining in the axial direction, or may be narrowed by changing the width in a stepped manner. Further, when the passage is inclined in the axial direction, the inclination angle may be changed at a plurality of places, and the inclination angle may not be constant.

The interpolation member 25F is provided inside the hollow member 22F. The shape of the interpolation member 25F is preferably a solid shape such as a columnar or prismatic shape, or a hollow shape such as a cylindrical shape or a polygonal cylinder shape, and is a solid shape in order to increase the strength of the needle mechanism 2F. Is more preferable.

The shape of the tip of the interpolation member 25F is not particularly limited as long as the thread-like object 70 held by the trapping portion 15 can be pushed out to the distal side, but as shown in FIGS. It preferably has a sharp needle shape. In that case, the tip of the interpolation member 25F is preferably located at the outermost position in the radial direction of the interpolation member 25F. If the interpolation member 25F has a needle shape, the interpolation member 25F can easily puncture the suture target. When the suture target is punctured with the needle-shaped interpolation member 25F, puncture debris is generated from the suture target and is less likely to fall off as compared with the case where the suture target is punctured with the twin peak-shaped needle mechanism. Here, the removal of the puncture debris means that the cut portion of the suture target (for example, the dura mater) that is punctured, that is, cut off by the needle mechanism 2F is completely cut off from the suture target. If the puncture debris falls off near the thread-like object 70 and the needle mechanism 2F, it may hinder the movement of the needle mechanism 2F and the thread-like object 70 during the suturing operation. Therefore, it is better to puncture the suture target with the needle-shaped interpolation member 25F. It is advantageous.

In order to make the distal end of the interpolation member 25F into a needle shape, an inclined portion 26 may be provided at the distal end of the interpolation member 25F. The inclined portion 26 may have an inclination angle similar to that of a medical suture needle, and the inclined portion 26 has an inclination portion 26 of 5 degrees or more, 8 degrees or more, 10 degrees or more, and 15 with respect to the axial direction of the hollow member 22G. It is preferably inclined to a degree or less, or 20 degrees or less.

The hollow member 22F and the interpolation member 25F are preferably made of a metal material such as stainless steel or a resin material, similarly to the needle member 10 and the inner cylinder member 20 of the first to fifth embodiments.

A method of gripping the thread-like object 70 by the needle mechanism 2F will be described with reference to FIGS. 27 to 28. By arranging a part of the thread-like object 70 on the distal side of the needle mechanism 2F and moving the needle mechanism 2F to the distal side, the thread-like object 70 passes through the entrance / exit portion 12. Further, by moving the needle mechanism 2F to the distal side, the thread-like object 70 is made to enter the passage 13 as shown in FIG. 27, and the thread-like object 70 is press-fitted toward the terminal portion 14, so that the thread-like object 70 is press-fitted into the passage 13. The filament 70 can be held at the proximal end.
As a method of press-fitting the thread-like object 70 into the terminal portion 14, a method of fixing two points of the thread-like object 70 and moving the needle mechanism 2F so as to grip between the two points, or a method of moving the thread-like object 70 into the needle mechanism 2F. After inserting into the passage 13, a method of sandwiching the thread-like object 70 with the needle mechanism 2F, fixing one side, and pulling the other side can be mentioned.

To release the holding of the thread-like object 70, as shown in FIG. 28, the interpolation member 25F is moved to the distal side with respect to the needle mechanism 2F, and the thread-like object 70 is moved to the distal side at the tip of the insertion member 25F. It can be done by pushing it out. At this time, it is preferable that the interpolation member 25F is not rotated with respect to the hollow member 22F.

In the seventh to ninth embodiments described below, the needle mechanism 2 is provided in a hollow member 22 having an inclined portion 23 at the distal end portion and inside the hollow member 22, and is centered on the axis of the hollow member 22. It has an interpolating member 25 capable of performing at least one of a rotational movement and an axial movement of the hollow member 22, and the entrance / exit portion 12 is provided on the proximal side of the inclined portion 23. Here is an example. The inclined portion 23 can be configured in the same manner as the hollow member 22F described in the sixth embodiment of the needle mechanism. By providing the entrance / exit portion 12 on the proximal side of the inclined portion 23, the filamentous material 70 can be easily guided to the entrance / exit portion 12 along the side surface of the inclined portion 23, so that the filamentous material 70 can be easily held.

(Embodiment 7 of the needle mechanism)
The needle mechanism 2 (2G) according to the seventh embodiment will be described with reference to FIGS. 29 to 35. 29 to 30 show a side view and a perspective view of the hollow member 22G on the distal side. 31 to 32 show side views and perspective views showing the distal side of the interpolation member 25 (25G). 33 to 35 show side views (partial cross-sectional views) showing the distal side of the needle mechanism 2G.

A groove 24 is provided at the distal end of the hollow member 22G shown in FIGS. 29 to 30. The groove portion 24 of the hollow member 22G can form at least a part of the entrance / exit portion 12, the passage 13 and the terminal portion 14 for holding the filamentous material 70. For example, the entrance / exit portion 12 is provided on the distal side of the groove portion 24. Can be provided.

The depth of the groove 24 of the hollow member 22G is not particularly limited as long as it is at least the diameter of the thread-like object 70, but from the viewpoint of ease of processing, strength of the needle mechanism, and ease of holding the thread-like object 70. It is preferably equal to or less than the radius of the hollow member 22G. The width of the groove 24 of the hollow member 22G is not particularly limited as long as it is equal to or larger than the diameter of the filament 70, but is twice or more the diameter of the filament 70 or 3 from the viewpoint of ease of processing and the strength of the hollow member 22G. It is preferably more than double. Here, the depth of the groove 24 of the hollow member 22G refers to the length along the radial direction, and the width of the groove 24 refers to the length in the direction perpendicular to the axial direction when the groove 24 is viewed from above.

In the hollow member 22G, the groove 24 is formed by three inner walls, a bottom wall 24A, a distal side wall 24B, and a proximal side wall 24C. From the viewpoint of ease of manufacturing the hollow member 22G, it is preferable that the distal side wall 24B and the proximal side wall 24C are formed perpendicular to the axial direction of the needle mechanism 2G as shown in FIG. Further, it is preferable that the proximal side wall 24C is formed higher than the distal side wall 24B in the radial direction. This prevents the filamentous material 70 from unintentionally falling off from the proximal side of the needle mechanism 2G.

An inclined portion 23 is provided at the distal end portion of the hollow member 22G. In the seventh embodiment, the inclined portion 23 functions as a portion for puncturing the suture target. In the hollow member 22G, it is preferable that the inclined portion 23 is provided on the distal side of the groove portion 24. By arranging the inclined portion 23 and the groove portion 24 in this way, the thread-like object 70 can be easily guided to the groove portion 24 by aligning the thread-like object 70 with the side surface of the inclined portion 23, and the thread-like object 70 can be smoothly held. Further, the filamentous material 70 can be hung on the step between the proximal end of the inclined portion 23 and the distal end of the groove portion 24 (that is, the proximal side wall 24C constituting the groove portion 24).

The interpolation member 25G is provided inside the hollow member 22G, and is capable of at least one of a rotation operation about the axis of the hollow member 22G and an axial movement operation of the hollow member 22G. Is. By moving or rotating the interpolation member 25G in the axial direction with respect to the hollow member 22G, the passage 13 can be formed in the needle mechanism 2. Further, the width of the passage 13 and the entrance / exit portion 12 can be narrowed by adjusting the axial position and the rotation angle of the interpolation member 25G. That is, in the needle mechanism 2G shown in FIG. 33, the capturing portion 15 is composed of a hollow member 22G and an interpolation member 25G.

