JP6933204B2 - Suture device - Google Patents

Description

The present invention relates to a suturing device. More specifically, transluminal endoscopic surgery in which a through hole is formed in the gastrointestinal tract or intraperitoneal surgery is performed by a flexible endoscope inserted into the body through natural holes such as the mouth, anus, and vaginal opening. Regarding the suturing device used for.

Transluminal endoscopic surgery (hereinafter referred to as NOTES) is the removal of lesions in the gastrointestinal tract and abdominal cavity by a flexible endoscope inserted into the body through natural holes such as the mouth, anus, and vaginal opening. It is an operation to perform the procedure of.

For example, surgery to remove a stomach wall that has a hole that penetrates the stomach wall, specifically a tumor that is deeper than the submucosa formed in the stomach wall, that is, a tumor that reaches the muscularis propria. Surgery to remove with a flexible endoscope falls under NOTES.

In addition, a flexible endoscope is inserted through the mouth, a hole is formed in the stomach wall by the tip of the flexible endoscope, and the tip of the flexible endoscope is invaded into the abdominal cavity through this hole to be formed in the pancreas, liver, etc. Surgery to remove a tumor or the like with a flexible endoscope also falls under NOTES.

When a tumor such as the stomach wall or pancreas is resected by such NOTES, it is necessary to suture the site or the hole in the stomach wall after the resection. Therefore, for example, a suturing device used by being attached to an endoscope shown in Patent Document 1 below has been proposed. However, in the conventional suture device, when the suture device is put into the body, the suture is tilted greatly or the suture device collides with the body wall or the like and receives an impact, so that the suture is released from the suture device. I had to be careful not to come off.

Japanese Patent No. 5294181

The present invention has been made in view of such an actual situation, and an object of the present invention is to provide an endoscopic suture device in which a suture thread does not easily come off from the suture device when the suture device is inserted into the body.

In order to achieve the above object, the suturing device according to the present invention
A suturing device that is used by being inserted into the body while attached to an endoscope.
With the front arm
It is provided with a rear arm provided so as to be close to and separated from the front arm.
The rear arm includes at least one needle-like member.
The front arm is provided with at least two needle insertion portions capable of accommodating the tip end portion of the needle-shaped member when the front arm and the rear arm are close to each other.
An engaging member that can be engaged with the needle-shaped member is detachably housed in each of the needle insertion portions.
At least one set of the engaging members housed in each of the needle insertion portions is connected to each other by a suture.
It is characterized by including a dropout prevention member configured so that the engaging member does not fall off from the needle insertion portion until the needle-shaped member is inserted into the needle insertion portion.

In the suture device of the present invention, a part of the engaging member or the suture is dislodged by the disengagement prevention member so that the engaging member does not fall off from the needle insertion portion until the needle-shaped member is inserted into the needle insertion portion. It has been prevented. Therefore, the suture does not easily come off from the suture device even when the suture device is put into the body.

Further, after the needle-shaped member is inserted into the needle-shaped member, the prevention of falling off is released, the engaging member engages with the needle-shaped member, and moves in the direction away from the needle-shaped member together with the needle-shaped member. do. Therefore, using the suturing device of the present invention, the wound can be sutured to the same extent as in surgery by an endoscope inserted into the gastrointestinal lumen.

The dropout prevention member has a film for preventing the engaging member from falling off from the needle insertion portion, and the film is located around the needle insertion portion so as to cover the needle insertion portion. It may be adhered to the surface of the front arm.

Further, the fall-off prevention member (the film) may be broken or peeled off from the surface of the front arm with a force equal to or higher than a predetermined value. The force exceeding a predetermined value is the force when the needle-shaped member is inserted into the engaging member, or the needle insertion portion together with the engaging member after the needle-shaped member is inserted into the engaging member. It is the force when pulling out from.

Alternatively, the dropout prevention member has a resin for temporarily fixing the engaging member to the needle insertion portion, and the resin is a hole in which a part of the engaging member or the suture is accommodated. , A part of the groove or recess may be filled.

Further, the dropout prevention member (the resin) is temporarily fixed to the engaging member or a part of the suture and the needle insertion portion so as to be broken or separated by a force equal to or higher than a predetermined value. May be good.

FIG. 1 is a schematic explanatory view of a main part of an endoscope provided with a suturing device according to an embodiment of the present invention. FIG. 2A is an enlarged plan view of a main part of the IIA portion shown in FIG. FIG. 2B is a perspective view of a main part of the thread assembly and the needle insertion portion shown in FIG. 2A. FIG. 2C is a cross-sectional view of a main part along the line IIC-IIC shown in FIG. 2A. FIG. 3 is a cross-sectional view taken along the line III-III shown in FIG. 4 (A) to 4 (D) are schematic explanatory views showing an example of use of the suturing device shown in FIG. 5 (A) to 5 (D) are schematic explanatory views showing an example of use of the suturing device showing the steps following the steps of FIG. 4 (D). 6 (A) to 6 (D) are schematic explanatory views showing an example of use of the suturing device showing the steps following the steps of FIG. 5 (D).

Next, an embodiment of the present invention will be described with reference to the drawings.

The suturing device of the present embodiment is a device used for suturing an organ in the abdominal cavity, an incision formed in the gastrointestinal tract, and the like, and transluminal endoscopic surgery using a flexible endoscope. (Hereinafter referred to as NOTES) is characterized in that it has a structure that can be attached to a flexible endoscope so that an incision or the like can be sutured from inside the gastrointestinal cavity.

The suturing device can be used by being attached to the tip of a rigid endoscope such as a laparoscope as well as a flexible endoscope. However, when the suturing device is attached to a flexible endoscope and used, in NOTES, it is formed for excision of a tumor or the like from excision of a tumor or the like only by the flexible endoscope placed in the gastrointestinal cavity. Since it becomes possible to perform sutures such as incisions, there is an advantage that surgery can be performed without forming a wound on the body surface.

Hereinafter, a case where the suturing device of the present embodiment is attached to a flexible endoscope and used will be described as a representative.

In order to make the structure of each part of the device easy to understand, the relative size of each part in each drawing does not necessarily correspond to the size in the actual device.

(Explanation of endoscope 1)
As shown in FIG. 1, the suturing device 10 of the present embodiment is attached to the endoscope 1. The endoscope 1 is a flexible endoscope used in general endoscopic surgery. The diameter, length, material, and the like of the shaft 2 of the endoscope 1 are not particularly limited as long as it is used by being inserted into the digestive tract of a living body.

For example, the diameter of the shaft 2 is about 10 mm in a general endoscope, but may be about 5 to 15 mm. The length of the shaft 2 is about 1200 mm for a general endoscope, but may be about 1200 to 3000 mm.

In particular, when performing surgery on an organ in the abdominal cavity, the endoscope 1 preferably has a function such as a narrow band imaging (NBI) function or a water jet.

