WO2012096280A1 - Suturing system and endoscopic system - Google Patents

Suturing system and endoscopic system Download PDF

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Publication number
WO2012096280A1
WO2012096280A1 PCT/JP2012/050329 JP2012050329W WO2012096280A1 WO 2012096280 A1 WO2012096280 A1 WO 2012096280A1 JP 2012050329 W JP2012050329 W JP 2012050329W WO 2012096280 A1 WO2012096280 A1 WO 2012096280A1
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WO
WIPO (PCT)
Prior art keywords
tissue
suturing
thread
tissue penetrating
suturing system
Prior art date
Application number
PCT/JP2012/050329
Other languages
French (fr)
Japanese (ja)
Inventor
山本　哲也
Original Assignee
オリンパスメディカルシステムズ株式会社
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Filing date
Publication date
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Publication of WO2012096280A1 publication Critical patent/WO2012096280A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646—Type of implements
    • A61B2017/00663—Type of implements the implement being a suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0409—Instruments for applying suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0419—H-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004—Means for attaching suture to needle
    • A61B2017/06009—Means for attaching suture to needle having additional means for releasably clamping the suture to the needle, e.g. actuating rod slideable within the needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A61B2017/06104—Needles, e.g. needle tip configurations interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/2833—Locking means
    • A61B2017/2837—Locking means with a locking ratchet

Definitions

  • the present invention relates to a suturing system and an endoscope system for suturing tissue.
  • This application is the application which claimed the priority based on provisional application 61/431580 for which it applied to the United States on January 11, 2011, and uses the content of the said US provisional application here.
  • the automatic suturing device described in Patent Document 1 has a structure in which needles (36, slender thread-like members) formed with pointed ends are alternately moved to the tip portions (34a, 34b) of a pair of jaws. ing.
  • the surgical needle (12) having both ends formed at the tip is a pair of jaws (18, 20), as in the automatic suturing device described in Patent Document 1 above. It has a structure that can be changed alternately.
  • the pair of arms (24a, 24b) formed in the shape of a hollow needle having a curved tip are opened and closed with respect to the tubular member (12). It has a configuration that can.
  • the thread-like suture material (30) disposed in the lumen of one arm is used as the lumen of the other arm. Sent out.
  • This structure allows the suture material to pass through the tissue. Thereafter, the device is removed from the body, and two suture materials coming out of the mouth and the like are tied outside the body to form a knot, and the suture site is ligated and sutured by a device (70) having a knot pusher function.
  • the present invention has been made in view of the above circumstances, and a suturing system and an endoscope system capable of preventing a needle-like member from dropping and damaging surrounding tissue and continuously suturing the tissue.
  • the purpose is to provide.
  • a suturing system is a suturing system comprising: an elongated thread-like member; and a suturing device that allows the elongated thread-like member to be detachable and sutures tissue using the elongated thread-like member.
  • the elongated thread-like member has a tip member, a thread-like main body portion whose one end is connected to the tip member, and whose outer diameter is set smaller than the outer diameter of the tip member, and the other end of the thread-like main body portion.
  • a tissue fixing member having one end connected to the mediation unit and disposed on the opposite side of the filamentous main body, and having an outer diameter set larger than the outer diameter of the filamentous main body.
  • the suturing device has a pair of tissue penetrating members having a lumen capable of accommodating the tip member and an opening communicating with the lumen, and the pair of tissue penetrating members is one of the tissue penetrating members. A portion of the other tissue A communicating position where the lumen of each other are made to communicate with each enters into the lumen of the member, and a separated position in which the pair of the tissue-piercing member is spaced apart from each other, the provided movable relative.
  • the tissue penetrating members are respectively fixed to a pair of jaw members that approach and separate from each other.
  • the tissue penetrating member has a slit into which the thread-like main body portion can be inserted.
  • a pair of detaching members that are disposed so as to be able to advance and retreat in the lumen of the tissue penetrating member and push out the tip member housed in the tissue penetrating member from the opening. It has.
  • the inner peripheral surface of the tissue penetrating member is locked from protruding from the inner peripheral surface and moving the distal end member of the elongated thread-like member toward the opening side.
  • the protrusion is deformed by pushing out the tip member by the removing member, and a convex portion is formed on which the tip member can get over.
  • the suturing device includes a switching mechanism for alternately moving the pair of detaching members forward and backward along the lumen of the tissue penetrating member.
  • the switching mechanism is rotated around a predetermined axis, whereby the position of the removal member in the lumen of the tissue penetrating member is set along the lumen.
  • the suturing system further includes a rotation assist mechanism that restricts the rotating member to rotate about the same direction of the predetermined axis.
  • the tissue penetrating member has the pair of tissue penetrating members positioned at the communicating position with the tissue sandwiched between the openings.
  • a blade portion capable of incising a portion of the tissue sandwiched between the openings is provided.
  • the thread main body is formed of a material having a higher tensile strength than the tissue fixing member.
  • the thread-like main body portion of the elongated thread-like member is made of metal.
  • the tissue fixing member of the elongated thread-like member is formed of resin.
  • the tip member of the elongated thread-like member is formed in a substantially spherical shape.
  • At least a part of the tip member of the elongated thread-like member is pointed like a needle.
  • the elongated thread-like member has a thread locking member that can be fixed to the tissue fixing member.
  • An endoscope system includes the suturing system and an endoscope in which a forceps channel into which the suturing device can be inserted is formed and which can observe a predetermined visual field range. Prepare.
  • the suturing device is provided with an index capable of confirming that the pair of tissue penetrating members are in the communication position.
  • the index is set so as to be positioned within the visual field range of the endoscope when the suture instrument is inserted into the forceps channel and the suture instrument is attached to the endoscope.
  • the indicator moves in conjunction with movement of the tissue penetrating member between the communication position and the separation position.
  • the treatment portion and the insertion portion of the suturing device can be substantially reduced in size and diameter. Further, it is possible to prevent the needle-like member from falling off and damaging the surrounding tissue, which can occur with a conventional suture instrument. In addition, the tissue can be continuously sutured. Furthermore, according to the endoscope system of the present invention, since the suture instrument and the endoscope are provided, the tissue can be sutured with the suture instrument while observing the front with the observation unit of the endoscope.
  • 1 is an overall view of an endoscope system according to a first embodiment of the present invention.
  • 1 is an overall view of an elongated thread-like member attached to a suture instrument of an endoscope system according to a first embodiment of the present invention. It is a plane sectional view of a treatment part of a suture instrument of a 1st embodiment of the present invention. It is side surface sectional drawing of the treatment part of the suturing device of 1st Embodiment of this invention.
  • It is a disassembled perspective view of a front-end
  • FIG. It is a principal part enlarged view of FIG. It is a side view of the principal part of the treatment part of 1st Embodiment of this invention. It is side surface sectional drawing of the principal part of the treatment part of 1st Embodiment of this invention. It is side surface sectional drawing of the operation part of the suturing device of 1st Embodiment of this invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention.
  • FIGS. 1 to 20 This endoscope system is a system that performs a treatment of suturing tissue with a suture instrument while observing the inside of a body cavity with an endoscope.
  • FIGS. 3, 12, 14 to 18, 29, and 31 to 34 are conceptual diagrams, and are partially different in shape from other detailed views.
  • the endoscope system 1 includes an endoscope 3, an insertion portion 4, a suture device 5, and an elongated thread-like member 24.
  • the endoscope 3 has a forceps channel 2 formed therein.
  • the suturing device 5 is configured such that a long insertion portion 4 provided on the distal end side can be inserted into the forceps channel 2.
  • the elongated thread-like member 24 is detachable from the suturing device 5 and is used for suturing tissue.
  • the suture device 5 can be used not only for a flexible endoscope but also for a surgical operation in combination with a rigid endoscope. In this case, you may make the above-mentioned insertion part 4 rigid.
  • the endoscope 3 has a long endoscope insertion portion 8 and an endoscope operation portion 9 connected to the proximal end portion of the endoscope insertion portion 8.
  • An endoscope having a known configuration is used as the endoscope 3.
  • the endoscope insertion portion 8 includes a distal end hard portion 10, a bending portion 11, and a flexible tube portion 12.
  • the tip hard portion 10 is provided at the tip.
  • the bending portion 11 can be bent and is connected to the proximal end side of the distal end hard portion 10.
  • the flexible tube portion 12 is connected to the proximal end side of the bending portion 11.
  • An illumination unit 13 that emits illumination light and an observation unit 14 that detects reflected illumination light are provided on the front surface of the distal end hard portion 10.
  • a glass fiber, an LED, or the like is used for example.
  • the observation unit 14 a member having a plurality of optical lenses and a CCD is used. Moreover, the observation unit 14 is set so that the inside of the predetermined visual field range R ahead can be observed.
  • the endoscope operation section 9 is provided with an operation dial 17 for operating the bending state of the bending section 11.
  • One end of a universal cable 18 is connected to the endoscope operation unit 9.
  • the other end of the universal cable 18 is connected to a display unit (not shown). On the display unit, an image within the field of view acquired by the observation unit 14 can be displayed.
  • the aforementioned forceps channel 2 communicates with an opening formed in the front surface of the distal end hard portion 10 and extends through the endoscope insertion portion 8 to the endoscope operation portion 9.
  • the forceps channel 2 further communicates with an opening of a forceps plug 19 provided in the endoscope operation unit 9.
  • the suturing device 5 includes the above-described insertion portion 4, a treatment portion 22, and an operation portion 23.
  • the treatment portion 22 is provided at the distal end portion of the insertion portion 4.
  • the operation unit 23 is connected to the proximal end portion of the insertion unit 4.
  • An elongated thread-like member 24 that is sutured to the tissue by the suture device 5 is detachably attached to the treatment portion 22.
  • the suturing system according to this embodiment includes a suturing device 5 and an elongated thread-like member 24.
  • the elongate thread-like member 24 has a linear main body portion 28 and a tip member 27 attached to one end portion of the main body portion 28.
  • the tip member 27 is formed in a substantially spherical shape having an outer diameter larger than that of the main body portion 28.
  • the main body portion 28 includes a thread-like main body portion 29, an intermediary portion 30, and a tissue fixing portion 31.
  • One end of the thread-like main body 29 is connected to the tip member 27, and the mediation part 30 is connected to the other end of the thread-like main body 29.
  • the tissue fixing member 31 is disposed on the opposite side of the filamentous main body 29 with the mediation portion 30 interposed therebetween, and one end thereof is connected to the mediation portion 30.
  • the thread-like main body portion 29 is formed with an outer diameter smaller than that of the tip member 27.
  • the filamentous main body 29 is formed of a material having a higher tensile strength than the tissue fixing member 31.
  • the thread-like main body 29 is made of a material having flexibility and characteristics that are harder to cut than a general suture.
  • the material is, for example, metal, and specifically, stainless steel, titanium, Ni—Ti, rubber metal ( ⁇ -type titanium alloy), gold, or composite fiber liquid crystal polymer combined with resin, carbon fiber, and the like are suitable. Can be used.
  • the filamentous main body 29 may be in any form such as a monofilament form or a multifilament form, but the multifilament form has a lower resistance during stitching.
  • the mediation part 30 has a narrow width in a cross section in a plane orthogonal to the axial direction of the thread-like main body part 29 and the tissue fixing member 31 so that the tissue can pass smoothly.