The shape of the interpolation member 25G can be the same as that of the interpolation member 25G described in the sixth embodiment, but from the viewpoint of ensuring the strength of the needle mechanism 2G and firmly holding the thread-like object 70, it is possible to form the interpolation member 25G. The shape of the interpolation member 25G is preferably solid.

A method of gripping the thread-like object 70 by the needle mechanism G will be described with reference to FIGS. 33 to 35. In the axial direction, the interpolation member 25G is moved to the proximal side of the groove 24 of the hollow member 22G. At this time, when the needle mechanism 2G is viewed from the distal side, it is preferable that the tip of the interpolation member 25G and the tip of the hollow member 22G are arranged so as to face each other with the axis C of the needle mechanism 2G interposed therebetween. This makes it easier to adjust the passage 13 and the entrance / exit portion 12 to an appropriate width that makes it easy to hold the thread-like object 70.

By arranging a part of the filamentous material 70 on the distal side of the needle mechanism 2G and moving the needle mechanism 2G to the distal side, a part of the filamentous material 70 is guided to the inclined portion 23 of the hollow member 22G. Then, it reaches the entrance / exit portion 12 formed by the groove portion 24. Further, by moving the hollow member 22G to the distal side, the filamentous material 70 enters the passage 13. Next, when the interpolation member 25G is moved to the distal side, the width of the passage 13 is narrowed by the inclined portion 27 of the interpolation member 25G. As shown in FIG. 33, the filament 70 can be held by sandwiching the filament 70 between the bottom wall 24A of the groove 24, the distal side wall 24B, and the inclined portion 27 of the interpolation member 25G.

As shown in FIG. 34, the holding of the filamentous material 70 can be released by moving the interpolation member 25G to the proximal side with respect to the hollow member 22G. Further, in order to easily hold and release the filamentous material 70, the interpolation member 25G is moved to the proximal side with respect to the hollow member 22G, and then the interpolation member 25G is rotated, and as shown in FIG. It is preferable to move the interpolation member 25G to the distal side again. As a result, the filamentous material 70 can be pushed out to the distal side by the inclined portion 26 of the interpolation member 25G. Instead of moving the interpolation member 25G to the proximal side with respect to the hollow member 22G, the interpolation member 25G may be rotated and the interpolation member 25G may be moved to the distal side again. When the thread-like object 70 is not pushed out by the interpolation member 25G and the holding of the thread-like object 70 is released by moving the entire suturing device or the like, the interpolation member 25G only holds the thread-like object 70. In that case, the filamentous material 70 can be held by only one of the rotational operation and the axial movement operation of the interpolation member 25G.

(Embodiment 8 of the needle mechanism)
The needle mechanism 2 (2H) according to the eighth embodiment will be described with reference to FIGS. 36 to 41. 36 to 37 show a side view and a perspective view of the hollow member 22 (22H) on the distal side, respectively. 38 to 39 show a side view and a perspective view of the insertion member 25H on the distal side, respectively. 40 to 41 show side views (partial cross-sectional views) showing the distal side of the needle mechanism 2H.

As shown in FIGS. 36 to 37, an inclined portion 23 is provided at the distal end portion of the hollow member 22H. The inclined portion 23 of the hollow member 22H functions as a portion for puncturing the suture target. As the configuration of the inclined portion 23, the configuration described in the seventh embodiment can be adopted.

As shown in FIGS. 38 to 39, it is preferable that the groove portion 27 is provided at the distal end portion of the interpolation member 25H. The groove portion 27 of the interpolation member 25H can form at least a part of the entrance / exit portion 12, the passage 13, and the terminal portion 14 for holding the filamentous material 70.

The depth of the groove 27 of the interpolation member 25H is not particularly limited as long as it is at least the diameter of the thread-like object 70, but from the viewpoint of ease of processing, strength of the needle mechanism, and ease of holding the thread-like object 70. It is preferable that the diameter is equal to or less than the radius of the hollow member 22H. The width of the groove 27 of the interpolating member 25H is not particularly limited as long as it is equal to or larger than the diameter of the thread-like object 70, but is three times or more the diameter of the thread-like object 70 or 5 from the viewpoint of ease of processing and strength of the needle mechanism. It is preferably 2 times or more, and preferably 8 times or less, or 10 times or less.

The groove 27 of the interpolation member 25H is formed by three inner walls, a bottom wall 27A, a distal side wall 27B, and a proximal side wall 27C. The distal side wall 27B and the proximal side wall 27C of the groove 27 may be formed perpendicular to the axial direction of the needle mechanism 2H as shown in FIG. 38, and may be inclined with respect to the axial direction of the needle mechanism 2H. It may be formed in.

It is preferable that the semi-cylindrical portion 28 is provided on the proximal side of the hollow member 22H with respect to the proximal end of the inclined portion 23. In a side view with the long axis of the hollow member 22H in the horizontal direction, the semi-cylindrical portion 28 is preferably a portion starting from the proximal end of the inclined portion 23. In the side view, the semi-cylindrical portion is preferably linear along the long axis of the hollow member 22H, and may be linear or curved so as to be inclined with respect to the axial direction. A passage 13 can be formed in the needle mechanism 2 by exposing the groove 27 of the interpolation member 25H and the distal portion from the groove 27 from the semi-cylindrical portion 28 of the hollow member 22H in the axial direction of the needle mechanism 2H. can. Here, the exposure means a state in which the groove portion 27 of the interpolation member 25H is arranged on the distal side from the proximal end of the semi-cylindrical portion 28, and the distal side wall 27B of the interpolation member 25H and the semi-cylindrical portion 28. This includes both cases where the proximal side wall 28C faces (FIG. 40) and where it does not (FIG. 41). Further, the width of the passage 13 and the entrance / exit portion 12 can be narrowed by adjusting the axial position and the rotation angle of the interpolation member 25H. That is, in the needle mechanism 2H, the catching portion 15 is composed of the hollow member 22H and the interpolation member 25H.

As shown in FIG. 39, the interpolation member 25H may have a flat portion 29 on the distal side. In that case, it is preferable that the flat portion 29 is provided with the groove portion 27. By rotating the interpolation member 25H with respect to the hollow member 22H, the passage 13 is not formed in the needle mechanism 2, so that the holding of the thread-like object 70 can be easily released.

The thickness of the flat portion 29 is preferably smaller than the maximum outer diameter of the interpolation member 25H, more preferably 3/4 or less, still more preferably two-thirds or less of the maximum outer diameter of the interpolation member 25H. The size is preferable. The thickness of the flat portion 29 may be constant in the axial direction of the interpolation member 25H or may decrease toward the distal end.

In the axial direction, the flat portion 29 of the interpolation member 25H preferably has a length of 28 or less of the semi-cylindrical portion 28 of the hollow member 22H. As a result, when the interpolation member 25H is rotated with respect to the hollow member 22H, the height at which the distal portion of the interpolation member 25H is exposed from the semi-cylindrical portion 28 is lower than that of the groove portion 27. Can be smoothly held and released. The exposed height is the distance between the plane parallel to the axial direction of the semi-cylindrical portion 28 and the point farthest from the plane parallel to the axial direction of the semi-cylindrical portion 28 among the exposed portions of the flat portion 29. That is. In order to reduce the height at which the distal portion of the interpolation member 25H is exposed from the semi-cylindrical portion 28, the distal side wall 27B of the interpolation member 25H and the proximal side wall 28C of the semi-cylindrical portion 28 are surfaced. Rotate the interpolating member so that it does not or the facing portion is made smaller.