(Explanation of the suturing device 10 of the present embodiment)
As shown in FIG. 1, the suturing device 10 of the present embodiment includes a pair of front and rear arms 11 and 12 and an arm moving means 13 for operating the pair of front and rear arms 11 and 12. In this embodiment, the front-back direction means the up-down direction in FIG. 1, and coincides with the longitudinal direction of the arm moving means 13. Further, the front-back and front-rear directions coincide with the downward direction in FIG. 1, and mean the front of the endoscope 1.

As shown in FIG. 1, the suturing device 10 of the present embodiment is used by fixing the arm moving means 13 to the shaft 2 of the endoscope 1 so as to be fixed to the endoscope 1. In the suturing device 10 of the present embodiment, both the front and rear pairs of arms 11 and 12 are located in front of the tip surface 1s of the shaft 2 of the endoscope 1, and the rear arm 12 is inside the front arm 11. It is used by being attached to the shaft 2 of the endoscope 1 so as to be located on the tip surface 1s side of the endoscope 1.

Moreover, the suturing device 10 of the present embodiment is attached so that the axial direction of each tube 13a to 13c of the arm moving means 13, which will be described later, and the axial direction of the shaft 2 are substantially parallel to each other. Therefore, while checking the movement of the pair of front and rear arms 11 and 12 with the camera of the endoscope 1, the pair of front and rear arms 11 and 12 are used to make an incision formed in the digestive tract such as the stomach. Can be sutured.

Further, if the axial directions of the tubes 13a to 13c and the axial directions of the shaft 2 are attached so as to be substantially parallel, the pair of front and rear arms 11 and 12 can be smoothly operated by the arm moving means 13. Further, it is possible to facilitate the operation of the pair of front and rear arms 11 and 12 by the operator. Then, since the arm moving means 13 can be reliably made to follow the bending of the shaft 2 when the shaft 2 is bent, it is possible to prevent the arm moving means 13 from interfering with the bending of the shaft 2.

The arm moving means 13 does not necessarily have to be provided along the shaft 2 of the endoscope 1, and only the tip of the arm moving means 13 may be fixed to the tip of the shaft 2. Even in this case, if the axial direction of the arm moving means 13 and the axial direction of the tip of the shaft 2 are substantially parallel at the tip of the shaft 2, the operator can operate the pair of front and rear arms 11 and 12. Can be facilitated.

Next, each part of the suturing device 10 of the present embodiment will be described. First, the arm moving means 13 will be described.

The arm moving means 13 is a long member extending along the axial direction, and is attached to the shaft 2 of the endoscope 1. The length of the arm moving means 13 may be as long as the length of the shaft 2 of the endoscope 1, and is not particularly limited.

The arm moving means 13 is fixed to the shaft 2. For example, as described above, the arm moving means 13 has the arm moving means 13 fixed along the shaft 2 or only the tip of the arm moving means 13 fixed to the tip of the shaft 2. It is fixed to the shaft 2.

The method of fixing the arm moving means 13 to the shaft 2 is not particularly limited, and any method may be used as long as it can be fixed so as not to hinder deformation such as bending of the shaft 2. For example, it can be fixed by a belt-shaped member made of polyethylene, polyvinyl chloride, reinforced plastic, aluminum or the like, or a ring-shaped fastener made of polyethylene, reinforced vinyl, metal or the like, but is not particularly limited.

The arm moving means 13 is formed so as to have flexibility enough to follow the bending of the shaft 2 and bend in a state of being fixed to the shaft 2. That is, the arm moving means 13 is formed to have a strength that does not interfere with the operation of the endoscope 1 even if it is attached to the shaft 2 of the endoscope 1.

Specifically, the arm moving means 13 is composed of three tubes (or two tubes and a wire) having flexibility enough to follow the bending of the shaft 2 and bend. That is, the arm moving means 13 is formed by the case tube 13a, the rear arm moving tube 13b, and the front arm moving tube 13c (or the front arm moving wire).

The case tube 13a is a hollow tube-shaped member fixed to the shaft 2, and is fixed to the shaft 2 by a belt-shaped member or the like. The material of the case tube 13a is not particularly limited, but it is preferably formed of, for example, a material such as polyethylene or polyvinyl chloride.

The rear arm moving tube 13b is a hollow tube-shaped member inserted into the case tube 13a, and is arranged in the case tube 13a so as to be movable along the axial direction and rotate around the axis. ing. The rear arm 12 is connected to the tip of the rear arm moving tube 13b. The material of the rear arm moving tube 13b is not particularly limited. For example, it is preferably formed of a material such as polyethylene, polyvinyl chloride, or metal.

In particular, since the rear arm moving tube 13b is rotated to swing the rear arm 12, the rear arm moving tube 13b has a rotation amount when the rear arm moving tube 13b is rotated on the hand side. It is preferable that the rear arm 12 can be swung by the same amount. For example, if a tubular member is formed of a plurality of metal wires arranged so as to be parallel to each other and arranged in a coaxial circle in the axial direction to form a rear arm moving tube 13b, the above-mentioned functions are satisfied. Can be.

The front arm moving tube 13c is a tube inserted into the rear arm moving tube 13b, and is arranged in the rear arm moving tube 13b so as to be movable along the axial direction and rotate around the axis. ing. The front arm 11 is connected to the tip of the front arm moving tube 13c. The material of the front arm moving tube 13c is not particularly limited, but it is preferable that the tip portion of about 10 mm has high rigidity and the hand side is softer than the tip portion but does not contract or expand in the advancing / retreating direction.

For example, a rod-shaped portion having a high rigidity formed of metal or the like at the tip of about 10 mm and formed of a wire or the like other than that portion can be used as the front arm moving tube 13c. In particular, since the front arm moving tube 13c is rotated to swing the rear arm 12, the front arm moving tube 13c is the same as the amount of rotation when the rear arm moving tube 13b is rotated on the hand side. Those capable of swinging the rear arm 12 are preferable.

The base end of the front arm moving tube 13c and the base end of the rear arm moving tube 13b extend to the vicinity of the operating portion for operating the shaft 2 of the endoscope 1. Therefore, by manipulating the base end of each tube, the movement of the tip end of each tube (advance / retreat along the axial direction, rotation around the axis) can be manipulated.

Since the arm moving means 13 has the above-described configuration, if the front arm moving tube 13c and the rear arm moving tube 13b are moved at the same time or one of them is moved along the axial direction, the front and rear arm moving tubes 13c and the rear arm moving tube 13b are moved back and forth. The pair of arms 11 and 12 can be brought close to each other and separated from each other.

Moreover, if the front arm moving tube 13c is rotated around the axis, the front arm 11 can be rotated around the axis of the front arm moving tube 13c, and the rear arm moving tube 13b is rotated around the axis. Then, the rear arm 12 can be rotated around the axis of the rear arm moving tube 13b.

The front arm moving tube 13c may be movable relative to the rear arm moving tube 13b in the axial direction, and rotates about the axis of the rear arm moving tube 13b. It doesn't have to be possible. In this case, there is an advantage that the central axis of the needle-shaped member 14 of the rear arm 12, which will be described later, and the central axis of the needle insertion portion 16 of the front arm 11 can always be aligned with each other.