  • the tissue fixing member 31 has an outer diameter that is set to be larger than the outer diameter of the filamentous main body 29 and is configured to be long.
  • the tissue fixing member 31 is made of resin.
  • a non-absorbable thread and a suture material including an absorbent thread can also be used as a material of the tissue fixing member 31 as a material of the tissue fixing member 31, a non-absorbable thread and a suture material including an absorbent thread can also be used.
  • the other end of the tissue fixing member 31 is provided with a bar 32 disposed so as to be orthogonal to the tissue fixing member 31.
  • the bar 32 may not be provided on the elongated thread-like member 24 depending on the contents of the procedure performed using the endoscope system of the present embodiment.
  • the tip holding portion 35 is formed in a substantially cylindrical shape extending along the central axis C ⁇ b> 1 of the insertion portion 4, and is disposed on the tip side of the insertion portion 4.
  • the distal end side of the forceps operation wire 36 extending along the central axis C1 is inserted.
  • a hole 35a is provided in the vicinity of the tip of the tip holding portion 35, and a slit 35b is provided on the inner peripheral surface of the tip holding portion 35.
  • the base end portion of the slit 35b extends to the base end side from the hole 35a.
  • a pin 37 that is a first locking member (tip locking member) is disposed in the hole 35a. A part of the pin 37 protrudes into the tip holding portion 35 in a state of being inserted into the hole 35a.
  • the pin 37 is attached to the outer peripheral surface of the tip holding portion 35 by a leaf spring 38 that is an urging member. By this leaf spring 38, the pin 37 is urged in a direction to be accommodated in the hole 35a.
  • an elongated release member 39 is inserted into the slit 35b.
  • the release member 39 is a second release member (forceps release member) fixed to the tip holding portion 35 by laser welding or an adhesive.
  • the release member 39 is cut obliquely on the central axis C1 side on the base end side.
  • a cylinder portion 40a of the tip cover 40 is inserted from the tip opening side.
  • the tip cover 40 has the above-described tube portion 40a and a cover main body 40b.
  • the cylindrical portion 40 a has an outer diameter that is substantially equal to or slightly smaller than the inner diameter of the tip holding portion 35.
  • the cover main body 40b is disposed on the distal end side of the cylindrical portion 40a and is formed integrally with the cylindrical portion 40a.
  • a coil spring 41 is disposed outside the cylindrical portion 40a and urges the tip cover 40 away from the tip holding portion 35 in the direction of the central axis C1.
  • slits 40c and 40d are formed in the cylindrical portion 40a along the direction of the central axis C1.
  • the slit 40c is formed around the axis of the cylindrical portion 40a in accordance with the position where the hole 35a of the tip holding portion 35 is formed (see FIG. 4).
  • the width of the slit 40c is such that the pin 37 cannot enter (see FIG. 6), but only the base end portion 40f of the slit 40c is widened so that the tip of the pin 37 can enter.
  • the slit 40d is formed around the axis of the cylindrical portion 40a in accordance with the formation position of the slit 35b of the tip holding portion 35.
  • the width of the slit 40d is such that the release member 39 can be disposed (see FIG. 7).
  • the base end of the slit 40d extends to the base end side from the base end portion 40f of the slit 40c. Further, at the base end of the slit 40d, the inner diameter of the through-hole is increased with respect to the width of the slit 40d, and a large-diameter portion 40g communicating with the slit 40d is formed (see FIG. 7).
  • a rod 44 constituting an opening / closing mechanism is inserted into the tip cover 40 so as to be movable forward and backward in the direction of the central axis C1.
  • the distal end portion of the forceps operation wire 36 is fixed to the proximal end portion of the rod 44.
  • a concave portion 44 a extending in the radial direction is formed at a position near the proximal end of the rod 44.
  • a ball 45 as a second locking member (forceps locking member) is inserted into the recess 44a.
  • the second locking member (forceps locking member) is formed in a spherical shape, but may be formed in any shape such as a columnar shape or a prismatic shape.
  • the ball 45 is urged radially outward by a coil spring 46 disposed in the recess 44a. As shown in FIG. 7, the ball 45 is formed in such a size that it can enter the large diameter portion 40g provided at the base end portion of the slit 40d of the cylindrical portion 40a but cannot enter the slit 40d.
  • the first release member (at the tip side of the position where the ball 45 is disposed and at a position which is symmetrical with respect to the central axis C1 from the position where the ball 45 is disposed).
  • a release member 47 which is a tip release member is attached to the rod 44.
  • the release member 47 is fixed to the outer surface of the rod 44 in a state where a part protrudes radially outward.
  • a tapered surface is provided on the outer peripheral surface of the base end portion of the release member 47 so that the pin 37 can easily ride on the release member 47 when the release member 47 moves to the base end side.
  • Two link members 49 and 50 are attached to the tip of the rod 44 through pins 48 so that one end portions of each of the link members 49 and 50 are rotatable.
  • the other end of the link member 49 and the one end 52 a of the jaw member 52 are connected to each other via a pin 51 so as to be freely rotatable.
  • the jaw member 52 has a through-hole formed at a predetermined position from one end 52a to the other end 52b (see FIG. 3).
  • the jaw member 52 is pivotally supported by the tip cover 40 by allowing the through hole to engage with a pin (pivot shaft) 53 fixed to the tip cover 40.
  • the other end of the link member 50 is rotatably connected to one end 55a of the jaw member 55 by a pin 54.
  • the jaw member 55 is pivotally supported by the tip cover 40 by a pin 53.
  • the treatment portion 22 configured as described above pulls the forceps operation wire 36 to rotate the other end portion 52b of the jaw member 52 and the other end portion 55b of the jaw member 55 around the axis of the pin 53. , Can be closed close to each other. Further, by pushing the forceps operation wire 36, the other end 52b of the jaw member 52 and the other end 55b of the jaw member 55 can be opened apart from each other.
  • the tissue penetrating member 58 is formed in a curved tubular shape with a hollow structure.
  • a through hole 52 c is formed in the other end 52 b of the jaw member 52.
  • the tissue penetrating member 58 is attached to the outside of the jaw member 52 in the opening / closing direction so as to extend substantially parallel to the central axis C1.
  • the distal end side of the tissue penetrating member 58 is curved toward the other end 55b side of the jaw member 55 through the through hole 52c.
  • the lumen of the tissue penetrating member 58 is set to a size that can accommodate the distal end member 27 of the elongated thread-like member 24.
  • the tissue penetrating member 58 has a slit 58a extending from a distal end opening to a predetermined length in the axial direction of the tissue penetrating member 58.
  • the width of the slit 58a is set such that the thread-like main body 29 of the elongated thread-like member 24 can be inserted.
  • a cutting edge 59 for penetrating tissue is provided at the edge of the distal end portion of the tissue penetrating member 58 over the entire circumference except the portion where the slit 58a is formed.
  • a pusher (detaching member) 60 that is disposed so as to be able to advance and retreat in the lumen and pushes the distal end member 27 accommodated in the tissue penetrating member 58 from the opening.
  • the pusher 60 is made of a material that is flexible enough to advance and retreat along the lumen of the curved tissue penetrating member 58 and at the same time has little expansion and contraction in the axial direction of the pusher 60.
  • the proximal end side of the pusher 60 extends toward the distal end holding portion 35 side together with the proximal end side of the tissue penetrating member 58.
  • a convex portion 58 b protruding from the inner peripheral surface is formed on the inner peripheral surface on the distal end side of the tissue penetrating member 58.
  • the convex portion 58b is formed so that the tip member 27 can be moved over the opening side, and the tip member 27 deformed by pushing the tip member 27 by the pusher 60 can be overcome.
  • the convex portion 58b is formed by deforming the tissue penetrating member 58 formed in a tubular shape, but another component is attached to the tissue penetrating member 58 with an adhesive, brazing, soldering, laser processing, or the like. You may form a convex part by joining.
  • tissue penetrating member 61 is attached to the outside of the jaw member 55 in the opening / closing direction so as to extend substantially parallel to the central axis C1.
  • a tissue penetrating member 61 formed in a tubular shape is fixed to the other end portion 55 b of the jaw member 55.
  • the distal end side of the tissue penetrating member 61 is curved toward the other end 52b of the jaw member 52, and the opening at the distal end of the tissue penetrating member 61 and the opening at the distal end of the tissue penetrating member 58 are configured to face each other.
  • the tissue penetrating member 61 can accommodate the distal end member 27 of the elongated thread-like member 24 in the lumen, and the inner diameter is set to be approximately equal to the outer diameter of the tissue penetrating member 58.
  • the tissue penetrating member 61 has a slit 61 a extending from the opening at the tip to a predetermined length in the axial direction of the tissue penetrating member 61.
  • the width of the slit 61a is set in the same manner as the slit 58a.
  • a cutting edge 62 for penetrating the tissue is provided at the edge of the distal end portion of the tissue penetrating member 61 over the entire circumference except the portion where the slit 61a is formed.
  • a pusher 63 is provided in the lumen of the tissue penetrating member 61.
  • the pusher 63 is disposed so as to be able to advance and retreat in the lumen of the tissue penetrating member 61, and pushes the distal end member 27 accommodated in the tissue penetrating member 61 from the opening.
  • a convex portion 61b having the same configuration as the convex portion 58b is formed on the inner peripheral surface on the distal end side of the tissue penetrating member 61.
  • the tissue penetrating member 58 configured in this manner pulls the forceps operation wire 36 to close the jaw members 52 and 55, so that the tip of the tissue penetrating member 58 enters the lumen of the tissue penetrating member 61, and the tissue The lumen of the penetrating member 58 and the lumen of the tissue penetrating member 61 can be moved to a communicating position (see FIG. 8). Further, the tissue penetrating member 61 can be moved to a spaced position (see FIG. 13) where the openings of the tissue penetrating members 58 and 61 are separated from each other by pushing the forceps operation wire 36 to open the jaw members 52 and 55. .
  • tissue penetrating members 58 and 61 When the tissue penetrating members 58 and 61 are disposed at the communication position in a state where the tissue is sandwiched between the openings of the tissue penetrating members 58 and 61, a portion of the tissue sandwiched between the openings by the cutting blades 59 and 62 An incision can be made.
  • the switching member (rotating member) 67 is formed in a substantially cylindrical shape and is rotatably disposed on the outer peripheral surface of the tip holding portion 35.
  • the position of the pin 68 attached to the outer peripheral surface of the tip cover 40 is shifted by 90 ° around the central axis C1 with respect to the position of the pin 68 in FIG. Is written.
  • the switching member 67 is configured to be attachable to and detachable from the tip holding portion 35.
  • Contact surface 69a, 69b, 69c which the base end parts 60a and 63a of pusher 60 and 63 contact
  • the contact surface which is not shown in figure is formed also in the part on the opposite side of the front-end
  • a cam groove 70 is formed on the inner peripheral surface of the switching member 67, and the pin 68 engages with the cam groove 70 so as to be slidable within the cam groove 70.
  • the cam groove 70 includes a parallel cam groove 70a formed substantially parallel to the central axis C1 and an inclined cam groove 70b that moves toward the proximal end as it rotates in the direction D1 with respect to the central axis C1 around the central axis C1. It is configured to be connected alternately. In the present embodiment, for example, four parallel cam grooves 70a and four inclined cam grooves 70b arranged at equal angles around the central axis C1 are alternately connected.