A method of gripping the thread-like object 70 by the needle mechanism 2H will be described with reference to FIGS. 40 to 41. In the axial direction, the interpolation member 25H is moved proximal to the groove 24 of the hollow member 22H. Alternatively, the portion distal to the distal end of the groove 24 of the interpolation member 25H is arranged distal to the proximal end of the semi-cylindrical portion 28 of the hollow member 22H. At this time, the height at which the distal portion of the interpolation member 25H is exposed from the semi-cylindrical portion 28 is made as low as possible, and the interpolation member 25H is hollow so as to easily guide the filamentous material 70 to the semi-cylindrical portion 28. It is preferable to rotate the member 22H. That is, it is preferable to rotate the interpolating member 25H so that the depth direction of the groove portion 24 is parallel to the plane parallel to the axial direction of the semi-cylindrical portion 28.

By arranging a part of the filamentous material 70 on the distal side of the needle mechanism 2H and moving the needle mechanism 2H to the distal side, a part of the filamentous material 70 is guided to the inclined portion 23 of the hollow member 22H. The hollow member 22H is hooked on the proximal side wall 28C, which is a plane perpendicular to the axial direction at the proximal end of the semi-cylindrical portion 28. Next, when the interpolation member 25H is rotated with respect to the hollow member 22H so that the height at which the distal portion is exposed from the semi-cylindrical portion 28 is higher than the groove portion of the interpolation member 25H, the interpolation member 22H and the interpolation member 22H are inserted. The passage 13 is formed by the member 25H. That is, when the depth direction of the groove 24 of the interpolation member 25H is rotated so as to be perpendicular to the plane parallel to the axial direction of the semi-cylindrical portion 28, the passage 13 is formed by the hollow member 22H and the interpolation member 25H. NS. Further, when the hollow member 22H is moved to the distal side, the width of the passage 13 is narrowed. As shown in FIG. 40, the filament 70 is held by sandwiching the filament 70 between the distal side wall 27B of the groove 27 of the interpolation member 25H and the proximal side wall 28C of the semi-cylindrical portion 28 of the hollow member 22H. can do.

As shown in FIG. 41, when the interpolation member 25H is rotated with respect to the hollow member 22H to lower the height at which the distal portion of the interpolation member 25H is exposed from the semi-cylindrical portion 28 with respect to the groove portion 27, the filamentous material is formed. The 70 is released from the needle mechanism 2H. That is, when the depth direction of the groove portion 24 of the interpolation member 25H is rotated so as to be parallel to the plane parallel to the axial direction of the semi-cylindrical portion 28, the thread-like object 70 is released from the needle mechanism 2H.

(Embodiment 9 of the needle mechanism)
The needle mechanism 2 (2I) according to the ninth embodiment will be described with reference to FIGS. 42 to 47. The needle mechanism 2 (2I) has a hollow member 22 (22I) and an interpolation member 25 (25I) provided inside the hollow member 22I. Grooves 24 and 27 are provided in the hollow member 22I and the interpolation member 25I, respectively. 42 to 43 show a side view and a perspective view of the hollow member 22I on the distal side, respectively. FIG. 44 shows a perspective view of the insertion member 25I on the distal side. 45 to 47 show an enlarged side view (partial cross-sectional view) of the distal side of the needle mechanism 2 (2I) according to the ninth embodiment.

As shown in FIGS. 42 to 43, an inclined portion 23 is provided at the distal end portion of the hollow member 22I. Further, as shown in FIG. 44, an inclined portion 26 is also provided at the distal end portion of the interpolation member 25I. As the configuration of the inclined portion 23 of the hollow member 22I and the inclined portion 26 of the interpolation member 25I, the configuration described in the seventh embodiment can be adopted.

In the axial direction, the length of the inclined portion 23 of the hollow member 22I and the length of the inclined portion 26 of the interpolation member 25I may be the same or different. At least one of the inclined portions 23 and 26 may function as a portion to puncture the suture object. In FIGS. 45 to 47, the inclined portion 23 of the hollow member 22I is formed to be longer in the axial direction than the inclined portion 26 of the interpolation member 25I.

Further, the inclined portion 23 of the hollow member 22I and the inclined portion 26 of the interpolation member 25I may have the same inclination angle or different inclination angles. These tilt angles may be, for example, 45 degrees or more, 60 degrees or more, 70 degrees or more, 85 degrees or less, or 80 degrees or less. 45 to 47 show an example in which the inclination angle of the inclined portion 23 is smaller than the inclination angle of the inclined portion 26.

In the seventh to eighth embodiments, the groove portion is provided in either the hollow member 22 or the interpolation member 25, whereas in the ninth embodiment, the groove portion 24 is provided in both the hollow member 22I and the interpolation member 25I, respectively. , 27 are provided. Further, in the seventh to eighth embodiments, the proximal side walls (24C, 27C) and the distal side walls (24B, 27B) of the grooves 24, 27 of the hollow member 22I or the interpolation member 25I are arranged with respect to the axial direction of the needle mechanism 2. However, in the ninth embodiment, the side wall forming the groove is formed so as to be inclined with respect to the axial direction of the needle mechanism 2.

The depth and width of the groove 24 of the hollow member 22I can be set in the same manner as the hollow member 22I of the seventh embodiment. Further, the depth and width of the groove portion 27 of the interpolation member 25I can be set in the same manner as the interpolation member 25I of the eighth embodiment.

It is preferable that at least one of the distal side wall 24B and the proximal side wall 24C constituting the groove portion 24 of the hollow member 22I is inclined with respect to the axial direction. Further, it is preferable that at least one of the distal side wall 27B and the proximal side wall 27C of the groove 27 of the interpolation member 25I is inclined with respect to the axial direction. By inclining the inner wall of the groove portion of the hollow member 22I or the interpolation member 25I in this way, it becomes easy to hold and release the filamentous material 70.

In the hollow member 22I, it is preferable that either one of the distal side wall 24B and the proximal side wall 24C of the groove portion 24 is inclined in the axial direction and the other is perpendicular to the axial direction. Similarly, in the interpolation member 25I, it is preferable that either one of the distal side wall 27B and the proximal side wall 27C of the groove 27 is inclined in the axial direction and the other is perpendicular to the axial direction. By adjusting the inclination angles of the distal side wall and the proximal side wall of the groove portion in this way, it becomes easy to hold and release the filamentous material 70.

As shown in FIGS. 45 to 47, the distal side wall 24B of the groove 24 of the hollow member 22I is inclined to the distal side with respect to the axial direction, and the proximal side wall 27C of the groove 27 of the interpolation member 25I is the axis. It is preferably inclined to the proximal side with respect to the direction. In that case, it is preferable that the proximal side wall 24C of the groove 24 of the hollow member 22I and the distal side wall 27B of the groove 27 of the interpolation member 25I are formed perpendicular to the axial direction, respectively. The filament 70 is sandwiched between the proximal side wall 24C of the groove 24 of the opposing hollow member 22I and the distal side wall 27C of the groove 27 of the interpolation member 25I, that is, two side walls formed perpendicular to the axial direction. If it is held, it is possible to prevent the filamentous material 70 from falling off from the needle mechanism 2I. On the other hand, the width of the passage 13 is widened by the distal side wall 24B of the groove 24 of the opposing hollow member 22I and the proximal side wall 27C of the groove 27 of the interpolation member 25I, that is, the two side walls inclined in the axial direction. Narrows inward in the radial direction. Therefore, the thread-like object 70 is easily pushed out in the radial direction, and the thread-like object 70 is easily held and released from the needle mechanism 2I. By adjusting the axial position and rotation angle of the interpolation member 25I with respect to the hollow member 22I, the width of the passage 13 and the entrance / exit portion 12 can be narrowed. That is, also in the needle mechanism 2I, the catching portion 15 is composed of the hollow member 22I and the interpolation member 25I.