Further, the rear arm moving tube 13b also needs to be able to move relative to the case tube 13a along the axial direction, and cannot be rotated about the axis of the case tube 13a. You may.

Further, it is preferable that the rear arm moving tube 13b and the front arm moving tube 13c can move independently in the axial direction, but the pair of front and rear arms 11 and 12 can be brought close to each other and separated from each other. If possible, the configuration may be such that only one of them can move in the axial direction.

Further, the outer diameter of the arm moving means 13 (that is, the outer diameter of the case tube 13a) allows the endoscope 1 to which the suturing device 10 of the present embodiment is attached to be inserted into the digestive tract (or the overtube). It does not have to be limited as long as it is a degree. For example, as for the outer diameter of the arm moving means 13, the total diameter of the arm moving means 13 and the outer diameter of the shaft 2 is preferably about 11 to 13 mm, more preferably about 11 to 12 mm.

(Explanation of a pair of front and rear arms 11 and 12)
Next, a pair of front and rear arms 11 and 12 will be described.

(About the rear arm 12)
First, the rear arm 12 will be described.
As shown in FIG. 1, the rear arm 12 is a member formed in a substantially strip shape, and the front surface 12a and the back surface 12b are formed on a flat surface parallel to each other.

The tip of the rear arm moving tube 13b is connected to the base end of the rear arm 12. The rear arm moving tube 13b is connected to the rear arm 12 at a connecting portion with the rear arm 12 so that its central axis is orthogonal to the front surface 12a and the back surface 12b of the rear arm 12. Hereinafter, the central axis of the rear arm moving tube 13b at the connecting portion between the rear arm moving tube 13b and the rear arm 12 is simply referred to as the central axis of the tip of the rear arm moving tube 13b.

A through hole 12h is formed at the base end of the rear arm 12 so as to penetrate between the front surface 12a and the back surface 12b, and the central axis of the tip of the rear arm moving tube 13b is the center of the through hole 12h. It is arranged so as to be substantially coaxial with the shaft, and the reason will be described later.

On the other hand, a needle-shaped member 14 is provided at the tip of the rear arm 12. The needle-shaped member 14 has a shaft portion 14b and a portion having a large outer diameter (a ridge-shaped portion 14a) at the tip provided at the tip of the shaft portion 14b. The arrow-shaped portion 14a is formed so that the outer diameter of the base end thereof is larger than the outer diameter of the tip end of the shaft portion 14b and a step is formed at the connecting portion with the shaft portion 14b. As will be described later, the arrow-shaped portion 14a serves as a resistance when the needle-shaped member 14 is pulled out from the engaging member 21.

Further, the needle-shaped member 14 is attached to the rear arm 12 so that the tip thereof faces the front arm 11 and the axial direction thereof is orthogonal to the front arm 12a. In other words, the needle-shaped member 14 is attached to the rear arm 12 so that its central axis is parallel to the central axis of the tip of the rear arm moving tube 13b.

Since the structure is as described above, if the rear arm moving tube 13b is rotated around its central axis, the rear arm 12 can be swung around the central axis of the rear arm moving tube 13b. The central axis of the needle-shaped member 14 is parallel to the central axis of the tip of the rear arm moving tube 13b. Therefore, the needle-shaped member 14 is swiveled around the central axis of the tip of the rear arm moving tube 13b while maintaining the state in which the central axis of the needle-shaped member 14 is parallel to the central axis of the tip of the rear arm moving tube 13b. be able to. The central axis of the tip of the rear arm moving tube 13b corresponds to the swing axis.

The rear arm 12 is in a state where the central axis of the needle-shaped member 14 is parallel to the central axis of the tip of the rear arm moving tube 13b when the rear arm moving tube 13b is rotated around its central axis. It suffices if it can be turned while maintaining it. That is, the surface of the rear arm 12 (front surface 12a or back surface 12b) does not necessarily have to be a flat surface, and the back surface 12b of the rear arm 12 and the central axis of the tip of the rear arm moving tube 13b are not necessarily orthogonal to each other. It does not have to be.

The position where the needle-shaped member 14 is provided on the rear arm 12 is not particularly limited. The needle-shaped member 14 may be provided at a position separated from the central axis of the tip of the rear arm moving tube 13b, and the needle-shaped member 14 does not necessarily have to be provided at the tip of the rear arm 12.

Further, the needle-shaped member 14 has a length and strength such that it can pierce the object to be sutured and penetrate the object, and can be moved in the opposite direction from the state of penetrating the object and pulled out from the object. Any material may be used, and the material, length, and shaft diameter are not particularly limited. For example, when the stomach wall is sutured by the suturing device 10 of the present embodiment, the length may be such that the length from the front surface of the rear arm 12 to the tip thereof can penetrate the stomach wall. Metal is preferable in terms of strength. For example, in a state where the needle-shaped member 14 is attached to the rear arm 12, the length from the front surface of the rear arm 12 to the tip thereof is preferably about 7 to 20 mm, more preferably about 7 to 10 mm. Further, as for the shaft diameter of the needle-shaped member 14, the shaft diameter of the base end portion of the shaft portion 14b is preferably about 0.5 to 1 mm, and the shaft diameter of the tip portion of the shaft portion 14b is preferably about 0.5 to 1 mm. The maximum diameter of the spiral portion 14a is preferably about ± 0.1 to 1 mm at the tip of the shaft portion 14b.

Further, the number of needle-shaped members 14 included in the rear arm 12 may be at least one, and may be two or more. When two or more needle-shaped members 14 are provided on the rear arm 12, two or more needle insertion portions 16 are provided on the front arm 11 so as to correspond to the positions of the respective needle-shaped members 14. , The rear arm 12 may not be swung.

(About the front arm 11)
Next, the front arm 11 will be described.
As shown in FIGS. 1 and 2A, the front arm 11 is a member having a pair of strip-shaped portions (hereinafter referred to as branch portions 11s1, 11s2), and the base ends of the pair of branch portions 11s1, 11s2 are connected to each other. It is formed in a substantially V shape. In the front arm 11, the back surfaces (that is, the surfaces on the rear arm 12 side) are formed flat on each other.

In the front arm 11, the tip of the front arm moving tube 13c is connected to the portion where the pair of branch portions 11s1 and 11s2 are connected. The front arm moving tube 13c is connected to the front arm 11 at a connecting portion with the front arm 11 so that its central axis is orthogonal to the back surface of the front arm 11. Hereinafter, the central axis of the front arm moving tube 13c at the connecting portion between the front arm moving tube 13c and the front arm 11 is simply referred to as the central axis of the tip of the front arm moving tube 13c.