  • a plurality of mountain-shaped bodies 71 and 72 are provided integrally with the switching member 67 on the distal end side and the proximal end side of the switching member 67.
  • the mountain-shaped bodies 71 and 72 are continuously formed in a mountain shape around the central axis C1 at equal angles.
  • four parallel cam grooves 70 a are formed in the switching member 67. Therefore, the mountain-shaped bodies 71 and 72 are provided, for example, at equal angles around the central axis C1 by 12 that is a multiple of 4. For this reason, the angle which the top part 72a of the adjacent mountain-shaped body 72 makes around the central axis C1 is 30 °.
  • the mountain-like bodies 73 and 74 formed in a mountain shape corresponding to the mountain-like bodies 71 and 72 at positions opposite to the mountain-like bodies 71 and 72 are equiangularly around the central axis C1.
  • the valley 74a of the mountain 74 that engages the top 72a of the mountain 72 is around the direction D1 of the central axis C1 from the position moved from the top 72a of the mountain 72 to the proximal end in the direction of the central axis C1. It is arranged at a position moved by a predetermined angle. Since the mountain-shaped body 74 is also provided around the central axis C1 every 30 °, the predetermined angle can be 8 °, which is a value smaller than half of 30 °, for example.
  • the mountain-like body 73 is also disposed at a position where the position in the direction of the central axis C1 relative to the mountain-like body 71 is moved by a predetermined angle around the central axis C1. Then, as the pin 68 moves in the cam groove 70, the switching member 67 is formed to rotate intermittently around the direction D1.
  • the switching member 67 does not rotate around the central axis C1, but the pin 68 side rotates.
  • the switching member 67 does not rotate when the pin 68 moves to the proximal end side as indicated by the arrow A1 in the parallel cam groove 70a. Then, when the pin 68 reaches the position Q1 in the parallel cam groove 70a and moves to the base end side together with the switching member 67 as will be described later, the mountain body 72 and the mountain body 74 are engaged, The switch member 67 is rotated by 8 ° around the direction D2 opposite to the direction D1 with respect to the central axis C1, and reaches the position Q2. Actually, the switching member 67 rotates in the direction D1. Thereafter, when the pin 68 moves to the tip end side as indicated by the arrow A2, the switching member 67 rotates in the direction D1 by the pin 68 coming into contact with the inclined cam groove 70b.
  • the cam groove 70 and the pin 68 constitute a cam mechanism that rotates the switching member 67 around the central axis C1.
  • the switching member 67 and the cam mechanism constitute a switching mechanism for alternately moving the pushers 60 and 63 back and forth.
  • the mountain-like bodies 71 to 74 constitute a rotation assist mechanism that restricts the switching member 67 to rotate around the same direction of the central axis C1.
  • the insertion portion 4 has a sheath 80 that is flexible and formed in a tubular shape.
  • the aforementioned distal end holding portion 35 is attached to the distal end of the sheath 80.
  • a forceps operation wire 36 is inserted into the sheath 80 so as to be able to advance and retreat.
  • the proximal end portion of the sheath 80 is connected to the distal end side of the substantially rod-shaped operation portion body 84.
  • a wire operation slider 86 is attached to the operation portion body 84 so as to be able to advance and retract.
  • a proximal end portion of the forceps operation wire 36 is attached to the wire operation slider 86.
  • the operation unit 23 has a ratchet mechanism.
  • the button 87 When the button 87 is pushed in as shown in FIG. 11, the ratchet mechanism is released. Then, the locking portion 87 a formed on the button 87 is separated from the notch member 91 formed on the operation portion body 84, and the wire operation slider 86 can be freely advanced and retracted with respect to the operation portion body 84.
  • the stopper 88 formed on the button 87 is removed from the engaging portion 89 formed on the wire operation slider 86, and the button 87 is slid into the pulled-out state. Then, the locking portion 87a urged in the radial direction by the spring 90 moves in the radial direction, the locking portion 87a engages with the notch member 91 of the operation portion body 84, and the wire operation slider 86 is It can move only to the base end side with respect to the body 84. Thereby, the jaw members 52 and 55 cannot move in the opening direction.
  • the target site is not limited to this, and may be a luminal organ such as the esophagus, duodenum, small intestine, large intestine, uterus, and bladder.
  • the natural opening into which the endoscope 3 is inserted is not limited to the mouth but may be the nose or the anus.
  • it may be used for the treatment of hemorrhage such as perforation due to ulcer, mucosal defect part, digestive tract diverticulum and the like.
  • the surgeon inserts the insertion unit 4 of the suture device 5 into the forceps channel 2 of the endoscope 3 and attaches the suture device 5 to the endoscope 3. Then, the suture device 5 is inserted into the stomach through the patient's mouth together with the endoscope 3.
  • the suturing device 5 is directly fixed to the endoscope 3 and used. Also good.
  • the jaw members 52 and 55 are opened in the stomach prior to suturing.
  • the surgeon pushes the wire operation slider 86 of the operation unit 23 shown in FIG.
  • the forceps operation wire 36 moves forward, and the link members 49 and 50 connected to the rod 44 rotate the jaw members 52 and 55 around the pin 53.
  • the jaw members 52 and 55 are opened, and the openings of the tissue penetrating members 58 and 61 are arranged at spaced apart positions.
  • the position and orientation of the operation unit 23 are adjusted, and the opened jaw members 52 and 55 are brought close to the opening W1 of the patient P that is the evening-getting part.
  • the wire operation slider 86 is pulled back so as to squeeze the tissue W2 on one side with respect to the opening W1 by the jaw members 52 and 55.
  • the forceps operation wire 36 is retracted together with the link members 49 and 50, and the jaw members 52 and 55 are rotated around the pin 53 and closed. Then, the tissue penetrating members 58 and 61 fixed to the jaw members 52 and 55 are moved to the communication position with the tissue W2 sandwiched between the respective openings and inserted into the tissue W2, and the tissue penetrating member 58, 61 lumens communicate with each other. It should be noted that puncture can be performed with the same operation even when the suture target is not an opening shape but a flat portion.
  • the distal end member 27 moves from the tissue penetrating member 61 to the tissue penetrating member 58, and the filamentous main body 29 passes through the tissue W2.
  • the proximal end portion 60a of the pusher 60 does not contact the contact surfaces 69a, 69b, 69c, the pusher 60 is at the same position inside the tissue penetrating member 58.
  • the switching member 67 does not rotate around the central axis C1 when the pin 68 moves in the direction of the arrow A1, but when the pin 68 reaches the proximal end of the cam groove 70, the pin 68 is engaged with the cam groove 70.
  • the pin 68 and the switching member 67 are integrally moved to the proximal end side.
  • the mountain-shaped body 72 and the mountain-shaped body 74 come into contact with each other, and the switching member 67 rotates by a predetermined angle in the direction D1 of FIG. Thereafter, the moving direction of the pin 68 is switched from the arrow A1 to the arrow A2.
  • FIG. 4 shows a state in which the cylindrical portion 40a and the rod 44 are connected.
  • the operation of opening the jaw members 52 and 55 will be described.
  • the integrated tip cover 40 and rod 44 move to the tip side.
  • the switching member 67 rotates in the direction D1 in FIG. 9, and the contact surface of the proximal end portion 63a of the pusher 63 is changed from the contact surface 69a to the contact surface 69c by the rotation. , Switching through the contact surface 69b.
  • the angle at which the switching member 67 rotates about the central axis C1 is generally 90 ° rotation, but may be other than 90 ° depending on use conditions.
  • the pin 68 reaches the distal end side of the cam groove 70, whereby the pin 68 and the switching member 67 move together to the distal end side. Due to this movement, the mountain-shaped body 73 and the mountain-shaped body 71 come into contact with each other, the switching member 67 rotates by a predetermined angle in the direction D1, and the pin 68 engages with a portion (not shown) of the cam groove 70.
  • the ball 45 is pushed up by the release member 39, the engagement between the rod 44 and the tip cover 40 is released, and the jaw members 52 and 55 are opened.
  • the release member 47 moves to the proximal end side in parallel to the central axis C1.
  • the pin 37 enters the proximal end portion 40f of the slit 40c formed in the tip cover 40 through the hole 35a of the tip holding portion 35, and the tip cover 40 and the tip holding portion 35 are integrated.
  • the protrusions of the pusher 60 and the pusher 63 are repeatedly switched alternately so that the distal end member 27 moves alternately between the tissue penetrating member 58 and the tissue penetrating member 61.
  • the tissue W2 on one side and the tissue W3 on the other side with respect to the opening W1 can be alternately sutured by the elongated thread-like member 24.
  • the opening 5 may be closed by moving the suturing device 5 to the proximal end side.
  • the tip member 27 has a substantially spherical shape. Therefore, for example, even if the distal end member 27 falls off, it is possible to prevent the needle-like member from dropping off and damaging the surrounding tissue as in a conventional suture instrument. Further, the tissue can be continuously sutured by repeatedly delivering the tip member 27 between the tissue penetrating members 58 and 61.
  • the elongated thread-like member 24 has a tip member 27 and a thread-like main body portion 29 having an outer diameter smaller than that of the tip member 27. Therefore, the thread-like main body portion 29 is formed in a hole formed by penetrating the tip member 27 into the tissue. Can be reliably inserted.
  • the tissue penetrating member 58 is fixed to the jaw member 52, and the tissue penetrating member 61 is fixed to the jaw member 55. For this reason, by moving the jaw members 52 and 55 closer to and away from each other, the position of the tissue penetrating members 58 and 61 can be easily moved between the communication position and the separation position, and the elongated thread-like member 24 can be easily sutured. be able to.
  • the tissue penetrating member 58 has a slit 58a into which the thread-like main body portion 29 of the elongated thread-like member 24 can be inserted.
  • the tissue penetrating member 58 passes through the slit-like body portion 29 connected to the distal end member 27 accommodated in the lumen of the tissue penetrating member 58 through the slit 58a. Lead outside. As a result, it is possible to prevent the filamentous main body 29 from interfering with the movement of the distal end member 27 in the lumen of the tissue penetrating member 58.
  • the suture instrument 5 includes the pushers 60 and 63, the distal end member 27 in the tissue penetrating members 58 and 61 can be easily pushed out from the opening.
  • the distal end member 27 accommodated on the proximal end side from the convex portion 58 b in the lumen of the tissue penetrating member 58 is mistakenly inserted into the tissue penetrating member 58. Prevents falling off from the tip side of the. Then, if necessary, the distal end member 27 can be ejected from the distal end side of the tissue penetrating member 58 by pushing the distal end member 27 with the pusher 60.
  • the pushers 60 and 63 can be easily advanced and retracted along the lumens of the tissue penetrating members 58 and 61. Since the switching mechanism includes the switching member 67 and the cam mechanism, the pushers 60 and 63 can be advanced and retracted only by rotating the switching member 67 around the central axis C1 by the cam mechanism. Since the switching mechanism has a rotation assist mechanism that restricts the switching member 67 to rotate about the same direction of the central axis C1, the movement of the switching member 67 can be stabilized.