A method of holding and releasing the thread-like object 70 by the needle mechanism 2I will be described with reference to FIGS. 45 to 47. The groove portion 24 of the hollow member 22I and the groove portion 27 of the interpolation member 25I are arranged so as to overlap each other in the axial direction and the circumferential direction.

By arranging a part of the thread-like object 70 on the distal side of the needle mechanism 2I and moving the needle mechanism 2I to the distal side, a part of the thread-like object 70 is guided to the inclined portion of the hollow member 22I. , It reaches the entrance / exit portion 12 composed of the groove portion 24 of the hollow member 22I and the groove portion 27 of the interpolation member 25. Further, by moving the hollow member 22I to the distal side, as shown in FIG. 45, the filamentous material 70 enters the passage 13 composed of the groove portion 24 of the hollow member 22I and the groove portion 27 of the interpolation member 25I. Next, the interpolation member 25I is moved proximal to the hollow member 22I. As shown in FIG. 46, the filament 70 can be held by sandwiching the filament 70 between the proximal side wall 24C of the groove 24 of the hollow member 22I and the distal side wall 27B of the groove 27 of the interpolation member 25I.

As shown in FIG. 47, when the interpolation member 25I is moved to the distal side with respect to the hollow member 22I, the distal side wall 24B of the groove 24 of the inclined hollow member 22I and the groove 27 of the interpolation member 25I The width of the passage 13 formed by the proximal side wall 27C of the above is narrowed, and the filament 70 is pushed out of the needle mechanism 2I. In this way, the holding of the filamentous material 70 can be released.

In the sixth embodiment of the needle mechanism, a configuration example in which the entrance / exit portion 12, the passage 13 and the terminal portion 14 are formed in the hollow member 22 is shown. Further, in the 7th to 9th embodiments of the needle mechanism, a configuration example in which the entrance / exit portion 12, the passage 13 and the terminal portion 14 are formed by the hollow member 22 and the interpolation member 25 is shown. Although not shown, the interpolation member 25 may be formed with an entrance / exit portion 12, a passage 13, and a terminal portion 14. In any aspect, the filamentous material 70 can be held and released.

(2) Thread-like object holding member The thread-like object holding member is a member provided to hold the thread-like object 70 on the distal side of the object to be sewn. The thread-like object holding member may have a mechanism capable of holding and releasing the thread-like object 70. For example, a mechanism (not shown) having a slit for hanging the thread-like object 70 and a stopper for preventing the thread-like object 70 from falling out from the slit, a plurality of arms arranged in a circle gather in the diameter reduction direction, or the diameter is expanded. A mechanism for holding and releasing the thread-like object 70 by spreading in a direction (not shown), a mechanism for pressing the thread-like object 70, a mechanism for hanging the thread-like object 70, and the like.

The material of the thread-like material holding member is preferably biocompatible, more preferably a metal material such as stainless steel or a resin material, and stainless steel from the viewpoint of rust resistance and ease of processing. Is more preferable.

First, an example in which the thread-like object 70 is held by rotating the thread-like object holding member to hold and release the thread-like object 70 will be described. The thread-like material holding member contacts and holds the thread-like material by hooking the thread-like material on the thread-like material holding member or pressing the thread-like material against an insertion portion described later. FIG. 48 shows a perspective view of the filamentous material holding member according to the present invention, and FIGS. 49 to 50 show a perspective view when the filamentous material holding member is incorporated in the apparatus.

The thread-like object holding member 30 (30A) shown in FIG. 48 is provided on one side of a rotating shaft 31 having a first direction (described later) as an axis and the rotating shaft 31, and is provided with an operation unit (third operation). It has a fixing portion 32 that is directly or indirectly connected to the portion) and a pressing portion 33 that is provided on the other side of the rotating shaft 31 and holds the filamentous material 70.

The filament holding member 30A is provided on the distal side of the device 1 (housing 50). The housing 50 is formed in a shape capable of holding the thread-like material holding member 30A. The thread-like object holding member 30A is arranged so that the axial direction of the rotating shaft 31 is perpendicular to the axial direction of the needle mechanism 2. In the following, the needle mechanism 2 will be described with reference to a configuration example in which the needle member 10 and the inner cylinder member 20 are provided. However, the mode of the needle mechanism 2 is not limited to this, and various modes described above are adopted. can do.

The fixing portion 32 provided on one side of the rotating shaft 31 is connected to the operating portion (not shown) on the hand side via the connecting member 40. The connection between the fixing portion 32 and the connecting member 40 is, for example, mechanical fixing by fitting, screwing, caulking or the like, welding by laser or metal brazing, polyurethane-based, epoxy-based, cyano-based, silicone-based adhesive or the like. A method such as bonding using the above can be used. The shape of the connecting member 40 is not particularly limited as long as it extends in the perspective direction of the device 1, and may be a plate-shaped member as shown in FIGS. 49 to 50, and may be a linear member such as a wire. Or a rod-shaped member may be used. The thread-like object holding member 30A and the connecting member 40 are arranged below the needle mechanism 2, but may be arranged above the needle mechanism 2. Further, in FIGS. 49 to 50, although the thread-like object holding member 30A and the connecting member 40 are held inside the housing 50, they may be provided outside the housing 50.

The pressing portion 33 can be formed in a plate shape or a lump shape, for example, but is preferably formed in a plate shape from the viewpoint of weight reduction.

The plate-shaped pressing portion 33 has a first main surface 33A that is most likely to come into contact with the thread-like object 70, a second main surface 33B on the opposite side thereof, and a side surface 33C. The surface of the pressing portion 33 may be flat or may be provided with irregularities. In order to prevent the filament 70 from falling off from the filament holding member 30, it is preferable that the first main surface 33A and / or the side surface 33C of the pressing portion 33 is provided with irregularities. Alternatively, the thread-like object holding member 30, preferably the pressing portion 33, may be provided with a groove or a protrusion for holding the thread-like object 70.

The operation of the thread-like object holding member 30A will be described with reference to FIGS. 49 to 50. In FIG. 49, in which the connecting member 40 connecting the thread-like object holding member 30 and the operating portion is moved to the distal side, the fixing portion 32 is arranged on the distal side of the rotating shaft 31 and is located on the proximal side. The holding portion 33 is arranged. In the vertical direction of the device 1, the pressing portion 33 is arranged between the needle mechanism 2 and the connecting member 40. In the thread-like object holding member 30A, the first main surface 33A of the pressing portion 33 faces the needle mechanism 2 side, and the second main surface 33B faces the connecting member 40 side. When the operation unit is operated to move the connecting member 40 to the proximal side, the fixing portion 32 connected to the connecting member 40 moves to the proximal side around the rotation shaft 31. Then, the pressing portion 33 rotates about the rotation shaft 31, so that the first main surface 33A of the pressing portion 33 faces the distal side and the second main surface 33B faces the proximal side as shown in FIG. Be placed.

It is preferable that the distal end portion of the housing 50 is provided with an insertion portion 51 through which at least the distal end portion of the needle mechanism 2 of the housing 50 is inserted. When the thread-like object 70 is moved to the distal side of the suture object by using the needle mechanism 2, the thread-like object 70 is folded back in the axial direction of the needle mechanism 2 along the shape of the insertion portion 51 of the housing 50. A midway portion (folded portion 71) is arranged. At the location where the filament 70 is in contact with the wall surface of the insertion portion 51 due to tension, the filament 70 is stretched in the direction of pushing the wall surface. As a result, the folded-back portion 71 can be accommodated in the insertion portion 51, and it is possible to prevent the filamentous material 70 from moving in an unintended direction and becoming difficult to hold. The size of the insertion portion 51 may be larger than the outer diameter of the needle mechanism 2, but in order to firmly hold the thread-like object 70 by the thread-like object holding member 30, the maximum size of the holding portion 33 of the thread-like object holding member 30 is reached. The outer diameter is preferably 80% or more, more preferably 90% or more of the size of the insertion portion 51. Here, the size of the insertion portion 51 means the maximum diameter in the cross section perpendicular to the extending direction of the insertion portion 51.