As shown in FIG. 1, a needle insertion portion 16a1 is formed in one of the branch portions 11s1 and 11s2 provided on the front arm 11. Further, the other branch portion 11s2 is formed with a needle insertion portion 16a2 similar to the needle insertion portion 16a1 and a needle temporary placement portion 16a3 formed on the tip end side of the needle insertion portion 16a2. .. As shown in FIG. 3, the pair of needle insertion portions 16a1 and 16a2 are arranged symmetrically with respect to each other with the front arm moving tube 13c as the center, and the needle-shaped member 14 shown in FIG. It has an insertion hole 17 into which 14a can be inserted.

As shown in FIG. 3, the needle temporary placement portion 16a3 is formed at the tip end portion of the branch portion 11s2, and is either an intermediate position between the pair of needle insertion portions 16a1, 16a2 or the needle insertion portions 16a1, 16a2. It is formed at a position close to the crab and has an insertion hole 17a for temporary placement having an inner diameter larger than the inner diameter of the insertion hole 17. The needle tip portion including the needle-shaped portion 14a of the needle-shaped member 14 shown in FIG. 1 can be inserted into the temporary placement insertion hole 17a.

Each of the insertion holes 17 and 17a is a through hole penetrating between the front surface and the back surface of the front arm 11, and the central axis thereof is formed so as to be parallel to the central axis of the tip of the front arm moving tube 13c. There is. As shown in FIGS. 2A and 2C, an engaging recess (step portion) having an inner diameter larger than the inner diameter of the insertion hole 17 is located above (back side) of the insertion holes 17 of the needle insertion portions 16a1 and 16a2. 18 is formed. An engaging member 21 of the thread assembly 20, which will be described later, is detachably attached to each engaging recess 18. The inner diameter of each insertion hole 17 is formed to be larger than the outer diameter of the spiral portion 14a, and the reason why it is formed in such a shape will be described later.

The distance from the central axis of each of the insertion holes 17 and 17a to the central axis of the tip of the front arm moving tube 13c is the distance from the central axis of the needle-shaped member 14 to the central axis of the tip of the rear arm moving tube 13b. It is formed to have the same length as. As described above, since the central axis of the tip of the rear arm moving tube 13b is arranged so as to be substantially coaxial with the central axis of the through hole 12h, the central axis of the tip of the front arm moving tube 13c can be used. It can be coaxial with the central axis of the tip of the rear arm moving tube 13b. In other words, the central axis of the tip of the front arm moving tube 13c can be coaxial with the swing axis.

Therefore, when the rear arm moving tube 13b is rotated around its central axis, the needle-shaped member 14 may be arranged so that its central axis is coaxial with the central axis of each of the insertion holes 17, 17a. can. Therefore, if the front arm 11 and the rear arm 12 are brought close to each other in a state where the central axes of both are coaxial, the needle-shaped member 14's arrowhead-shaped portion 14a can be inserted into the insertion holes 17 and 17a. Can be inserted.

The front arm 11 may be provided so that the central axis of each of the insertion holes 17 and 17a is parallel to the central axis of the tip of the front arm moving tube 13c. That is, the back surface of the front arm 11 does not necessarily have to be formed on a flat surface, and the back surface of the rear arm 12 and the central axis of the tip of the front arm moving tube 13c do not necessarily have to be orthogonal to each other.

The distance between the insertion holes 17 and 17a is from the central axis of the needle-shaped member 14 to the central axis of the tip of the front arm moving tube 13c. It is not necessary to provide the pair of branch portions 11s1 and 11s2 as long as they are arranged so as to have the same length as the above. For example, without providing either one of the branch portions 11s1 and 11s2, only one arm may be left, and the needle insertion portions 16a1, 16a2 and the needle temporary placement portion 16a3 may be provided there. The shape of the front arm 11 is not particularly limited, and may be formed in a substantially arc shape or a rectangular shape (U-shape or the like).

(About thread assembly 20)
Next, the thread assembly 20 will be described. As shown in FIG. 1, the suturing device 10 of the present embodiment includes a thread assembly 20. As shown in FIG. 2B, the thread assembly 20 is composed of a pair of engaging members 21 and 21 formed in an annular shape and a suture thread 22 connecting the pair of engaging members 21 and 21. There is. As shown in FIGS. 2A and 2C, the pair of engaging members 21 and 21 of the thread assembly 20 are detachably attached to the engaging recesses 18 of the pair of needle insertion portions 16a1 and 16a2 of the front arm 11. It is housed in the needle insertion portions 16a1 and 16a2.

Each engaging member 21 is formed with a through hole 21h penetrating the front and back surfaces thereof, and as shown in FIGS. 2B and 2C, the inner diameter of the through hole 21h is preferably smaller than the inner diameter of the insertion hole 17. .. Each engaging member 21 is arranged in each engaging recess 18. Specifically, each engaging member 21 is formed so that its outer diameter is smaller than the inner diameter of each engaging recess 18 and larger than the inner diameter of the insertion hole 17.

Moreover, the through hole 21h of each engaging member 21 can be inserted through the needle-shaped portion 14a of the needle-shaped member 14, but when the spiral portion 14a completely inserts the through hole 21h, the through hole 21h is engaged from the needle-shaped member 14. The member 21 is formed in a structure that does not fall off. Specifically, each engaging member 21 has an inner diameter smaller than the outer diameter of the spiral portion 14a of the needle-shaped member 14, but is connected to the tip of the shaft portion 14b of the needle-shaped member 14 (that is, the connection with the spiral portion 14a). It is formed so as to be larger than the shaft diameter of the portion).

Specifically, as shown in FIG. 2A, the insertion hole 21h may be provided with an inwardly convex piece 21f for holding. An inward convex piece 21f for holding made of an elastic material that is difficult to bend on the insertion side but easily bends is provided on the opposite side, and the distance between the tips thereof is the outer diameter of the spiral portion 14a of the needle-shaped member 14. It is formed so as to be narrower than the outer diameter of the tip portion of the shaft portion 14b but wider than the outer diameter.

With such a structure, when the needle-shaped portion 14a of the needle-shaped member 14 is completely inserted, the holding inward convex piece 21f is restored to the original state by an elastic force. That is, the tapered portion leading to the shaft portion 14b or the shaft portion 14b is sandwiched by the tip of the holding inward convex piece 21f. Since the holding inward convex piece 21f acts as a resistance to movement, even if the needle-shaped member 14 is pulled out from the engaging member 21, the engaging member 21 does not come off from the needle-shaped member 14.

In the present embodiment, each engaging member 21 is fixed to the end of the suture thread 22. The method of fixing the engaging member 21 to the end of the suture thread 22 is not particularly limited. For example, the suture thread 22 may be tied to the engaging member 21 and fixed, or as shown in FIG. 2B, a connecting piece 21b is provided on the engaging member 21 and the connecting piece 21b and the suture thread 22 are connected to each other. May be.

The engaging member 21 provided with the connecting piece 21b includes an engaging portion 21a in which the through hole 21h is formed, and a connecting piece 21b integrally formed with the engaging portion 21a. The connecting piece 21b is bent at a connecting portion with the engaging portion 21a and is provided so that its axial direction is parallel to the central axis of the through hole 21h. The connecting piece 21b is provided with a plurality of gripping pieces 21k along the axial direction thereof.