  • a cutting edge 59 is provided at the distal end portion of the tissue penetrating member 58, and a cutting edge 62 is provided at the distal end portion of the tissue penetrating member 61. Therefore, when the tissue penetrating members 58 and 61 are disposed at the communication position, the tissue sandwiched between the tissue penetrating member 58 and the tissue penetrating member 61 can be easily penetrated by the cutting blades 59 and 62.
  • the outer diameter can be set smaller than the outer diameter of the tissue fixing member 31.
  • the tip member 27 which is a member which moves back and forth between tissues at the time of suturing can be designed small. Therefore, the tissue penetrating members 58 and 61 that operate in cooperation with the distal end member 27 can also be reduced in size. As a result, the treatment portion 22 and the insertion portion 4 of the suturing device 5 can be substantially reduced in size and diameter.
  • the tissue penetrating members 58 and 61 can selectively grasp a site to be sutured in the tissue.
  • the tissue penetrating members 58 and 61 are configured so that the tissue does not fall off the tissue penetrating members 58 and 61.
  • the tissue can be reliably penetrated.
  • the thread-like main body 29 is made of metal, it is possible to prevent the thread-like main body 29 from being cut during the procedure.
  • the tissue fixing member 31 is made of resin, the tissue fixing member 31 can be bent along the shape of the sutured tissue. Since the tip member 27 is formed in a substantially spherical shape, it is possible to reduce the invasion given to surrounding tissues when the tip member 27 is accidentally dropped.
  • the endoscope system 1 includes the suturing device 5 and the endoscope 3, the tissue can be sutured with the suturing device 5 while observing the front with the observation unit 14 of the endoscope 3.
  • an elongated thread-like member 94 shown in FIG. 19 may be used instead of the elongated thread-like member 24.
  • the elongated thread-like member 94 includes a distal end member 95 instead of the distal end member 27 of the elongated thread-like member 24.
  • the tip member 95 is formed in a substantially cylindrical shape extending in a direction substantially orthogonal to the thread-like main body portion 29, and needle-pointed portions, more specifically conical pointed portions 95a and 95b, are formed at both ends of the tip member 95. ing.
  • the elongated thread-like member 94 is loaded into the suturing device 5 in the same manner as the elongated thread-like member 24.
  • the elongated thread-like member 94 By configuring the elongated thread-like member 94 in this way, when the tissue penetrating members 58 and 61 penetrate the tissue at the time of tissue puncture by the suturing device 5 and the lumens of the tissue penetrating members 58 and 61 communicate with each other, the apex It becomes easy to puncture the tissue by the portions 95a and 95b.
  • the pointed portion may be formed only at one end of the tip member 95.
  • the inner diameter of the tissue penetrating member 61 on the proximal side from the convex portion 61b may be substantially equal to the inner diameter of the tissue penetrating member 58 on the distal side from the convex portion 58b. With this configuration, the distal end member 27 can move between the tissue penetrating member 58 and the tissue penetrating member 61 more smoothly.
  • the endoscope system of this embodiment includes the endoscope 3 of the above embodiment, the elongated thread-like member 105 shown in FIG. 21, the suturing device 5 of the above embodiment, and the pusher tube 113 shown in FIG. Yes.
  • the elongated thread-like member 105 is detachably attached to the treatment portion 22 of the suturing device 5. As shown in FIG. 21, the elongated thread-like member 105 includes a mediating part 106 instead of the mediating part 30 of the elongated thread-like member 24, and a thread locking member 107 that can be fixed to the tissue fixing member 31.
  • a slit 106a having a predetermined length is formed along the longitudinal direction from the end on the tissue fixing member 31 side.
  • a plurality of slits 106 a are provided around the axis of the tissue fixing member 31.
  • a taper portion 106b whose outer diameter decreases toward the thread-like main body portion 29 side is formed in the portion on the thread-like main body portion 29 side in the mediation portion 106.
  • the thread locking member 107 has thread fixing parts 108 and 109 and a folding part 110.
  • the thread fixing portions 108 and 109 are formed in a cylindrical shape, are arranged at a predetermined distance from each other, and the tissue fixing member 31 is inserted therein. Both ends of the folding unit 110 are connected to the thread fixing units 108 and 109.
  • a plurality of folding sections 110 are provided around the axis of the tissue fixing member 31. 21 and 22, the folding part 110 is a bent part 110a formed near the center of the folding part 110.
  • the folding part 110 is wide in the axial direction and in the direction orthogonal to the axial direction. It can be folded so that
  • the thread fixing portion 108 is formed with a tongue-shaped stopper 108a bent toward the tissue fixing member 31 side. Then, the tip of the stopper 108a contacts the outer peripheral surface of the tissue fixing member 31, so that the thread fixing portion 108 can move from the tip member 27 side to the bar 32 side with respect to the tissue fixing member 31, It is configured not to move from the bar 32 side to the tip member 27 side.
  • a stopper 109a is also formed in the thread fixing portion 109 similarly to the thread fixing portion 108, and the movement of the thread fixing portion 109 with respect to the tissue fixing member 31 is similarly restricted. Further, as shown in FIGS. 24 and 25, a convex portion 109 b formed integrally or separately with the thread fixing portion 109 can be fitted into the slit 106 a formed in the mediating portion 106. .
  • a stopper (not shown) is used so that the mediating portion 106 and the thread locking member 107 are not easily detached, or a press-fitting is performed when the convex portion 109b is inserted into the slit 106a so that the slit 106a and the convex portion are not convex. Friction resistance is generated between the portion 109b and the like.
  • the suturing device 5 of the present embodiment includes a pusher tube 113 shown in FIG. 26 and an operation unit as shown in FIG. 23 is provided with a pusher tube operation section 85 arranged at 23.
  • the pusher tube 113 has a pusher main body 114 formed in a long tubular shape, and a ring-shaped pusher front end portion 115 fixed to the front end of the pusher main body 114.
  • the pusher tip portion 115 is provided with a pair of projecting portions 116 that project inward from the inner peripheral surface of the pusher tip portion 115 with a certain distance from each other.
  • a slit 117 is formed between the pair of protruding portions 116 along the central axis C1 and through which the thread-like main body 29 of the elongated thread-like member 105 can pass.
  • a plurality of convex portions 118 (three convex portions 118 in the present embodiment) are formed on the front surfaces of the pair of projecting portions 116 so as to be spaced apart from each other and project toward the distal end side.
  • the elongated thread-like member 105 and the pusher tube 113 configured as described above are, as shown in FIG. 28, the thread-like main body part with the thread locking member 107 fitted to the mediating part 106 of the elongated thread-like member 105. 29 is disposed in the slit 117, and the mediating portion 106 is disposed on the distal end side of the filamentous main body portion 29. Then, by pulling the thread-like main body portion 29 toward the proximal end with a predetermined strength, the mediating portion 106 can be automatically inserted between the pair of protruding portions 116 by the tapered portion 106b.
  • the thread locking member 107 is separated from the mediation portion 106 and the mediation portion 106 is pulled into the pusher tube 113 as shown in FIG. It is. Along with this, the protrusion 109 b is inserted between the protrusions 118, whereby the thread fixing portion 109 of the thread locking member 107 is locked to the pusher tip 115.
  • the fixing portion 108 moves to the proximal end side of the suture instrument 5 in a state where the yarn fixing portion 109 is fixed to the pusher tip portion 115.
  • the folding part 110 is folded, and the thread fixing part 108 comes into contact with the thread fixing part 109.
  • the pusher tube operation unit 85 is attached to the operation unit body 84 so as to be able to advance and retreat.
  • a proximal end portion of the pusher tube 113 is attached to the pusher tube operation portion 85.
  • the surgeon pulls the operation portion body 84 against the pusher tube operation portion 85 of the suturing device 5 of the present embodiment to push the treatment portion 22 into the pusher. It is accommodated in the tube 113.
  • the operator further operates the operation portion 23 to place the thread-like main body portion 29 of the elongated thread-like member 105 between the pair of protrusions 116 of the pusher tube 113.
  • the operation portion body 84 is further pulled to the proximal end side, the thread engaging member 107 is fitted to the mediation portion 106, and the mediation portion 106 is interposed between the pair of projecting portions 116. insert.
  • the mediation portion 106 is pulled into the pusher tube 113 as shown in FIG.
  • the thread locking member 107 is locked to the pusher tip portion 115, and the tissues W2 and W3 are tightly bound by the thread locking member 107 and the bar 32 in which the folded portion 110 is folded.
  • the position of the thread locking member 107 with respect to the tissue fixing member 31 is fixed by the thread fixing portions 108 and 109.
  • the pusher tube operation portion 85 is pulled to expose the treatment portion 22 from the pusher tube 113 as shown in FIG. 33, and the wire operation slider 86 is pushed in, so that the jaw members 52, 55 are shown in FIG. Open.
  • the distal end member 27 is removed from the tissue penetrating members 58 and 61, and the elongated thread-like member 105 to which the tissues W2 and W3 are bound is placed in the body of the patient P.
  • the tissue can be continuously sutured while preventing the tissue from being damaged.
  • stitch for convenience of explanation, only one stitch (seam) is described or illustrated, but it goes without saying that a plurality of stitches can be stitched at a time.
  • the elongated thread-like member 105 has a thread locking member 107 that can be fixed to the tissue fixing member 31, the tissue sutured by the tissue fixing member 31 can be fixed in a state of being tightly bound by the thread locking member 107. it can.
  • the thread fixing portions 108 and 109 may be formed integrally with the plurality of folding portions 110.
  • the index 121 may be provided on the jaw members 52 and 55, and the index 122 may be provided on the tip cover 40.
  • the jaw members 52 and 55 are closed and the openings of the tissue penetrating members 58 and 61 are in the communicating position with each other, the index 121 and the index 122 are aligned on the same straight line. You may comprise so that the position of 61 can be confirmed.
  • the index 121 can be provided by being stamped or printed on the jaw members 52 and 55, or can be provided by being integrally formed with the jaw members 52 and 55.
  • the index 122 is also provided on the tip cover 40 in the same manner. With this configuration, when the tissue penetrating members 58 and 61 move between the communication position and the separation position, the index 121 moves in conjunction with each other.
  • the index set that is a set of the index 121 and the index 122 is aligned on the same straight line when the tissue penetrating members 58 and 61 are in the communication position. For this reason, the tip member 27 is moved safely and reliably by moving the tip member 27 between the tissue penetrating member 58 and the tissue penetrating member 61 when the indicator 121 and the indicator 122 are aligned on the same straight line. be able to.
  • the suture instrument when used in a place where the treatment unit 22 of the suture instrument cannot be directly visually recognized, such as in a body cavity of a patient, the suture instrument is inserted into the forceps channel 2 and the suture instrument is inserted into the endoscope. 3 is set so that the index set is positioned within the field-of-view range R of the endoscope 3. With this configuration, the index set provided in the treatment unit 22 can be observed by the observation unit 14 of the endoscope 3.
  • index set may be provided in one place, or the index set may be provided in the operation unit body 84, the pusher tube operation unit 85, the wire operation slider 86, and the like of the operation unit 23.
  • an elongated thread member 125 as shown in FIG. 37 may be used instead of the elongated thread member 24.