In order to firmly hold the filament 70 by the filament holding member 30A, in a state where the filament 70 is held by the filament holding member 30A, the side surface 33C and the insertion portion 51 of the holding portion 33 of the filament holding member 30A It is preferable to sandwich the filamentous material 70.

The extending direction of the rotating shaft 31 provided on the thread-like object holding member 30A is not particularly limited, but the passage 13 penetrates in one direction (M direction) perpendicular to the axial direction (L direction) of the needle mechanism 2. The thread-like object holding member 30A is axially oriented in a first direction other than the direction perpendicular to the two directions (the L direction) of the needle mechanism 2 and the penetrating direction (M direction) of the passage 13. It is preferable to rotate as. FIG. 51 is a perspective view showing a direction perpendicular to the axial direction of the needle mechanism 2 and the penetrating direction of the passage 13. The portion of the thread-like object 70 that remains in the passage 13 of the needle mechanism 2 is the object to be sutured 100 when the needle mechanism 2 is released from the holding by the needle mechanism 2 and the needle mechanism 2 is moved from the proximal side to the distal side. On the distal side of the needle mechanism, it tends to extend along the virtual plane VP formed by the axial direction (L direction) of the needle mechanism and the penetrating direction (M direction) of the passage. When the thread-like object holding member 30A is rotated in the B direction, for example, with the direction (A direction) perpendicular to the virtual plane VP entering the passage 13 of the needle mechanism 2 as an axis, the holding portion 33 of the thread-like object holding member 30A becomes the thread-like object 70. This is because the pressing portion 33 is less likely to come into contact with the thread-like object 70 because it moves substantially along the extending direction of the.

In order to facilitate holding the thread-like object 70 on the distal side of the suture object 100, as shown in FIGS. 49 to 50, the first direction, which is the rotation axis 31 of the thread-like object holding member 30A, is the needle mechanism 2. It is preferable that it is perpendicular to the axial direction (L direction) of the above and is also perpendicular to the above-mentioned A direction. That is, it is preferable that the first direction is the penetrating direction of the passage 13.

The shape of the thread-like object holding member 30A is not limited as long as the thread-like object 70 can be held and released by rotating the thread-like object holding member 30A. 52 to 53 show perspective views of the device using the filamentous material holding member of another aspect. In order to make it easier to visually recognize the movement of the thread-like object holding member, the thread-like object is omitted in FIGS. 52 to 53. For example, in FIGS. 48, 49, and 50, the fixing portion 32 is provided on one side of the rotating shaft 31 and the pressing portion 33 is provided on the other side, but the present invention is not limited to this. For example, as shown in FIGS. 52 and 53, the thread-like object holding member 30 (30B) has a pressing portion 33 for pressing the thread-like object and a rotating shaft 31 for rotating the pressing portion 33, and the pressing portion 33 has a pressing portion 33. It may have a fixed portion 32 that is directly or indirectly connected to the operating portion. In this case, it is preferable that the pressing portion 33 has a plate shape, and the fixing portion 32 for fixing the distal end portion of the connecting member 40 is provided on the second main surface 33B of the pressing portion 33. In FIGS. 52 to 53, a bent-shaped connecting member 40 (40A) is fixed to the second main surface 33B of the pressing portion 33. On the other hand, the connecting member 40C is connected and fixed to the operation unit, and the connecting member 40A and the connecting member 40B connected to the connecting member 40A and 40C are rotated via the rivet 41. The shape and number of the connecting members 40 are not particularly limited as long as the holding portion can be rotated. The method of connecting between the connecting members 40A, 40B and 40C, the method of fixing the second main surface 33B of the connecting member 40 and the holding portion 33, and the method of connecting the connecting member 40 and the operating portion are as described above. It is not limited, and can be selected from rivets, connections using screws and nuts, welding, fixing using adhesives, and the like. As shown in FIG. 52, in a state where the connecting member 40 is moved to the proximal side, the fixing portion 32 and the pressing portion 33 are arranged on the proximal side of the rotating shaft 31. In the thread-like object holding member 30B, the first main surface 33A of the pressing portion 33 faces the side surface of the needle mechanism 2 (upper side of the device 1), and the second main surface 33B faces the lower side of the device 1. When the operation unit is operated to move the connecting member 40 to the distal side as shown in FIG. 53, the fixing portion 32 connected to the connecting member 40 about the rotation shaft 31 moves to the distal side. Then, the pressing portion 33 rotates about the rotation shaft 31, and is arranged so that the first main surface 33A of the pressing portion 33 faces the distal side and the second main surface 33B faces the proximal side.

Similar to the needle mechanism 2, the material of the thread-like material holding member 30 is preferably, for example, a metal material such as stainless steel or a resin material, and particularly preferably stainless steel from the viewpoint of rust resistance and ease of processing.

The shape of the thread-like object holding member that holds the thread-like object 70 by the rotation operation is not limited to the mode shown in FIGS. 48 to 53. 54 to 55 show perspective views of the device using the filamentous material holding member of still another aspect. For example, as shown in FIGS. 54 to 55, the thread-like object holding member 30 (30C) is provided on one side of the rotating shaft 31 and the rotating shaft 31, and is directly or indirectly connected to the operating portion. It may have a fixed portion (not shown) and a pressing portion 33 provided on the other side of the rotating shaft 31 to press the thread-like object 70. The pressing portion 33 has a flat surface including the axial direction of the rotating shaft 31. In this case, it is preferable that the proximal end of the rotating shaft 31 is connected to the operating portion.

As shown in FIGS. 54 to 55, the first direction A of the rotating shaft 31 may be parallel to the axial direction of the needle mechanism 2. The pressing portion 33 is provided at the distal end portion of the rotating shaft 31. The pressing portion 33 is formed in a plate shape, and has a side surface connecting the first main surface 33A, the second main surface 33B on the opposite side of the first main surface 33A, and the first main surface 33A and the second main surface 33B. It has 33C. In FIG. 54, the first main surface 33A of the pressing portion 33 faces the needle mechanism 2 side (upper side of the device 1), and the second main surface 33B faces the lower side of the device 1.

As shown in FIG. 55, when the rotation shaft 31 of the thread-like object holding member is rotated clockwise (clockwise) when viewed from the proximal side, the first main surface 33A of the holding portion 33 becomes the folded-back portion 71 of the thread-like object 70. Contact. Therefore, the thread-like material 70 can be held by sandwiching it between the pressing portion 33 and the wall of the insertion passage.

In FIGS. 54 to 55, the rotating shaft 31 extends in the perspective direction of the device 1, but the rotating shaft 31 is provided only at the distal end of the device 1, and the rotating shaft 31 is provided via another member. It may be connected to the operation unit.

An example of holding and releasing the thread-like object 70 by sliding the thread-like object holding member will be described with reference to FIGS. 56 to 57. 56 to 57 show a perspective view of the device 1 using the filamentous material holding member of still another aspect.