Therefore, if the end portion of the suture thread 22 is arranged along the axial direction of the connecting piece 21b and the suture thread 22 is sandwiched between the plurality of gripping pieces 21k and the connecting piece 21b, the suture thread 22 is provided. Can be fixed to the engaging member 21.

Since the connecting piece 21b is provided so that the axial direction is parallel to the central axis of the through hole 21h, when the spiral portion 14a of the needle-shaped member 14 is inserted into the through hole 21h of the engaging member 21. The connecting piece 21b can be in a state along the side surface of the spiral portion 14a, or the central axis of the needle-shaped member 14 and the axial direction of the connecting piece 21b can be parallel to each other. Then, even if the connecting piece 21b is provided, the resistance caused by the connecting piece 21b can be reduced when the needle-shaped member 14 passes through the stomach wall or the like. In particular, when the connecting piece 21b and the engaging portion 21a are integrally formed, if the connecting portion of both is bent so as to have a curved surface, the resistance when passing through the stomach wall or the like can be further reduced. can.

The method of fixing the end of the suture thread 22 to the connecting piece 21b is not limited to the above method. For example, as a plate-shaped or rod-shaped member having no gripping piece 21k, the end of the suture 22 is untwisted, the connecting piece 21b is wrapped with the untwisted thread, and the connecting piece 21b is hardened with an adhesive or the like to be connected to the suture 22. The piece 21b may be fixed.

Further, when a member having the connecting piece 21b as described above is used as the engaging member 21, when the engaging member 21 is accommodated in the needle insertion portions 16a1 and 16a2 of the front arm 11, the connecting piece 21b It is preferable that the front arm 11 is provided with a mechanism capable of holding the above.

For example, as shown in FIGS. 2A to 2C, a thread end accommodating groove 19 is provided on the side surface of the front arm 11 along the axial direction of the needle insertion portions 16a1 and 16a2. Then, on the back surface of the front arm 11, the thread end accommodating groove 19 and the engaging recess 18 communicate with each other. Then, the width of the thread end accommodating groove 19 is made slightly wider than the width of the connecting piece 21b when the end of the suture thread 22 is attached.

Then, when the engaging member 21 is arranged in the needle insertion portions 16a1 and 16a2, the engaging portion 21a can be arranged in the engaging recess 18 and the connecting piece 21b can be arranged in the thread end accommodating groove 19. .. Then, since the connecting piece 21b is held in a state where its axial direction is parallel to the axial direction of the thread end accommodating groove 19, the central axis of the through hole 21h of the engaging portion 21a and the central axis of the insertion hole 17 are held. It can be reliably held in a matched state. Moreover, since the connecting piece 21b is housed in the thread end accommodating groove 19, the engaging portion 21a can be prevented from tilting in the engaging recess 18.

In the above example, the case where the shape of the engaging member 21 (the engaging portion 21a when the connecting piece 21b is provided) and the shape of the through hole 21h are circular has been described, but the shape of the engaging member 21 and the through hole 21h has been described. Is not limited to such a shape. For example, the shape of the engaging member 21 may be a quadrangular shape, a triangular shape, a pentagonal shape, or the like, and the shape is not particularly limited. The shape of the through hole 21h may be a quadrangular shape, a triangular shape, a pentagonal shape, or the like, and the shape is not particularly limited. When the outer diameter of the engaging member 21 is quadrangular or the like, it is preferable to chamfer the corners so that the engaging member 21 does not damage the stomach wall or the like. Further, the engaging member 21 may be a coil spring or the like in which a linear member is spirally wound.

In the present embodiment, when the engaging member 21 is attached to the engaging recess 18, the engaging portion 21a of the engaging member 21 is fitted inside the engaging recess 18, and the connecting piece 21b is the thread end portion. It fits into the accommodating groove 19. Therefore, the engaging member 21 can be moved only in the direction of pulling upward along the central axis (swing axis) of the tip of the rear arm moving tube 13b shown in FIG. 1, and each needle insertion portion 16a1, 16a2. Attached to.

In the present embodiment, even if the front arm 11 is greatly tilted from the horizontal direction when the suturing device 10 is put into the body, or the front arm 11 collides with the body wall or the like and receives an impact, each engagement is performed. As shown in FIGS. 2A and 2C, a film is used as the dropout prevention member 30 in order to prevent the member 21 from falling off from the needle insertion portions 16a1 and 16a2. The film-shaped fall-off prevention member 30 adheres to the surface of the front arm 11 located around the needle insertion portion 16a1 (16a2) so as to cover the needle insertion portion 16a1 (16a2) on the back surface of the front arm 11. There is.

The film-shaped fall-off prevention member 30 may be configured so that the engaging member 21 does not fall off from the needle insertion portion 16a1 (16a2), and in the present embodiment, it is adhered only to the surface of the front arm 11. By covering the needle insertion portion 16a1 (16a2) with the film-shaped fall-off prevention member 30, the engagement member 21 is prevented from coming off. However, the engagement member 21 may be prevented from falling off by adhering the film-shaped fall-off prevention member 30 to the surface of the front arm 11 and also to a part of the engagement member 21 or the suture thread 22. .. That is, as shown in FIG. 2C, in the present embodiment, a gap is formed between the film-shaped fall-off prevention member 30 and the engaging member 21, but the configuration may be such that there is no such gap. In the present embodiment, the shape of the film-shaped fall-off prevention member 30 is substantially in line with the shape of the back surface of the front arm 11 located around the needle insertion portion 16a1 (16a2). The shape of the dropout prevention member 30 is not particularly limited as long as the engagement member 21 can be prevented from falling off.

Further, the film-shaped fall-off prevention member 30 may be formed with through holes 32 penetrating the front and back surfaces thereof. The through hole 32 is preferably arranged coaxially with the through hole 21h of the engaging portion 21a. The inner diameter of the through hole 32 may be smaller or larger than the inner diameter of the through hole 21h, but is preferably smaller than the outer diameter of the engaging portion 21a.

When the film-shaped fall-off prevention member 30 is transparent, it is not always necessary to provide the through hole 32. This is because the through hole 21h can be seen through. Further, even when a means for coaxially aligning the tip of the needle-shaped member 14 shown in FIG. 1 or the twisted portion 14a with the through holes 21h of the needle insertion portions 16a1 and 16a2 is provided, it is not always necessary. It is not necessary to provide the through hole 32.

The material of the film-shaped fall-off prevention member 30 is not particularly limited, but is preferably a material that does not cause any problem even if it remains in the body, and examples thereof include polyester, polyamide, polyurethane, polycarbonate, polyolefin, and polysulfone. ..