  • the elongated thread-like member 125 includes a mediating part 126 in place of the mediating part 30 of the elongated thread-like member 24, and a tissue fixing member 127 that is a commercially available suture instead of the tissue fixing member 31.
  • the mediation portion 126 has a hole 126a through which the tissue fixing member 127 is passed.
  • the end portion of the tissue fixing member 127 is fixed to the mediation portion 126 with a knot 127a or the like.
  • At least one step 126b is formed in the mediation portion 126, and the puncture resistance of the tissue fixing member 127 fixed to the mediation portion 126 can be reduced by the step 126b.
  • the mediation portion 126 is formed with tapered portions 126c and 126d whose outer diameters become thinner toward the end portion for the purpose of reducing tissue resistance during puncturing.
  • tissue fixing member 127 which is a commercially available thread, as a part of the elongated thread-like member 125, so that versatility can be improved and cost can be reduced.
  • the materials of the component parts of the suturing device 5 and the elongated thread-like member described above are made of generally known materials. That is, as long as it is a metal material, it is made of stainless steel, titanium, titanium alloy, Ni—Ti metal, ⁇ titanium alloy, aluminum, gold, copper, brass, or the like. If it is a resin material, it is comprised with biocompatible resin, for example, a polyimide, polyetheretherketone, polysulfone, a liquid crystal polymer, and polyamide. In the case of a ceramic material, it is composed of biocompatible alumina, silicon nitride or the like.
  • the present invention it is possible to prevent the needle-like member from falling off and damaging the surrounding tissue like a conventional suture instrument.
  • the tissue can be continuously sutured.

Abstract

In this suturing system provided with a slender filament-shaped part (24) and a suturing instrument (5) to which the slender filament-shaped part (24) can be attached and detached and which is for suturing tissue using the slender filament-shaped part (24), the slender filament-shaped part (24) has: a leading end part (27); a main filament-shaped part (29), one end of which is connected to the leading end part (27) and the external diameter of which is smaller than the external diameter of the leading end part (27); a mediator part (30) connected to the other end of the main filament-shaped part (29); and a tissue-fixing part (31), one end of which is connected to the mediator part (30) and is disposed on the side opposite the main filament-shaped part (29) and the external diameter of which is larger than the external diameter of the main filament-shaped part (29). The suturing instrument (5) has a pair of tissue-piercing parts (58) with lumens capable of accommodating the leading end part (27) and apertures that communicate with said lumens.

Description

縫合システムおよび内視鏡システムSuture system and endoscope system
　本発明は、組織を縫合するための縫合システムおよび内視鏡システムに関する。本願は、２０１１年１月１１日に米国に出願された仮出願６１／４３１５８０号に基づく優先権を主張した出願であり、前記米国仮出願の内容をここに援用する。 The present invention relates to a suturing system and an endoscope system for suturing tissue. This application is the application which claimed the priority based on provisional application 61/431580 for which it applied to the United States on January 11, 2011, and uses the content of the said US provisional application here.
　従来、組織に形成された開口を閉塞するために、様々な構成の縫合システムが検討されている。
　たとえば、特許文献１に記載された自動縫合器は、両端が尖頭に形成された針（３６、細長糸状部材）が一対のジョーの先端部（３４ａ、３４ｂ）に交互に持ち替えられる構造を備えている。
　特許文献２に記載された縫合装置では、上記の特許文献１に記載された自動縫合器と同様に、両端が尖頭に形成された外科用針（１２）が一対のジョー（１８、２０）に交互に持ち替えられる構造を備えている。 Conventionally, various configurations of suturing systems have been considered in order to occlude openings formed in tissue.
For example, the automatic suturing device described in Patent Document 1 has a structure in which needles (36, slender thread-like members) formed with pointed ends are alternately moved to the tip portions (34a, 34b) of a pair of jaws. ing.
In the suturing device described in Patent Document 2, the surgical needle (12) having both ends formed at the tip is a pair of jaws (18, 20), as in the automatic suturing device described in Patent Document 1 above. It has a structure that can be changed alternately.
　また、特許文献３に記載された縫合機器は、先端が湾曲した中空針の形状に形成された一対の腕部（２４ａ、２４ｂ）が、管状部材（１２）と関連することで、互いに開閉することができる構成を備えている。これにより一対の腕部が組織を穿刺し、腕部の内腔が互いに連通した時に、一方の腕部の内腔に配設された糸状の縫合材料（３０）が他方の腕部の内腔へ送り出される。この構造により、縫合材料は組織を通過することができる。その後、機器を体外に抜去し、口などから出た２本の縫合材料を体外で結んで結び目を作り、ノットプッシャー機能を備えた装置（７０）により縫合部位を結紮し、縫合する。 Further, in the suturing device described in Patent Document 3, the pair of arms (24a, 24b) formed in the shape of a hollow needle having a curved tip are opened and closed with respect to the tubular member (12). It has a configuration that can. As a result, when the pair of arms puncture the tissue and the lumens of the arms communicate with each other, the thread-like suture material (30) disposed in the lumen of one arm is used as the lumen of the other arm. Sent out. This structure allows the suture material to pass through the tissue. Thereafter, the device is removed from the body, and two suture materials coming out of the mouth and the like are tied outside the body to form a knot, and the suture site is ligated and sutured by a device (70) having a knot pusher function.
米国特許第５８１４０５４号公報US Pat. No. 5,814,054 米国特許第５６７４２３０号公報US Pat. No. 5,674,230 米国特許第４９３６０２７号公報US Pat. No. 4,936,027
　特許文献１に記載された自動縫合器、および特許文献２に記載された縫合装置では、針をしっかりと把持できない場合や機器の不具合などで針が脱落して、周囲の組織を傷つける可能性がある。 In the automatic suturing device described in Patent Literature 1 and the suturing device described in Patent Literature 2, there is a possibility that the needle may fall off due to inability to grasp the needle firmly or due to a malfunction of the device, and the surrounding tissue may be damaged. is there.
　また、特許文献３に記載された縫合機器では、結節縫合（ｉｎｔｅｒｒｕｐｔｅｄ　ｓｕｔｕｒｅ）を行うことしかできず、連続縫合（Ｃｏｎｔｉｎｕｏｕｓ　ｓｕｔｕｒｅ）を行うことができない。 In addition, with the suturing device described in Patent Document 3, it is only possible to perform an interrupted suture, and it is not possible to perform continuous stitching (Continuous suture).
　本発明は上記事情に鑑みて成されたものであり、針状の部材が脱落して周囲の組織を傷つけることを防止し、組織を連続的に縫合することができる縫合システムおよび内視鏡システムを提供することを目的とする。 The present invention has been made in view of the above circumstances, and a suturing system and an endoscope system capable of preventing a needle-like member from dropping and damaging surrounding tissue and continuously suturing the tissue. The purpose is to provide.
　本発明の第１の態様に係る縫合システムは、細長糸状部材と、前記細長糸状部材を着脱可能とするとともに前記細長糸状部材を用いて組織を縫合するための縫合器と、を備える縫合システムであって、前記細長糸状部材は、先端部材と、一端が前記先端部材に接続され、自身の外径が前記先端部材の外径より小さく設定された糸状本体部と、前記糸状本体部の他端に接続された仲介部と、一端が前記仲介部に接続されるとともに前記糸状本体部の反対側に配置され、外径が前記糸状本体部の外径より大きく設定された組織固定部材と、を有し、前記縫合器は、前記先端部材を収容可能な内腔および前記内腔に連通する開口を有する一対の組織穿通部材を有し、一対の前記組織穿通部材は、一方の前記組織穿通部材の一部が他方の前記組織穿通部材の内腔に入り込んで互いの前記内腔が連通した連通位置と、一対の前記組織穿通部材が互いに離間した離間位置と、に相対移動可能に設けられている。 A suturing system according to a first aspect of the present invention is a suturing system comprising: an elongated thread-like member; and a suturing device that allows the elongated thread-like member to be detachable and sutures tissue using the elongated thread-like member. The elongated thread-like member has a tip member, a thread-like main body portion whose one end is connected to the tip member, and whose outer diameter is set smaller than the outer diameter of the tip member, and the other end of the thread-like main body portion. And a tissue fixing member having one end connected to the mediation unit and disposed on the opposite side of the filamentous main body, and having an outer diameter set larger than the outer diameter of the filamentous main body. The suturing device has a pair of tissue penetrating members having a lumen capable of accommodating the tip member and an opening communicating with the lumen, and the pair of tissue penetrating members is one of the tissue penetrating members. A portion of the other tissue A communicating position where the lumen of each other are made to communicate with each enters into the lumen of the member, and a separated position in which the pair of the tissue-piercing member is spaced apart from each other, the provided movable relative.
　本発明の第２の態様に係る縫合システムでは、前記組織穿通部材は、互いに接近、離間する一対のジョー部材にそれぞれ固定されている。 In the suturing system according to the second aspect of the present invention, the tissue penetrating members are respectively fixed to a pair of jaw members that approach and separate from each other.
　本発明の第３の態様に係る縫合システムでは、前記組織穿通部材は、前記糸状本体部が挿入可能なスリットを有している。 In the suturing system according to the third aspect of the present invention, the tissue penetrating member has a slit into which the thread-like main body portion can be inserted.
　本発明の第４の態様に係る縫合システムでは、前記組織穿通部材の前記内腔に進退可能に配置され、前記組織穿通部材内に収容された前記先端部材を前記開口からから押し出す一対の取外し部材を備えている。 In the suturing system according to the fourth aspect of the present invention, a pair of detaching members that are disposed so as to be able to advance and retreat in the lumen of the tissue penetrating member and push out the tip member housed in the tissue penetrating member from the opening. It has.
　本発明の第５の態様に係る縫合システムでは、前記組織穿通部材の内周面には、前記内周面から突出して前記細長糸状部材の前記先端部材が前記開口側に移動するのを係止するとともに、前記取外し部材により前記先端部材を押し出すことで変形され、前記先端部材が乗り越えることができる凸部が形成されている。 In the suturing system according to the fifth aspect of the present invention, the inner peripheral surface of the tissue penetrating member is locked from protruding from the inner peripheral surface and moving the distal end member of the elongated thread-like member toward the opening side. In addition, the protrusion is deformed by pushing out the tip member by the removing member, and a convex portion is formed on which the tip member can get over.
　本発明の第６の態様に係る縫合システムでは、前記縫合器は、前記一対の取外し部材を前記組織穿通部材の前記内腔に沿って交互に進退させる切替機構を備える。 In the suturing system according to the sixth aspect of the present invention, the suturing device includes a switching mechanism for alternately moving the pair of detaching members forward and backward along the lumen of the tissue penetrating member.
　本発明の第７の態様に係る縫合システムでは、前記切替機構は、所定の軸線回りに回転されることにより、前記組織穿通部材の前記内腔における前記取外し部材の前記内腔に沿った位置を変化させる回転部材と、前記回転部材を前記所定の軸線回りに回転させるためのカム機構とを有する。 In the suturing system according to the seventh aspect of the present invention, the switching mechanism is rotated around a predetermined axis, whereby the position of the removal member in the lumen of the tissue penetrating member is set along the lumen. A rotating member to be changed; and a cam mechanism for rotating the rotating member around the predetermined axis.