As shown in FIGS. 56 to 57, the thread-like object holding member 30 (30D) hangs a fixing portion 32 (not shown) directly or indirectly connected to the operation portion and an intermediate portion of the thread-like object 70. It may have a hook portion 34. Since it is not necessary to provide a rotation mechanism, the device 1 can be configured more simply. It is preferable that the thread-like object holding member 30 slides in a direction perpendicular to the axial direction of the needle mechanism 2 to hang the middle portion (folded portion 71) of the thread-like object 70. As a result, the thread-like object 70 can be easily hooked and held on the distal side of the suture object 100 even in a situation where the distal side cannot be seen under the endoscope.

The thread-like object holding member 30 is formed in a rod shape extending in the perspective direction of the device 1, and is held in the hollow portion 52 of the housing 50. At the distal end of the filament holding member 30, a hooking portion 34 for hooking the folded-back portion 71, which is an intermediate portion of the filament 70, is provided. The hollow portion 52 of the housing 50 extends in the perspective direction as a whole, and at the distal end portion, the hollow portion 52 is bent in a direction perpendicular to the axial direction of the needle mechanism 2. In FIGS. 56 to 57, the thread-like material holding member 30 is formed of an elastic material. Therefore, when the operation portion is operated to move the filament holding member 30 to the distal side, the hook portion 34 bends along the shape of the hollow portion 52 of the housing 50 as shown in FIG. 57, and the filament is formed. The middle part (folded part 71) of 70 can be hooked.

Although FIGS. 56 to 57 have been described with reference to an example in which the thread-like object holding member 30 has a rod shape extending over the entire perspective direction of the device 1 and is connected to the operating portion at the proximal end. , May be connected to the operation unit via another member. Further, the separate member may extend in the perspective direction of the device 1, and the filamentous material holding member 30 formed of an elastic material may be provided at the distal end of the separate member.

The hook portion 34 of the thread-like object holding member 30D is preferably formed of an elastic material. As the elastic material, for example, an organic material such as silicone rubber or a polyamide elastomer, or a metal material such as stainless steel can be used. As the thread-like material holding member 30D, an elastic wire, a stranded wire, or the like can also be used.

(3) Housing The housing 50 is for arranging at least a part of the thread-like material holding member 30 inside, and suppresses direct contact between each member and a living tissue. The housing 50 extends in the perspective direction.

The length of the housing 50 in the perspective direction can be adjusted according to the distance from the user's hand to the suture object 100, but when used for TSS, the length of the housing 50 in the perspective direction is, for example, It can be 5 cm or more and 50 cm or less.

As shown in FIGS. 1 and 2, it is preferable that the housing 50 has a handle portion 53 that the user grips by hand on the proximal side. The length from the distal end of the housing 50 to the handle portion 53 may be set with the distance from the operator's hand side to the suture position as a guide, and can be set to, for example, 10 cm or more and 80 cm or less. The TSS may be set with reference to the distance from the pituitary gland to the nostrils, and is preferably 20 cm or more and 50 cm or less, for example.

The material of the housing 50 is more preferably a metal material such as stainless steel or a resin material, similarly to the thread-like material holding member 30.

(4) Positional relationship between the needle mechanism and the thread-like object holding member In order to prevent the suture object 100 such as a living tissue from being inadvertently damaged, the distal end of the needle mechanism 2 is located proximal to the thread-like object holding member 30. The suture object 100 is placed between the needle mechanism 2 and the thread-like object holding member 30 in a state of being moved to. The separation distance from the distal end of the needle mechanism 2 to the proximal end of the thread-like object holding member 30 needs to be larger than the thickness of the suture object 100 in the perspective direction of the device 1. When used for TSS, the separation distance from the distal end of the needle mechanism 2 to the proximal end of the filamentous material holding member 30 in the state where the needle mechanism 2 is moved to the most proximal side is, for example, 0.5 mm. It can be set to 10 mm or more and 10 mm or less. On the other hand, when the needle mechanism 2 is moved to the most distal side, the separation distance from the distal end of the needle mechanism 2 to the distal end of the thread-like object holding member 30 is the distance between the suture target 100 on the distal side of the device 1. It is preferably within 10 mm, for example, in order to prevent inadvertent damage to living tissues other than the above.

(5) Operation Unit The present invention includes a device 1 which is connected to the proximal side of the needle mechanism 2 and is provided with a first operation unit 61 for moving the needle mechanism 2 in the perspective direction. 1 and 2 show an example of a lever when the first operation unit 61 pulls the lever to the proximal side, the needle mechanism 2 moves to the distal side, and when the lever is returned to the distal side, the needle mechanism 2 Is designed to move to the proximal side.

When the needle mechanism 2 has a plurality of members, one member may be connected to the first operation unit 61, and the other member may be connected to the second operation unit. For example, as shown in FIG. 10, when the thread-like object 70 is held by the needle mechanism 2 having the hollow needle member 10 and the inner cylinder member 20 arranged inside the needle member 10, the needle member 10 may be connected to the first operation unit 61. In that case, it is preferable that the device 1 is provided with a second operation unit that rotates the inner cylinder member 20 or moves the inner cylinder member 20 in the perspective direction with respect to the needle member 10.

The first operation unit 61 may also serve as the function of the second operation unit. That is, the first operation unit 61 may be connected to both a plurality of members, for example, the needle member 10 and the inner cylinder member 20. As a result, both the operation of moving the needle member 10 in the perspective direction and the operation of rotating or moving the inner cylinder member 20 can be performed by the first operation unit 61.

The present invention includes a device 1 which is connected to a thread-like object holding member 30 and is provided with a third operation unit 63 for holding and releasing the thread-like object 70. By pulling the third operation unit 63 toward the proximal side, the filamentous material 70 can be held or released.

Various input means can be used as the first operation unit 61 to the third operation unit 63, and for example, a trigger (lever), a slider, a dial (rotating body including a gear), a button, and the like can be used. Further, an input on / off operation and an input amount adjustment may be performed using a motor or an electronic component, the operation unit may be operated by a robot hand, or the operation unit may be installed outside the housing.

When the same type of input means is used as the first operation unit 61 to the third operation unit 63, it is preferable that the user can easily grasp which operation unit is at hand. For example, when both the first operation unit 61 and the third operation unit 63 are levers, the length of the lever of the first operation unit 61 can be made shorter than the length of the lever of the third operation unit 63. It is preferable that the first operation unit 61 is provided on the proximal side of the third operation unit 63 in order to match the operation feeling of the user with the actual arrangement of the members in the device 1.

2. Acting method of the medical bidirectional sewing device The operating method of the medical bidirectional sewing device of the present invention is a medical bidirectional sewing device having a perspective direction, which extends in the perspective direction and has a distal tip. It has a needle mechanism on the side and a thread-like material holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism is provided on one side of the passage through which the thread-like material passes and on one side of the passage. A step of preparing a medical bidirectional suturing device having a doorway, a terminal portion provided on the other side of the passage, and a catching part for narrowing the passage or the doorway, and a catching part of the needle mechanism hold the filament. A step of moving the needle mechanism to the distal side to move the filament to the distal side of the object to be sewn, a step of releasing the holding of the filament by the catching portion of the needle mechanism, and a step of the needle mechanism. It is characterized by having a step of moving the distal end to the proximal side of the object to be sewn, and a step of holding the thread by the thread-like object holding member on the side distal to the object to be sewn.