(Outline of operation of the suturing device 10 of the present embodiment)
With the above configuration, in the suturing device 10 of the present embodiment, if the arm moving means 13 is operated to swing the front arm 11, the needle-shaped member 14 and one of the needle insertion portions 16a1 or 16a2 Can be arranged so that the needle-shaped member 14 and one of the needle insertion portions 16a1 or 16a2 are coaxial with each other. In this state, if the front arm 11 and the rear arm 12 are brought close to each other by the arm moving means 13, the needle-shaped portion 14a of the needle-shaped member 14 can be inserted into one of the needle insertion portions 16a1 or 16a2.

Then, since one engaging member 21 of the thread assembly 20 is arranged in one of the needle insertion portions 16a1 or 16a2, the needle-shaped portion 14a of the needle-shaped member 14 is attached to the one engaging member 21. It can be inserted. Then, if the front arm 11 and the rear arm 12 are brought close to each other until the entire needle-shaped portion 14a of the needle-shaped member 14 is inserted into the insertion hole 17 of one needle insertion portion 16a1 or 16a2, the needle-shaped member 14 can be moved. , The shaft portion 14b can be penetrated through the through hole 21h of one of the engaging members 21. The inwardly convex piece 21f of the through hole 21h engages with the spiral portion 14a. When the spiral portion 14a of the needle-shaped member 14 penetrates the through hole 21h, the film-shaped fall-off prevention member 30 is broken in response to the penetrating operation of the spiral portion 14a.

In this state, if the arm moving means 13 is operated to separate the front arm 11 and the rear arm 12, the film-shaped fall-off prevention member 30 may be further torn or may be separated from the back surface of the front arm 11. The adhesive is peeled off, and the engaging member 21 and the needle-shaped member 14 are separated from the needle insertion portion 16. Next, the arm moving means 13 is operated to swing the front arm 11, and the needle-shaped member 14 and the other needle insertion portion 16a2 or 16a1 are arranged so as to be coaxial with each other.

The other engaging member 21 of the thread assembly 20 is arranged in the other needle insertion portion 16a2 or 16a1. Therefore, from this state, if the front arm 11 and the rear arm 12 are brought close to each other until the entire needle-shaped portion 14a of the needle-shaped member 14 is inserted into the insertion hole 17 of the other needle insertion portion 16a2 or 16a1, the needle The shaped member 14 can be passed through the through hole 21h of the other engaging member 21 up to its shaft portion 14b. The inwardly convex piece 21f of the through hole 21h engages with the spiral portion 14a. When the spiral portion 14a of the needle-shaped member 14 penetrates the through hole 21h, the film-shaped fall-off prevention member 30 is broken in response to the penetrating operation of the spiral portion 14a.

Then, if the arm moving means 13 is operated to separate the front arm 11 and the rear arm 12, the film-shaped fall-off prevention member 30 is further torn or the adhesive to the back surface of the front arm 11 is peeled off. The engaging member 21 and the needle-shaped member 14 are separated from the needle insertion portion 16. As a result, since the pair of engaging members 21 and 21 are all engaged with the needle-shaped member 14, the suture thread 22 connecting the pair of engaging members 21 and 21 can be formed into a ring shape (FIG. FIG. 5 (D)).

Therefore, according to the suturing device 10 of the present embodiment, the front arm 11 and the rear arm 12 are brought close to each other twice in a state where the object is arranged between the front arm 11 and the rear arm 12, and the engaging member is engaged. If the 21 is separated from the needle insertion portion 16 together with the needle-shaped member 14 and the position where the needle-shaped member 14 inserts the object is changed between the first time and the second time, the suture 22 is inserted at both ends of the object. Objects can be penetrated so that they are located on the same side. In other words, the suture thread 22 can be penetrated into the object so that the portion between both ends of the suture thread 22 is caught by the object (see FIG. 5 (D)).

(Regarding the suturing of a living body by the suturing device 10 of the present embodiment)
Since it has the above configuration, if the suturing device 10 of the present embodiment is attached to the shaft 2 of the endoscope 1, an incised portion such as a stomach wall can be sutured from the inside of the stomach.

Hereinafter, the operation of suturing the incised portion using the suturing device 10 of the present embodiment will be described with reference to FIGS. 4 to 6.

In the following, a case where the incision portion 72 formed in the stomach wall 70 is sutured will be described.

First, the shaft 2 of the endoscope 1 to which the suturing device 10 of the present embodiment is attached is inserted into the stomach. At the time of insertion, it is preferable to insert the stylus portion 14a of the needle-shaped member 14 into the temporary placement insertion hole 17a so that the stylus portion 14a does not damage the inside of the body cavity. Then, the tip surface of the shaft 2 is arranged in the vicinity of the incision portion 72 to be sutured. After that, the front arm moving tube 13c of the arm moving means 13 is operated to take out the arrow-shaped portion 14a of the needle-shaped member 14 from the temporary placement insertion hole 17a, and insert only the front arm 11 into the incision portion 72. ..

After that, the rear arm moving tube 13b and the front arm moving tube 13c of the arm moving means 13 are operated, and one branch portion 11s of the front arm 11 and the back surface 12b of the rear arm 12 allow one rim of the incision portion 72. The front arm 11 and the rear arm 12 are arranged so that the portion 72a is sandwiched (FIG. 4 (A)).

In the front arm 11 and the rear arm 12, the needle-shaped member 14 and the needle insertion portion 16a1 (one needle insertion portion 16a1) formed in one of the branch portions 11s1 are coaxial with each other. Needless to say, it is placed.

From the state of FIG. 4A, the rear arm moving tube 13b of the arm moving means 13 is operated to bring the rear arm 12 closer to the front arm 11. Then, the needle-shaped member 14 can be inserted into one of the rim portions 72a, and the needle-shaped portion 14a of the needle-shaped member 14 can be inserted into the one needle insertion portion 16a1. Then, since the spiral portion 14a of the needle-shaped member 14 can be penetrated through one engaging member 21 of the thread assembly 20, one engaging member 21 can be engaged with the needle-shaped member 14 ( FIG. 4 (B).

In FIG. 4, when the rear arm 12 and the front arm 11 are brought close to each other, the case where the rear arm 12 is brought close to the front arm 11 has been described, but the front arm 11 is brought close to the rear arm 12. Alternatively, both may be moved together to bring them closer to each other. This point is the same even when the rear arm 12 is separated from the front arm 11 in the following description. Therefore, in the following, only the case where the rear arm 12 is moved with respect to the front arm 11 will be described, and the other cases (the case where the front arm 11 is moved with respect to the rear arm 12 and the case where both are moved) will be described. ) Will be omitted.

When one of the engaging members 21 is engaged with the spiral portion 14a of the needle-shaped member 14, the rear arm moving tube 13b of the arm moving means 13 is operated to separate the rear arm 12 from the front arm 11. At this time, the needle-shaped member 14 returns to the stomach through a hole (hereinafter, referred to as a first perforation) formed when the needle-shaped member 14 is inserted into one of the rim portions 72a. Then, one of the engaging members 21 engaged with the needle-shaped member 14 also moves into the stomach together with the needle-shaped member 14.