　本発明の第８の態様に係る縫合システムでは、前記回転部材が前記所定の軸線の同一方向回りに回転するように規制する回転補助機構をさらに有する。 In the suturing system according to the eighth aspect of the present invention, the suturing system further includes a rotation assist mechanism that restricts the rotating member to rotate about the same direction of the predetermined axis.
　本発明の第９の態様に係る縫合システムでは、前記組織穿通部材には、前記一対の組織穿通部材が互いの前記開口の間に前記組織を挟んだ状態で前記連通位置に位置したときに、前記組織のうち前記開口の間に挟まれた部分を切開可能な刃部が設けられている。 In the suturing system according to the ninth aspect of the present invention, the tissue penetrating member has the pair of tissue penetrating members positioned at the communicating position with the tissue sandwiched between the openings. A blade portion capable of incising a portion of the tissue sandwiched between the openings is provided.
　本発明の第１０の態様に係る縫合システムでは、前記糸状本体部は前記組織固定部材よりも引張り強度の高い材料で形成されている。 In the suturing system according to the tenth aspect of the present invention, the thread main body is formed of a material having a higher tensile strength than the tissue fixing member.
　本発明の第１１の態様に係る縫合システムでは、前記細長糸状部材の前記糸状本体部は金属で形成されている。 In the suturing system according to the eleventh aspect of the present invention, the thread-like main body portion of the elongated thread-like member is made of metal.
　本発明の第１２の態様に係る縫合システムでは、前記細長糸状部材の前記組織固定部材は樹脂で形成されている。 In the suturing system according to the twelfth aspect of the present invention, the tissue fixing member of the elongated thread-like member is formed of resin.
　本発明の第１３の態様に係る縫合システムでは、前記細長糸状部材の前記先端部材は、略球状に形成されている。 In the suturing system according to the thirteenth aspect of the present invention, the tip member of the elongated thread-like member is formed in a substantially spherical shape.
　本発明の第１４の態様に係る縫合システムでは、前記細長糸状部材の前記先端部材は、少なくとも一部が針状に尖っている。 In the suturing system according to the fourteenth aspect of the present invention, at least a part of the tip member of the elongated thread-like member is pointed like a needle.
　本発明の第１５の態様に係る縫合システムでは、前記細長糸状部材は、前記組織固定部材に固定可能な糸係止部材を有する。 In the suturing system according to the fifteenth aspect of the present invention, the elongated thread-like member has a thread locking member that can be fixed to the tissue fixing member.
　本発明の第１６の実施態様に係る内視鏡システムは、上記縫合システムと、内部に前記縫合器が挿通可能な鉗子チャンネルが形成され、所定の視野範囲内を観察可能な内視鏡とを備える。 An endoscope system according to a sixteenth embodiment of the present invention includes the suturing system and an endoscope in which a forceps channel into which the suturing device can be inserted is formed and which can observe a predetermined visual field range. Prepare.
　本発明の第１７の実施態様に係る内視鏡システムでは、前記縫合器には、前記一対の組織穿通部材が前記連通位置にあることを確認可能な指標が設けられている。そして、前記指標は、前記鉗子チャンネルに前記縫合器を挿通して前記縫合器を前記内視鏡に装着したときに、前記内視鏡の前記視野範囲内に位置するように設定されている。 In the endoscope system according to the seventeenth embodiment of the present invention, the suturing device is provided with an index capable of confirming that the pair of tissue penetrating members are in the communication position. The index is set so as to be positioned within the visual field range of the endoscope when the suture instrument is inserted into the forceps channel and the suture instrument is attached to the endoscope.
　本発明の第１８の実施態様に係る内視鏡システムでは、前記指標は、前記組織穿通部材が前記連通位置と前記離間位置との間で移動したときに連動して移動する。 In the endoscope system according to the eighteenth embodiment of the present invention, the indicator moves in conjunction with movement of the tissue penetrating member between the communication position and the separation position.
　本発明の縫合システムによれば、縫合器の処置部や挿入部を実質的に小型化、かつ細径化することが可能となる。また、従来の縫合器で生じ得るような、針状の部材が脱落して周囲の組織を傷つけることを防止することができる。また、組織を連続的に縫合することができる。
　さらに、本発明の内視鏡システムによれば、縫合器と内視鏡とを備えるため、内視鏡の観察ユニットで前方を観察しながら、縫合器で組織を縫合することができる。 According to the suturing system of the present invention, the treatment portion and the insertion portion of the suturing device can be substantially reduced in size and diameter. Further, it is possible to prevent the needle-like member from falling off and damaging the surrounding tissue, which can occur with a conventional suture instrument. In addition, the tissue can be continuously sutured.
Furthermore, according to the endoscope system of the present invention, since the suture instrument and the endoscope are provided, the tissue can be sutured with the suture instrument while observing the front with the observation unit of the endoscope.
本発明の第１実施形態の内視鏡システムの全体図である。1 is an overall view of an endoscope system according to a first embodiment of the present invention. 本発明の第１実施形態の内視鏡システムの縫合器に取付けられる細長糸状部材の全体図である。1 is an overall view of an elongated thread-like member attached to a suture instrument of an endoscope system according to a first embodiment of the present invention. 本発明の第１実施形態の縫合器の処置部の平面断面図である。It is a plane sectional view of a treatment part of a suture instrument of a 1st embodiment of the present invention. 本発明の第１実施形態の縫合器の処置部の側面断面図である。It is side surface sectional drawing of the treatment part of the suturing device of 1st Embodiment of this invention. 先端カバー、ロッドおよび先端保持部の分解斜視図である。It is a disassembled perspective view of a front-end | tip cover, a rod, and a front-end | tip holding part. 図５におけるＢ１方向矢視図である。It is a B1 direction arrow directional view in FIG. 図５におけるＢ２方向矢視図である。It is a B2 direction arrow line view in FIG. 図３の要部拡大図である。It is a principal part enlarged view of FIG. 本発明の第１実施形態の処置部の要部の側面図である。It is a side view of the principal part of the treatment part of 1st Embodiment of this invention. 本発明の第１実施形態の処置部の要部の側面断面図である。It is side surface sectional drawing of the principal part of the treatment part of 1st Embodiment of this invention. 本発明の第１実施形態の縫合器の操作部の側面断面図である。It is side surface sectional drawing of the operation part of the suturing device of 1st Embodiment of this invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. 本発明の第１実施形態の変形例における細長糸状部材の全体図である。It is a whole view of the elongate thread-like member in the modification of 1st Embodiment of this invention. 本発明の第１実施形態の変形例における組織穿通部材の平面断面図である。It is a plane sectional view of the tissue penetration member in the modification of a 1st embodiment of the present invention. 本発明の第２実施形態の内視鏡システムの縫合器に取り付けられる細長糸状部材の全体図である。It is a whole view of the elongate thread-like member attached to the suturing device of the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムの縫合器に取り付けられる同細長糸状部材の折り畳み部を折りたたんだ状態を説明する図である。It is a figure explaining the state which folded the folding part of the same elongate thread-like member attached to the suturing device of the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の細長糸状部材の糸固定部の断面図である。It is sectional drawing of the thread | yarn fixing | fixed part of the elongate thread-like member of 2nd Embodiment of this invention. 本発明の第２実施形態の細長糸状部材の仲介部と糸固定部とを分離させた状態を説明する図である。It is a figure explaining the state which isolate | separated the mediation part and thread | yarn fixing | fixed part of the elongate thread-shaped member of 2nd Embodiment of this invention. 本発明の第２実施形態の細長糸状部材の仲介部と糸固定部とを結合させた状態を説明する図である。It is a figure explaining the state which joined the mediation part and thread | yarn fixing | fixed part of the elongate thread-shaped member of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムのプッシャーチューブの先端側の斜視図である。It is a perspective view of the front end side of the pusher tube of the endoscope system of a 2nd embodiment of the present invention. 本発明の第２実施形態の縫合器の操作部の側面断面図である。It is side surface sectional drawing of the operation part of the suturing device of 2nd Embodiment of this invention. 図２６の要部拡大図である。It is a principal part enlarged view of FIG. 本発明の第２実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of 2nd Embodiment of this invention. 本発明の第２実施形態の内視鏡システムを用いた手技を説明する図である。It is a figure explaining the procedure using the endoscope system of 2nd Embodiment of this invention. 本発明の変形例の縫合器に設けられた指標を一対の組織穿通部材が離間位置になったときの状態で説明する図である。It is a figure explaining the parameter | index provided in the suturing device of the modification of this invention in a state when a pair of tissue piercing member will be in a separation position. 本発明の変形例の縫合器に設けられた指標を一対の組織穿通部材が連通位置になったときの状態で説明する図である。It is a figure explaining the parameter | index provided in the suturing device of the modification of this invention in a state when a pair of tissue piercing member will be in a communicating position. 本発明の変形例の細長糸状部材の全体図である。It is a whole view of the elongate thread-like member of the modification of this invention. 同細長糸状部材の要部断面図である。It is principal part sectional drawing of the same elongate thread-like member.
　以下、本発明に係る内視鏡システムの第１実施形態について、図１から図２０を参照して説明する。この内視鏡システムは、内視鏡で体腔内を観察しながら縫合器で組織を縫合する処置を行うシステムである。なお、以下の図３、図１２、図１４～１８、図２９、図３１～３４は概念図であるため、他の詳細図とは一部の形状が異なる。 Hereinafter, a first embodiment of an endoscope system according to the present invention will be described with reference to FIGS. 1 to 20. This endoscope system is a system that performs a treatment of suturing tissue with a suture instrument while observing the inside of a body cavity with an endoscope. The following FIGS. 3, 12, 14 to 18, 29, and 31 to 34 are conceptual diagrams, and are partially different in shape from other detailed views.
図１に示すように、本実施形態に係る内視鏡システム１は、内視鏡３と、挿入部４と、縫合器５と、細長糸状部材２４とを備えている。内視鏡３は、内部に鉗子チャンネル２が形成されている。縫合器５は、先端側に設けられた長尺の挿入部４が鉗子チャンネル２に挿通可能に構成されている。細長糸状部材２４は、縫合器５に着脱可能とされ、組織を縫合するために用いられる。 As shown in FIG. 1, the endoscope system 1 according to the present embodiment includes an endoscope 3, an insertion portion 4, a suture device 5, and an elongated thread-like member 24. The endoscope 3 has a forceps channel 2 formed therein. The suturing device 5 is configured such that a long insertion portion 4 provided on the distal end side can be inserted into the forceps channel 2. The elongated thread-like member 24 is detachable from the suturing device 5 and is used for suturing tissue.
　縫合器５は、軟性内視鏡用だけでなく、硬性鏡と組合せて外科用にも用いることができる。この場合、前述の挿入部４を硬性にしてもよい。 The suture device 5 can be used not only for a flexible endoscope but also for a surgical operation in combination with a rigid endoscope. In this case, you may make the above-mentioned insertion part 4 rigid.