Further, the method of operating the medical bidirectional suturing device of the present invention is a medical bidirectional suturing device having a perspective direction, a needle mechanism extending in the perspective direction and having a tip on the distal side. It has a thread-like material holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism has a passage through which the thread-like material passes, an entrance / exit provided on one side of the passage, and the other side of the passage. A step of preparing a medical bidirectional suturing device having a terminal portion provided on the side and a catching portion for narrowing a passage or an entrance / exit, and a needle mechanism in a state where the filamentous material is not held by the filamentous material holding member. A step of moving the needle mechanism to the distal side of the object to be sewn, a step of holding the filament by the catching portion of the needle mechanism, and a step of moving the distal end of the needle mechanism to the proximal side of the stitched object. It is characterized by having.

Further, the method of operating the medical bidirectional suture device of the present invention is a medical bidirectional suture device having a perspective direction, a needle mechanism extending in the perspective direction and having a tip on the distal side. It has a thread-like material holding member provided on the distal side of the medical bidirectional suturing device, and the needle mechanism includes a passage through which the thread-like material passes, an entrance / exit portion provided on one side of the passage, and the needle mechanism. A step of preparing a medical bidirectional suturing device having a terminal portion provided on the other side of the passage and a catching portion for narrowing the passage or the entrance / exit portion, and a step of exchanging the needle mechanism with another needle mechanism. It is characterized by having.

Hereinafter, the operation method of the above device will be described in detail with reference to FIGS. 58 to 69. 58 to 69 show explanatory views of the operation method of the suturing device. Each member constituting the device is as described in "1. Medical bidirectional suturing device" in this specification.

(1) Preparation of device First, a medical bidirectional suture device having a perspective direction, a needle mechanism 2 extending in the perspective direction and having a puncture portion 11 on the distal side, and a distal suture device. A medical bidirectional suturing device 1 having a thread-like material holding member 30 provided on the side is prepared (step S1). The needle mechanism 2 includes a passage 13 through which the filament 70 passes, an entrance / exit 12 provided on one side of the passage 13, a terminal 14 provided on the other side of the passage 13, and a catching portion that narrows the passage 13 or the entrance / exit 12. It has 15 and. Hereinafter, the needle mechanism 2 will be described with reference to an example of the needle member 10 in which the inner cylinder member 20 is arranged inside, but the mode of the needle mechanism 2 is not limited to this.

(2) Suture from Proximal Side to Distal Side As shown in FIG. 58, the thread-like object 70 is held by the trapping portion 15 of the needle mechanism 2 (step S2). Specifically, the middle portion of the thread-like object 70 is inserted into the passage 13 from the entrance / exit portion 12 of the needle mechanism 2, and the thread-like object 70 is held by the catching portion 15. Then, the thread-like object 70 can be kept in the passage 13 in a state of being folded back in the axial direction of the needle mechanism 2. In FIG. 58, the inner cylinder member 20 arranged inside the hollow needle member 10 functions as the catching portion 15. The distal end of the inner cylinder member 20 does not move distal to the distal end of the needle member 10. For example, in FIG. 58, the entrance / exit portion 12 of the passage 13 is provided at the distal end of the needle member 10, and the opening 21 extending to the distal end is formed at the side portion of the inner cylinder member 20. There is. By pulling the lever which is the first operation unit to the proximal side and rotating the inner cylinder member 20 with respect to the needle member 10, the area where the passage 13 of the needle member 10 and the opening 21 of the inner cylinder member 20 overlap is narrowed. Therefore, the thread-like object 70 can be held by the needle mechanism 2.

As shown in FIG. 59, the needle mechanism 2 is moved to the distal side, and a part of the thread-like object 70 is moved to the distal side from the suture object 100 (step S3). Specifically, by penetrating the needle mechanism 2 holding the thread-like object 70 through the suture object 100, the folded-back portion 71 of the thread-like object 70 can be arranged on the distal side of the suture object 100. When the needle mechanism 2 is composed of a plurality of members, it may penetrate through the suture target 100 of at least one member. According to the operating method of the suture device 1 of the present invention, the folded-back portion 71 that easily holds the thread-like object 70 can be arranged on the distal side of the suture object 100, and therefore the distal side of the suture object 100. Even so, the filamentous material 70 can be easily held.

As shown in FIG. 60, the holding of the thread-like object 70 by the catching portion 15 of the needle mechanism 2 is released (step S4). Even if the thread-like object 70 is not held by the needle mechanism 2, since the thread-like object 70 is fixed by penetrating the suture target object 100, it is possible to prevent the thread-like object 70 from moving unintentionally. The holding of the thread-like object 70 by the needle mechanism 2 is released, for example, by rotating the inner cylinder member 20 arranged inside the needle mechanism 2 in the direction opposite to that at the time of holding (step S1). In order to prevent the thread-like object 70 from moving unintentionally, it is preferable to arrange the device 1 so that the perspective direction is along the gravity direction.

As shown in FIG. 61, the distal end of the needle mechanism 2 is moved proximal to the suture object 100 (step S5). For preferable suturing, it is necessary to move only the needle mechanism 2 to the proximal side without moving the filament 70 in the perspective direction. By moving the distal end of the needle mechanism 2 to the proximal side, it is possible to prevent the needle mechanism 2 from interfering with the holding of the filament 70 by the filament holding member 30 in step S6 described later.

As shown in FIG. 62, the thread-like object 70 is held by the thread-like object holding member 30 on the distal side of the suture object 100 (step S6). As a result, the thread-like object 70 is securely held on the distal side of the device 1, so that the thread-like object 70 can be prevented from coming off from the suture object 100 even if the device 1 is moved. This completes the suture from the proximal side to the distal side. Here, when the work is finished, as shown in FIG. 63, one end of the thread-like object 70 is collected by moving the device 1 to the proximal side while holding the thread-like object 70 by the thread-like object holding member 30. Can be done.

(3) Suture from the distal side to the proximal side As shown in FIG. 64, the position where the needle mechanism 2 is punctured at the time of suturing from the proximal side to the distal side described in the above item (2) is different. The device 1 is moved so that the needle mechanism 2 is arranged at the position. In FIG. 64, in order to move the suture position from the upper side to the lower side, the entire device 1 is rotated and turned upside down. The steps after the device 1 is turned upside down can be divided into the following two types.
(A) As shown in FIG. 64, when the thread-like object holding member 30 holds the thread-like object 70, the following steps S7 and subsequent steps are performed.
(B) When the thread-like object holding member 30 does not hold the thread-like object 70 as shown in FIG. 65, the following steps S8 and subsequent steps are performed.

As shown in FIG. 65, the holding of the filament 70 by the filament holding member 30 is released (step S7). In step S8, which will be described later, the thread-like object holding member 30 is prevented from interfering with the movement of the needle mechanism 2 to the distal side.

As shown in FIG. 66, the needle mechanism 2 is moved to the distal side of the suture target 100 in a state where the thread 70 is not held by the thread holding member 30 (step S8). At this time, the folded-back portion 71 of the thread-like object 70 passes through the entrance / exit portion 12 of the needle mechanism 2 and is arranged in the passage 13 or the terminal portion 14. This makes it easier for the needle mechanism 2 to hold the thread-like object 70 in step S9, which will be described later.

As shown in FIG. 67, the thread-like object 70 is held by the catching portion 15 of the needle mechanism 2 (step S9). As a result, even if the needle mechanism 2 is moved to the proximal side in step S10 described later, the filamentous material 70 can be prevented from falling off from the needle mechanism 2. Specifically, the folding portion 71 of the thread-like object 70 is preferably held by the capturing portion 15 of the needle mechanism 2. The method of holding the thread-like object 70 by the needle mechanism 2 is the same as in step S2.

As shown in FIG. 68, the distal end of the needle mechanism 2 is moved proximal to the suture object 100 (step S10). In this case, the needle mechanism 2 moves the filament 70 to the proximal side while holding it. As a result, the folded-back portion 71 of the thread-like object 70 is arranged on the proximal side of the suture object 100.