On the other hand, the other engaging member 21 of the thread assembly 20 remains in the needle insertion portion 16a2 formed in the other branch portion 11s2 even if one engaging member 21 moves, so that both engagement members 21 are engaged. The suture thread 22 connecting the members 21 is arranged so as to penetrate the first perforation. That is, the suture thread 22 is arranged so that one end fixed to one engaging member 21 is located in the stomach and one end fixed to the other engaging member 21 is located outside the stomach ( FIG. 4 (C).

From the state of FIG. 4C, the front arm 11 and the rear side are sandwiched between the other branch portion 11s1 of the front arm 11 and the rear arm 12 so that the other rim portion 72b of the incision portion 72 is sandwiched. The arm 12 is arranged (FIG. 4 (D)). Specifically, the front arm 11 is moved so that the other branch portion 11s2 is located on the outer surface of the other rim portion 72b. After that, the front arm 11 is swung so that the needle-shaped member 14 and the needle insertion portion 16a2 (the other needle insertion portion 16a2) formed in the other branch portion 11s2 are arranged so as to be coaxial with each other. ..

From the state of FIG. 4D, the rear arm moving tube 13b of the arm moving means 13 is operated to bring the rear arm 12 closer to the front arm 11. Then, as shown in FIG. 5A, the needle-shaped member 14 can be inserted into the other mouth edge portion 72b, and the needle-shaped portion 14a of the needle-shaped member 14 is inserted into the other needle insertion portion 16a2. Can be made to. Then, since the spiral portion 14a of the needle-shaped member 14 can be passed through the other engaging member 21 of the thread assembly 20, the other engaging member 21 can also be engaged with the needle-shaped member 14.

When the other spiral portion 14 is engaged with the needle-shaped member 14, the rear arm moving tube 13b of the arm moving means 13 is operated to separate the rear arm 12 from the front arm 11, and the needle-shaped member is separated from the front arm 11. The 14 returns to the stomach through a hole (hereinafter referred to as a second perforation) formed when the needle-shaped member 14 is inserted into the other rim portion 72b. Then, as shown in FIG. 5B, the other engaging member 21 engaged with the needle-shaped member 14 also moves into the stomach together with the needle-shaped member 14, and the suture thread 22 penetrates the second perforation. do.

As a result, the pair of engaging members 21 to which both ends of the suture 22 are fixed are in a state of being engaged with one needle-shaped member 14, so that the suture 22 causes the needle-shaped member 14 ( That is, a ring is formed which penetrates the first perforation (inside the stomach) and goes out of the stomach, and then penetrates the second perforation from the outer surface of the stomach and returns to the needle-shaped member 14 (that is, inside the stomach).

When the loop of the suture 22 as described above is formed, first, as shown in FIG. 5C, the arm moving means 13 is operated to move the anterior arm 11 into the stomach through the incision 72. Then, when the anterior arm 11 enters the stomach, the shaft 2 (see FIG. 1) itself or the posterior arm 12 is moved so that the needle-shaped member 14 is separated from the incision portion 72.

Then, as shown in FIGS. 5 (C) to 5 (D), both ends of the suture thread 22 move so as to be separated from the incision portion 72. Therefore, the length of the portion of the suture 22 located between the portion penetrating the first perforation and the portion penetrating the second perforation and located outside the stomach is shortened. The pair of rims 72a and 72b of the incision 72 move. That is, the pair of mouth edge portions 72a and 72b of the incision portion 72 move so that their end faces approach each other, and the incision portion 72 is sutured so that the end faces of the mouth edge portions 72a and 72b come into contact with each other.

Then, when the end faces of the pair of mouth edge portions 72a and 72b of the incision portion 72 come into contact with each other, the suture thread 22 is ligated in that state. Specifically, in the suture thread 22, a portion extending from the needle-shaped member 14 (that is, one engaging member 21) to the first perforation and a second portion from the needle-shaped member 14 (that is, the other engaging member 21). The part extending to the perforation is ligated. For this ligation, a commercially available clip or the like can be used. For example, if a clip or the like is supplied from the forceps opening of the endoscope 1 and attached to the suture thread 22, ligation can be performed.

Alternatively, the ligature member 50 as shown in FIGS. 6 (A) to 6 (D) may be used. That is, first, as shown in FIG. 6A, the loop portion of the linear member 52 of the ligature member 50 is moved, and both ends of the suture 22 (that is, the tip of the needle-shaped member 14) and a pair of rim portions. It is arranged so as to be located between 72a and 72b.

Next, after arranging the loop portion 52r at a position suitable for ligation, the linear member 52 is pulled from the tubular member 51 toward the hand side. Then, as shown in FIG. 6B, the loop portion 52r becomes smaller, and both ends of the suture thread 22 are bundled by the loop portion 52r.

Then, when the linear member 52 is further pulled toward the hand side from the state where both ends of the suture thread 22 are bundled by the loop portion 52r, the suture thread 22 is also pulled into the tubular member 51 together with the loop portion 52r. Then, since the inner diameter of the tubular member 51 is such that two linear members 52 can be inserted through the tubular member 51, the tubular member 51 is housed in the tubular member 51 in a state of being in close contact with the suture thread 22 and in a compressed state. That is, since the linear member 52 and the suture 22 are accommodated in the tubular member 51 in a tightened state, the suture 22 and the suture 52 are fixed so as not to fall out from the tubular member 51. Will be done. That is, both ends of the suture 22 are ligated.

As described above, when the ligature member 50 is used, the loop portion 52r of the linear member 52 is arranged so as to surround both ends of the suture thread 22, and the suture thread is provided by the loop portion 52r simply by pulling the linear member 52. Since the 22 can be bundled and ligated, the suture 22 can be ligated quickly and easily. The ligating member is not limited to the illustrated example.

Finally, if the portion of the suture thread 22 located closer to the needle-shaped member 14 than the ligated portion is cut, the incised portion is in contact with the end faces of the pair of mouth edge portions 72a and 72b of the incised portion 72. 72 can be fixed.

In the above example, the case where one needle-shaped member 14 is provided on the rear arm 12 of the suturing device 10 has been described, but a plurality of needle-shaped members 14 may be provided. Further, in the above example, the case where the number of branch portions 11s1 and 11s2 is two has been described, but the number of branch portions 11s provided on the front arm 11 may be three or more, or one (no branch).

In the suturing device 10 of the present embodiment, until the needle-shaped member 14 is inserted into the needle insertion portions 16a1, 16a2, the engaging member 21 housed in the needle insertion portions 16a1, 16a2 is along the direction of the swing axis. By covering the needle insertion portions 16a1, 16a2 with the film-shaped dropout prevention member 30 so that the needle insertion portion 16a1, 16a2 does not fall off from the needle insertion portion 16a1, 16a2, the engaging member 21 fixed to the suture thread 22 becomes the needle. It is configured so as not to fall off from the insertion portions 16a1 and 16a2. Therefore, even if the front arm 11 is greatly tilted from the horizontal direction when the suture device 10 is put into the body, or the front arm 11 collides with the body wall or the like and receives an impact, the suture thread 22 is the suture device. It is hard to come off from 10.