　内視鏡３は、長尺の内視鏡挿入部８と、内視鏡挿入部８の基端部に接続された内視鏡操作部９とを有している。内視鏡３は、公知の構成の内視鏡が用いられる。内視鏡挿入部８は、先端硬質部１０と、湾曲部１１と、可撓管部１２とで構成されている。先端硬質部１０は、先端に設けられている。、湾曲部１１は、湾曲可能であり、先端硬質部１０の基端側に接続されている。そして、湾曲部１１の基端側に可撓管部１２が接続されている。 The endoscope 3 has a long endoscope insertion portion 8 and an endoscope operation portion 9 connected to the proximal end portion of the endoscope insertion portion 8. An endoscope having a known configuration is used as the endoscope 3. The endoscope insertion portion 8 includes a distal end hard portion 10, a bending portion 11, and a flexible tube portion 12. The tip hard portion 10 is provided at the tip. The bending portion 11 can be bent and is connected to the proximal end side of the distal end hard portion 10. The flexible tube portion 12 is connected to the proximal end side of the bending portion 11.
　先端硬質部１０の前方の面には、照明光を発する照明ユニット１３と、反射された照明光を検出する観察ユニット１４とが設けられている。照明ユニット１３には、例えば、グラスファイバーやＬＥＤ等が使用される。観察ユニット１４としては、複数の光学レンズやＣＣＤを有する部材が使用される。また、観察ユニット１４は、前方の所定の視野範囲Ｒ内を観察可能に設定されている。 An illumination unit 13 that emits illumination light and an observation unit 14 that detects reflected illumination light are provided on the front surface of the distal end hard portion 10. For the lighting unit 13, for example, a glass fiber, an LED, or the like is used. As the observation unit 14, a member having a plurality of optical lenses and a CCD is used. Moreover, the observation unit 14 is set so that the inside of the predetermined visual field range R ahead can be observed.
　内視鏡操作部９には、湾曲部１１の湾曲状態を操作する操作ダイヤル１７が設けられている。内視鏡操作部９には、ユニバーサルケーブル１８の一端側が接続されている。そして、ユニバーサルケーブル１８の他端側は不図示の表示部に接続されている。表示部には、観察ユニット１４で取得された視野内の映像を表示することができる。 The endoscope operation section 9 is provided with an operation dial 17 for operating the bending state of the bending section 11. One end of a universal cable 18 is connected to the endoscope operation unit 9. The other end of the universal cable 18 is connected to a display unit (not shown). On the display unit, an image within the field of view acquired by the observation unit 14 can be displayed.
　前述の鉗子チャンネル２は、先端硬質部１０の前方の面に形成された開口に連通するとともに、内視鏡挿入部８内を通って内視鏡操作部９まで延びる。鉗子チャンネル２は、さらに、内視鏡操作部９に設けられた鉗子栓１９の開口に連通している。 The aforementioned forceps channel 2 communicates with an opening formed in the front surface of the distal end hard portion 10 and extends through the endoscope insertion portion 8 to the endoscope operation portion 9. The forceps channel 2 further communicates with an opening of a forceps plug 19 provided in the endoscope operation unit 9.
　縫合器５は、前述の挿入部４と、処置部２２と、操作部２３とを有している。処置部２２は、挿入部４の先端部に設けられている。操作部２３は、挿入部４の基端部に接続されている。
　処置部２２には、縫合器５により組織に縫合される細長糸状部材２４が着脱可能に取付けられる。本実施形態の縫合システムは、縫合器５および細長糸状部材２４で構成される。 The suturing device 5 includes the above-described insertion portion 4, a treatment portion 22, and an operation portion 23. The treatment portion 22 is provided at the distal end portion of the insertion portion 4. The operation unit 23 is connected to the proximal end portion of the insertion unit 4.
An elongated thread-like member 24 that is sutured to the tissue by the suture device 5 is detachably attached to the treatment portion 22. The suturing system according to this embodiment includes a suturing device 5 and an elongated thread-like member 24.
　以下ではまず、細長糸状部材２４について説明する。
　図２に示すように、細長糸状部材２４は、線状の本体部２８と、本体部２８の一方の端部に取付けられた先端部材２７とを有する。先端部材２７は、本体部２８よりも外径が大きい略球状に形成されている。そして、本体部２８は、糸状本体部２９と、仲介部３０と、組織固定部３１とを有する。糸状本体部２９は、一端が先端部材２７に接続されており、糸状本体部２９の他端には仲介部３０が接続されている。また、組織固定部材３１は、仲介部３０を挟んで糸状本体部２９の反対側に配置され、一端が仲介部３０に接続されている。 Below, the elongate thread-like member 24 is demonstrated first.
As shown in FIG. 2, the elongated thread-like member 24 has a linear main body portion 28 and a tip member 27 attached to one end portion of the main body portion 28. The tip member 27 is formed in a substantially spherical shape having an outer diameter larger than that of the main body portion 28. The main body portion 28 includes a thread-like main body portion 29, an intermediary portion 30, and a tissue fixing portion 31. One end of the thread-like main body 29 is connected to the tip member 27, and the mediation part 30 is connected to the other end of the thread-like main body 29. Further, the tissue fixing member 31 is disposed on the opposite side of the filamentous main body 29 with the mediation portion 30 interposed therebetween, and one end thereof is connected to the mediation portion 30.
　糸状本体部２９は、先端部材２７よりも外径が小さく形成される。また、糸状本体部２９は、組織固定部材３１よりも引張り強度の高い材料で形成されている。さらに、糸状本体部２９には、柔軟性と、一般的な縫合糸より切れにくい特性とを有した素材が用いられる。その材質は、たとえば金属であり、具体的には、ステンレス、チタン、Ｎｉ－Ｔｉ、ゴムメタル（β型チタン合金）、金、あるいは、樹脂を組合わせた複合繊維の液晶ポリマー、炭素繊維などを好適に用いることができる。更に、糸状本体部２９は、モノフィラメント形態、マルチフィラメント形態など、どの形態でも良いが、マルチフィラメント形態の方が縫合時の抵抗が小さくなる。 The thread-like main body portion 29 is formed with an outer diameter smaller than that of the tip member 27. The filamentous main body 29 is formed of a material having a higher tensile strength than the tissue fixing member 31. Furthermore, the thread-like main body 29 is made of a material having flexibility and characteristics that are harder to cut than a general suture. The material is, for example, metal, and specifically, stainless steel, titanium, Ni—Ti, rubber metal (β-type titanium alloy), gold, or composite fiber liquid crystal polymer combined with resin, carbon fiber, and the like are suitable. Can be used. Furthermore, the filamentous main body 29 may be in any form such as a monofilament form or a multifilament form, but the multifilament form has a lower resistance during stitching.
　仲介部３０は、組織をスムーズに通過できるように、糸状本体部２９および組織固定部材３１の軸線方向に直交する面における断面での幅が狭く設定されていることが好ましい。 It is preferable that the mediation part 30 has a narrow width in a cross section in a plane orthogonal to the axial direction of the thread-like main body part 29 and the tissue fixing member 31 so that the tissue can pass smoothly.
　組織固定部材３１は、外径が糸状本体部２９の外径より大きく設定されるとともに、長尺に構成されている。本実施形態では、組織固定部材３１は樹脂で形成されている。なお、組織固定部材３１の材料としては、非吸収糸、吸収糸を含む縫合糸素材も用いることができる。 The tissue fixing member 31 has an outer diameter that is set to be larger than the outer diameter of the filamentous main body 29 and is configured to be long. In the present embodiment, the tissue fixing member 31 is made of resin. In addition, as a material of the tissue fixing member 31, a non-absorbable thread and a suture material including an absorbent thread can also be used.
　また、本実施形態では、組織固定部材３１の他端に組織固定部材３１に対して直交するように配置されたバー３２が設けられている。このバー３２は、本実施形態の内視鏡システムを用いて行われる手技の内容によっては、細長糸状部材２４に備えられなくてもよい。 In the present embodiment, the other end of the tissue fixing member 31 is provided with a bar 32 disposed so as to be orthogonal to the tissue fixing member 31. The bar 32 may not be provided on the elongated thread-like member 24 depending on the contents of the procedure performed using the endoscope system of the present embodiment.
　次に、縫合器５の処置部２２について説明する。
　図３から図５に示すように、先端保持部３５は、挿入部４の中心軸線Ｃ１に沿って延びる略筒状に形成され、挿入部４の先端側に配置されている。先端保持部３５内には、中心軸線Ｃ１に沿って延びる鉗子操作ワイヤ３６の先端側が挿通されている。 Next, the treatment portion 22 of the suturing device 5 will be described.
As shown in FIGS. 3 to 5, the tip holding portion 35 is formed in a substantially cylindrical shape extending along the central axis C <b> 1 of the insertion portion 4, and is disposed on the tip side of the insertion portion 4. In the distal end holding portion 35, the distal end side of the forceps operation wire 36 extending along the central axis C1 is inserted.
　先端保持部３５の先端付近には孔３５ａが、先端保持部３５の内周面にはスリット３５ｂがそれぞれ設けられている。スリット３５ｂの基端部は、孔３５ａよりも基端側に延びている。孔３５ａには、第１の係止部材（先端係止部材）であるピン３７が配置されている。ピン３７は、孔３５ａに挿入された状態で、その一部が先端保持部３５内に突出している。ピン３７は、付勢部材である板バネ３８で先端保持部３５の外周面に取り付けられている。この板バネ３８により、ピン３７は孔３５ａに納まる方向に付勢されている。一方、スリット３５ｂには、細長の解除部材３９が挿入されている。解除部材３９は、レーザー溶接や接着剤などで先端保持部３５に固定された第２の解除部材（鉗子解除部材）である。解除部材３９は、基端側の中心軸線Ｃ１側が斜めにカットされている。 A hole 35a is provided in the vicinity of the tip of the tip holding portion 35, and a slit 35b is provided on the inner peripheral surface of the tip holding portion 35. The base end portion of the slit 35b extends to the base end side from the hole 35a. A pin 37 that is a first locking member (tip locking member) is disposed in the hole 35a. A part of the pin 37 protrudes into the tip holding portion 35 in a state of being inserted into the hole 35a. The pin 37 is attached to the outer peripheral surface of the tip holding portion 35 by a leaf spring 38 that is an urging member. By this leaf spring 38, the pin 37 is urged in a direction to be accommodated in the hole 35a. On the other hand, an elongated release member 39 is inserted into the slit 35b. The release member 39 is a second release member (forceps release member) fixed to the tip holding portion 35 by laser welding or an adhesive. The release member 39 is cut obliquely on the central axis C1 side on the base end side.
　先端保持部３５内には、先端カバー４０の筒部４０ａが先端開口側から挿入されている。先端カバー４０は、前述の筒部４０ａと、カバー本体４０ｂとを有する。筒部４０ａは、先端保持部３５の内径に略等しいかわずかに小さい外径を有する。カバー本体４０ｂは、筒部４０ａの先端側に配置され、筒部４０ａと一体に形成されている。筒部４０ａの外側には、コイルバネ４１が配置されており、先端保持部３５から先端カバー４０を中心軸線Ｃ１方向に離すように付勢している。 In the tip holding portion 35, a cylinder portion 40a of the tip cover 40 is inserted from the tip opening side. The tip cover 40 has the above-described tube portion 40a and a cover main body 40b. The cylindrical portion 40 a has an outer diameter that is substantially equal to or slightly smaller than the inner diameter of the tip holding portion 35. The cover main body 40b is disposed on the distal end side of the cylindrical portion 40a and is formed integrally with the cylindrical portion 40a. A coil spring 41 is disposed outside the cylindrical portion 40a and urges the tip cover 40 away from the tip holding portion 35 in the direction of the central axis C1.