As shown in FIG. 69, the device 1 is further moved to the proximal side, and the free end 72 of the thread-like object 70 is pulled out to the proximal side of the suture object 100 (step S11).

Then, when the suture is continued, the needle mechanism 2 can be performed from step S3 while holding the thread-like object 70. The suture object 100 may be an object on the side where the filamentous material 70 is passed from the distal side to the proximal side by the steps so far, or may be an object on the side where the thread-like object 70 is passed from the proximal side to the distal side. Further, another suture object (not shown) that has not passed through the thread-like object 70 may be sutured by the steps so far. The object to be sutured 100 is determined by the operator comprehensively from the purpose of suturing, the size and shape of the incision, and the like. When the suture is completed, the suture is performed by pulling one side and the other side of the thread-like object 70 exposed on the proximal side of the suture object 100 and pulling the suture objects 100 to each other to prepare a knot. Complete.

(4) Replacement of Needle Mechanism Although not shown, a step (S12) of replacing the needle mechanism 2 with another needle mechanism may be performed after the step (S1) of preparing the device 1. As a result, a new needle mechanism is attached to the device 1, so that the object to be sutured can be sutured using the new needle mechanism. The needle mechanism before replacement and the new needle mechanism may be of the same type or different types, and can be selected according to the procedure.

In the above description, suturing the dura mater with TSS has been described as an example, but the present invention is not limited to this, and the type of surgery and the suture target (that is, the type of living tissue) can be appropriately selected. For example, it can be used at any surgical position such as craniotomy, laparotomy, and thoracotomy, and with or without the use of an endoscope or microscope. Further, the present invention has been described by exemplifying the operation of the operation unit by a human such as a doctor, but the present invention is not limited to this, and the operation unit can be operated by using a robot having a manipulator. The biological tissue is not limited to membrane tissues such as dura mater, arachnoid mater, pleura mater, pericardium, and peritoneum, but includes all biological tissues such as skin, blood vessels, lungs, heart, digestive tract, bones, and muscles. be able to.

3. 3. Method of suturing living tissue The present invention also includes a method of suturing living tissue 101 as follows, without using the suturing device described in the section "1. Bidirectional suturing device for medical use". FIG. 70 shows an explanatory view of the method of suturing a living tissue of the present invention. As shown in FIG. 70, the present invention is a method of suturing the living tissue 101 with the filamentous material 70, in which the first section 70A and the second section 70B of the filamentous material 70 are arranged proximal to the living tissue 101. Then, the step of arranging the third section 70C between the first section 70A and the second section 70B on the distal side of the living tissue 101 and the third section 70C of the filamentous material 70 on the proximal side of the living tissue 101. Has a step to move to. According to the suturing method of the present invention, the third section 70C (folded portion 71) of the filamentous material 70, which is easy to hold, can be arranged on the distal side of the living tissue 101 as the suture object, so that the endoscopy can be performed. The suture 70 can be easily held on the distal side of the living tissue 101 even when the distal side cannot be seen under the microscope.

This application claims the benefit of priority under Japanese Patent Application No. 2016-163085 filed on August 23, 2016. The entire contents of the specification of Japanese Patent Application No. 2016-163085 filed on August 23, 2016 are incorporated herein by reference.

1: Medical bidirectional suturing device 2, 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I: Needle mechanism 10: Needle member 11: Puncture part 12: Doorway part 13: Passage 14: Termination part 15 : Catch 16: Protrusion 17: Narrow portion 20: Inner cylinder member 21: Inner cylinder member opening 22: Hollow member 23: Inclined portion 24: Groove portion 24A: Bottom wall, 24B: Distal side wall, 24C: Proximal side wall 25: Interpolation member 26: Inclined portion 27: Groove portion 27A: Bottom wall, 27B: Distal side wall, 27C: Proximal side wall 28: Semi-cylindrical portion of hollow member 28C: Proximal side wall 29: Flat portion 30 of the insertion member : Thread-like object holding member 31: Rotating shaft 32: Fixing portion 33: Holding portion 33A: First main surface, 33B: Second main surface, 33C: Side surface 40: Connecting member 50: Housing 61: First operating unit 63: Third operation part 70: Thread-like object 71: Folded part 100: Object to be sewn

Claims (15)

A medical bidirectional suturing device having a perspective direction, which extends in the perspective direction and is provided with a needle mechanism having a tip on the distal side and a distal side of the medical bidirectional suturing device. It has a thread-like material holding member and
The needle mechanism has a passage through which a thread-like object passes, an entrance / exit portion provided on one side of the passage, and a terminal portion provided on the other side of the passage.
The passage penetrates in one direction perpendicular to the axial direction of the needle mechanism.
A medical bidirectional suturing device characterized in that the thread-like object holding member rotates about a first direction other than a direction perpendicular to two directions of an axial direction of the needle mechanism and a penetrating direction of the passage. .. The medical bidirectional suturing device according to claim 1, wherein the first direction is perpendicular to the axial direction of the needle mechanism. The medical bidirectional suturing device according to claim 1 or 2, wherein the first direction is a penetrating direction of the passage. The medical bidirectional suturing device according to claim 1, wherein the first direction is parallel to the axial direction of the needle mechanism. Further, the medical bidirectional suturing device has an operation part on the proximal side.
The thread-like material holding member includes a rotation shaft about the first direction and a rotation shaft.
A fixed portion provided on one side of the rotating shaft and directly or indirectly connected to the operating portion, and a fixed portion.
The medical bidirectional suturing device according to any one of claims 1 to 4, which is provided on the other side of the rotating shaft and has a pressing portion for pressing a thread-like object. The medical bidirectional suturing device according to any one of claims 1 to 4, wherein the thread-like object holding member slides in a direction perpendicular to the axial direction of the needle mechanism to hang an intermediate portion of the thread-like object. The medical bidirectional suturing device according to any one of claims 1 to 6, wherein the needle mechanism has a catching portion that narrows the passage or the entrance / exit portion. The needle mechanism has a hollow member and an interpolating member provided inside the hollow member and capable of advancing and retreating in the axial direction with respect to the hollow member.
The passage, the entrance / exit portion, and the terminal portion are provided in the hollow member.
The doorway is at the distal end of the hollow member
The medical bidirectional suturing device according to claim 7, wherein the capturing portion is a proximal end portion of the passage. The needle mechanism is provided in a hollow member having an inclined portion at a distal end and inside the hollow member, and rotational operation around the axis of the hollow member and axial movement of the hollow member. It has an interpolating member capable of performing at least one of the movements, and has.
The medical bidirectional suturing device according to claim 7, wherein the entrance / exit portion is provided on the proximal side of the inclined portion. The medical bidirectional suturing device according to claim 9, wherein the catching portion is composed of the hollow member and the interpolating member. The needle mechanism is hollow and has a needle member whose entrance / exit portion is provided at the distal end, and the catching portion is provided inside the needle member and rotates with respect to the needle member. It is an inner cylinder member,
The medical bidirectional suturing device according to claim 7, wherein the inner cylinder member has an opening extending to its distal end. The medical bidirectional suturing device according to claim 7, wherein the catching portion is a protrusion protruding inward in the radial direction of the needle mechanism. The medical bidirectional suturing device according to any one of claims 1 to 12, wherein the needle mechanism is provided with the terminal portion proximal to the entrance / exit portion. The medical bidirectional suturing device according to any one of claims 1 to 13, wherein the passage penetrates in a direction perpendicular to the axial direction of the needle mechanism. The medical bidirectional suturing device according to any one of claims 1 to 14, wherein the passage extends along the axial direction of the needle mechanism.

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