Further, after the needle-shaped member 14 is inserted into the needle insertion portions 16a1 and 16a2, the film-shaped fall-off prevention member 30 is torn to release the fall-off prevention, and the engaging member 21 engages with the needle-shaped member 14. Then, together with the needle-shaped member 14, it moves in a direction away from the needle insertion portions 16a1 and 16a2 along a direction parallel to the swing axis. Therefore, if this suturing device 10 is used, the wound can be sutured to the same extent as in surgery by an endoscope inserted into the gastrointestinal lumen.

The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.

For example, as the drop-out prevention member, any member that restricts each engaging member from falling out of the needle insertion portion by moving along the axial direction with respect to each needle insertion portion. It is not limited to the above-mentioned film, and may be formed by filling with a resin. When the fall-off prevention member is formed by filling with resin, an engaging recess 18 in which the engaging member 21 is accommodated, or a thread end accommodating groove 19 in which the end portion of the suture thread 22 is accommodated together with the connecting piece 21b, etc. The holes, grooves or recesses in which the engaging member 21 or part of the suture 22 is housed may be filled with resin.

When the resin comes into contact with both the end of the engaging member 21 or the suture 22 and the peripheral wall of the needle insertion portion 16a1 or 16a2, the end of the engaging member 21 or the suture 22 is inserted into the needle. It can be temporarily fixed to the portions 16a1 or 16a2 (an example of preventing falling off). Then, if the resin is broken or separated by an operation of penetrating the needle-shaped member 14 through the through hole 21h of the engaging member 21, the temporary fixing is released. Operations for suturing can be performed.

The type of resin used for filling is not particularly limited, and examples thereof include epoxy resin, polyurethane, polyester, polyamide, polycarbonate, polyolefin, and polysulfone.

Alternatively, the dropout prevention member may be formed by filling the engaging member 21 with another material for preventing the engagement member 21 from falling off from the needle insertion portion 16a1 or 16a2. When the fall-off prevention member made of other material comes into contact with both the end portion of the engaging member 21 or the suture thread 22 and the peripheral wall of the needle insertion portion 16a1 or 16a2, the engaging member 21 or the suture thread 22 It is possible to effectively prevent the end portion from falling off from the needle insertion portion 16a1 or 16a2.

Other materials used for filling are not particularly limited, and examples thereof include adhesives, agar, and gelatin.

Further, the fall-out prevention member is formed from the opening edge of the needle insertion portion 16a1 or 16a2 so as to cover at least a part of the opening of the needle insertion portion 16a1 or 16a2, which is joined to the back surface of the front arm 11 by means such as adhesion. It may be a rod-shaped body or a plate-shaped body that protrudes and can be broken by a force equal to or higher than a predetermined value. The rod-shaped body or plate-shaped body closes the opening of the needle insertion portion 16a1 or 16a2 at least partially, so that the accommodated engaging member 21 effectively prevents the needle insertion portion 16a1 or 16a2 from falling off. be able to. Then, if the rod-shaped body or the plate-shaped body is broken or refracted by the operation of penetrating the barbed portion 14a of the needle-shaped member 14 through the through hole 21h of the engaging member 21, it is possible to prevent the rod-shaped body or the plate-shaped body from falling off. Can be released to perform an operation for suturing.

The material for forming a rod-shaped body or a plate-shaped body that can be broken or refracted with a force equal to or higher than a predetermined value is not particularly limited, but is not particularly limited, for example, polyester, polyamide, polyurethane, polyolefin, polysulfone, or polyvinyl chloride. Resins such as vinyl are exemplified.

In this way, the drop-out prevention member holds the engaging member 21 so as not to fall off from the needle insertion portions 16a1, 16a2 until the needle-shaped member 14 is inserted into the needle insertion portions 16a1, 16a2, and is equal to or more than a predetermined value. Anything that can release the dropout prevention by being broken by force or the like may be used. The force equal to or higher than a predetermined value is the force when the tip of the needle-shaped member 14 is inserted into the engaging member 21, or the needle-shaped force after the tip of the needle-shaped member 14 is inserted into the engaging member 21. This is the force when the member 14 is pulled out from the needle insertion portions 16a1 and 16a2 together with the engaging member 21.

Further, in the above-described embodiment, the front arm 11 and the rear arm 12 are made of metal, but these materials are not particularly limited and may be made of resin or the like. In particular, when the front arm 11 is made of a thermoplastic resin, if the fall-off prevention member 30 is made of the same type of thermoplastic resin as the front arm 11, it can be easily joined by means such as heat welding or solvent welding. can. The resin constituting the front arm 11 is not particularly limited, and examples thereof include polyester, polyamide, polyurethane, polycarbonate, polyolefin, and polysulfone, and among them, a thermoplastic resin such as polyolefin (for example, polypropylene) is preferably used.

1 Endoscope 2 Shaft 10 Suture device 11 Front arm 11s1, 11s2 Branch part 12 Rear arm 13 Arm moving means 14 Needle-shaped member 16a1 Needle insertion part 16a2 Needle insertion part 16a3 Needle temporary part 17 Insertion hole 18 For engagement Recess 19 Thread end accommodating groove 20 Thread assembly 21 Engagement member 22 Suture thread 30 Falling prevention member 32 Through hole 50 Ligature member 51 Tubular member 52 Linear member 70 Stomach wall 72 Stomach wall hole

Claims (3)

A suturing device that is used by being inserted into the body while attached to an endoscope.
With the front arm
It is provided with a rear arm provided so as to be close to and separated from the front arm.
The rear arm includes at least one needle-like member.
The front arm is provided with at least two needle insertion portions capable of accommodating the tip end portion of the needle-shaped member when the front arm and the rear arm are close to each other.
In each of the needle insertion portions, an engagement member having an engagement through hole that can be engaged with the needle-shaped member is detachably housed in each of the needle insertion portions.
At least one set of the engaging members housed in each of the needle insertion portions is connected to each other by a suture.
A drop-out prevention member configured to prevent the engaging member from falling off from the needle insertion portion until the needle-shaped member is inserted into the needle insertion portion is provided.
The dropout prevention member has a film for preventing the engagement member from falling off from the needle insertion portion.
The film is adhered to the surface of the front arm located around the needle insertion portion so as to cover the needle insertion portion.
A suture is characterized in that a through hole penetrating the front and back surfaces of the film is formed in advance in the film at a position where the engaging through hole of the engaging member can be visually recognized through the through hole. Device. The dropout prevention member further has a resin for temporarily fixing the engaging member to the needle insertion portion.
The suture device according to claim 1, wherein the resin is filled in a part of a hole, a groove or a recess in which the engaging member or a part of the suture is housed. The suture according to claim 2, wherein the fall-out prevention member is temporarily fixed to the engaging member or a part of the suture and the needle insertion portion so as to be broken or separated by a force equal to or higher than a predetermined value. Device.

Images