　図４、図６および図７に示すように、筒部４０ａには、スリット４０ｃ、４０ｄが中心軸線Ｃ１方向に沿ってそれぞれ形成されている。スリット４０ｃは、筒部４０ａの軸線回りで先端保持部３５の孔３５ａの形成位置に合わせて形成されている（図４参照）。スリット４０ｃの幅は、ピン３７が入ることはできない大きさであるが（図６参照）、スリット４０ｃの基端部４０ｆだけは拡幅されており、ピン３７の先端が進入可能になっている。 As shown in FIGS. 4, 6, and 7, slits 40c and 40d are formed in the cylindrical portion 40a along the direction of the central axis C1. The slit 40c is formed around the axis of the cylindrical portion 40a in accordance with the position where the hole 35a of the tip holding portion 35 is formed (see FIG. 4). The width of the slit 40c is such that the pin 37 cannot enter (see FIG. 6), but only the base end portion 40f of the slit 40c is widened so that the tip of the pin 37 can enter.
　また、図４に示すように、スリット４０ｄは、筒部４０ａの軸線回りに先端保持部３５のスリット３５ｂの形成位置に合わせて形成されている。スリット４０ｄの幅は、解除部材３９が配置可能な大きさである（図７参照）。スリット４０ｄの基端は、スリット４０ｃの基端部４０ｆよりも基端側に延びている。また、スリット４０ｄの基端には、貫通する孔の内径がスリット４０ｄの幅に対して拡径されるとともに、スリット４０ｄに連通した大径部４０ｇが形成されている（図７参照）。 Further, as shown in FIG. 4, the slit 40d is formed around the axis of the cylindrical portion 40a in accordance with the formation position of the slit 35b of the tip holding portion 35. The width of the slit 40d is such that the release member 39 can be disposed (see FIG. 7). The base end of the slit 40d extends to the base end side from the base end portion 40f of the slit 40c. Further, at the base end of the slit 40d, the inner diameter of the through-hole is increased with respect to the width of the slit 40d, and a large-diameter portion 40g communicating with the slit 40d is formed (see FIG. 7).
　図４および図５に示すように、先端カバー４０内には、開閉機構を構成するロッド４４が先端カバー４０に対して中心軸線Ｃ１方向に進退自在に挿入されている。ロッド４４の基端部には、鉗子操作ワイヤ３６の先端部が固定されている。ロッド４４の基端寄りの位置には、径方向に延びる凹部４４ａが形成されている。この凹部４４ａに、第２の係止部材（鉗子係止部材）であるボール４５が挿入されている。なお、本実施形態では、第２の係止部材（鉗子係止部材）は球状に形成されているが、円柱形状あるいは角柱形状など、どのうような形状に形成されていても良い。ボール４５は、凹部４４ａ内に配置されたコイルバネ４６によって径方向外側に付勢されている。図７に示すように、このボール４５は、筒部４０ａのスリット４０ｄの基端部に設けられた大径部４０ｇには入り込めるが、スリット４０ｄには入り込めない大きさに形成されている。 4 and 5, a rod 44 constituting an opening / closing mechanism is inserted into the tip cover 40 so as to be movable forward and backward in the direction of the central axis C1. The distal end portion of the forceps operation wire 36 is fixed to the proximal end portion of the rod 44. A concave portion 44 a extending in the radial direction is formed at a position near the proximal end of the rod 44. A ball 45 as a second locking member (forceps locking member) is inserted into the recess 44a. In the present embodiment, the second locking member (forceps locking member) is formed in a spherical shape, but may be formed in any shape such as a columnar shape or a prismatic shape. The ball 45 is urged radially outward by a coil spring 46 disposed in the recess 44a. As shown in FIG. 7, the ball 45 is formed in such a size that it can enter the large diameter portion 40g provided at the base end portion of the slit 40d of the cylindrical portion 40a but cannot enter the slit 40d.
　さらに、図４および図５に示すように、ボール４５の配設位置よりも先端側で、ボール４５の配設位置から中心軸線Ｃ１に対して対称となる位置には、第１の解除部材（先端解除部材）である解除部材４７がロッド４４に取り付けられている。解除部材４７は、ロッド４４の外表面に対し、一部が径方向外側に突出した状態で固定されている。
解除部材４７の基端部の外周面には、解除部材４７が基端側に移動したときにピン３７が解除部材４７に乗り上げ易くするテーパー面が設けられている。 Further, as shown in FIGS. 4 and 5, the first release member (at the tip side of the position where the ball 45 is disposed and at a position which is symmetrical with respect to the central axis C1 from the position where the ball 45 is disposed). A release member 47 which is a tip release member is attached to the rod 44. The release member 47 is fixed to the outer surface of the rod 44 in a state where a part protrudes radially outward.
A tapered surface is provided on the outer peripheral surface of the base end portion of the release member 47 so that the pin 37 can easily ride on the release member 47 when the release member 47 moves to the base end side.
　ロッド４４の先端には、ピン４８を介して、２つのリンク部材４９、５０が、それぞれの一端部が回動自在に取り付けられている。リンク部材４９の他端部とジョー部材５２の一端部５２ａとは、ピン５１を介して互いに回転自在に接続されている。
ジョー部材５２は、自身の一端部５２ａから他端部５２ｂ（図３参照）に至るまでの間の所定の位置に貫通孔が形成されている。そして、貫通孔が先端カバー４０に固定されたピン（枢支軸）５３に係合することで、ジョー部材５２は、先端カバー４０に回転自在に枢支される。 Two link members 49 and 50 are attached to the tip of the rod 44 through pins 48 so that one end portions of each of the link members 49 and 50 are rotatable. The other end of the link member 49 and the one end 52 a of the jaw member 52 are connected to each other via a pin 51 so as to be freely rotatable.
The jaw member 52 has a through-hole formed at a predetermined position from one end 52a to the other end 52b (see FIG. 3). The jaw member 52 is pivotally supported by the tip cover 40 by allowing the through hole to engage with a pin (pivot shaft) 53 fixed to the tip cover 40.
　リンク部材５０の他端部は、ピン５４でジョー部材５５の一端部５５ａと、回転自在に接続されている。ジョー部材５５は、ジョー部材５２と同様に、ピン５３により先端カバー４０に回転自在に枢支されている。 The other end of the link member 50 is rotatably connected to one end 55a of the jaw member 55 by a pin 54. Similarly to the jaw member 52, the jaw member 55 is pivotally supported by the tip cover 40 by a pin 53.
　このように構成された、処置部２２は、鉗子操作ワイヤ３６を牽引することで、ジョー部材５２の他端部５２ｂとジョー部材５５の他端部５５ｂとをピン５３の軸を中心として回転させ、互いに接近させて閉じさせることができる。また、鉗子操作ワイヤ３６を押し込むことで、ジョー部材５２の他端部５２ｂとジョー部材５５の他端部５５ｂとを互いに離間させて開かせることができる。 The treatment portion 22 configured as described above pulls the forceps operation wire 36 to rotate the other end portion 52b of the jaw member 52 and the other end portion 55b of the jaw member 55 around the axis of the pin 53. , Can be closed close to each other. Further, by pushing the forceps operation wire 36, the other end 52b of the jaw member 52 and the other end 55b of the jaw member 55 can be opened apart from each other.
　図３および図８に示すように、組織穿通部材５８は、中空構造で湾曲した管状に形成されている。ジョー部材５２の他端部５２ｂには、通し孔５２ｃが形成されている。組織穿通部材５８は、ジョー部材５２の開閉方向の外側に、中心軸線Ｃ１とほぼ平行に延びるように取り付けられている。組織穿通部材５８の先端側は、通し孔５２ｃを通してジョー部材５５の他端部５５ｂ側に向けて湾曲されている。組織穿通部材５８の内腔は、細長糸状部材２４の先端部材２７を収容可能な大きさに設定されている。 As shown in FIGS. 3 and 8, the tissue penetrating member 58 is formed in a curved tubular shape with a hollow structure. A through hole 52 c is formed in the other end 52 b of the jaw member 52. The tissue penetrating member 58 is attached to the outside of the jaw member 52 in the opening / closing direction so as to extend substantially parallel to the central axis C1. The distal end side of the tissue penetrating member 58 is curved toward the other end 55b side of the jaw member 55 through the through hole 52c. The lumen of the tissue penetrating member 58 is set to a size that can accommodate the distal end member 27 of the elongated thread-like member 24.
　組織穿通部材５８は、先端の開口から組織穿通部材５８の軸方向の所定の長さにわたり、スリット５８ａを有している。スリット５８ａの幅は、細長糸状部材２４の糸状本体部２９が挿入可能な大きさに設定されている。組織穿通部材５８の先端部の縁部には、スリット５８ａが形成された部分以外全周にわたり、組織を穿通するための切刃５９が設けられている。 The tissue penetrating member 58 has a slit 58a extending from a distal end opening to a predetermined length in the axial direction of the tissue penetrating member 58. The width of the slit 58a is set such that the thread-like main body 29 of the elongated thread-like member 24 can be inserted. A cutting edge 59 for penetrating tissue is provided at the edge of the distal end portion of the tissue penetrating member 58 over the entire circumference except the portion where the slit 58a is formed.
　組織穿通部材５８の内腔には、この内腔で進退可能に配置され、組織穿通部材５８内に収容された先端部材２７を開口から押し出すプッシャー（取外し部材）６０が備えられている。プッシャー６０は、湾曲する組織穿通部材５８の内腔に沿って進退可能となる程度に柔軟性を有すると同時に、自身の軸方向への伸縮の少ない材料で形成されている。プッシャー６０の基端側は、組織穿通部材５８の基端側とともに先端保持部３５側に延びている。 In the lumen of the tissue penetrating member 58, there is provided a pusher (detaching member) 60 that is disposed so as to be able to advance and retreat in the lumen and pushes the distal end member 27 accommodated in the tissue penetrating member 58 from the opening. The pusher 60 is made of a material that is flexible enough to advance and retreat along the lumen of the curved tissue penetrating member 58 and at the same time has little expansion and contraction in the axial direction of the pusher 60. The proximal end side of the pusher 60 extends toward the distal end holding portion 35 side together with the proximal end side of the tissue penetrating member 58.
　また、組織穿通部材５８の先端側の内周面には、内周面から突出した凸部５８ｂが形成されている。凸部５８ｂは、先端部材２７が開口側に移動するのを係止するとともに、プッシャー６０により先端部材２７を押し出すことで変形された先端部材２７が乗り越え可能に形成されている。本実施形態では凸部５８ｂは、管状に形成された組織穿通部材５８を変形させて形成しているが、組織穿通部材５８に別の部品を接着剤やロー付け、半田付、レーザー加工などで接合することで、凸部を形成してもよい。 Further, a convex portion 58 b protruding from the inner peripheral surface is formed on the inner peripheral surface on the distal end side of the tissue penetrating member 58. The convex portion 58b is formed so that the tip member 27 can be moved over the opening side, and the tip member 27 deformed by pushing the tip member 27 by the pusher 60 can be overcome. In this embodiment, the convex portion 58b is formed by deforming the tissue penetrating member 58 formed in a tubular shape, but another component is attached to the tissue penetrating member 58 with an adhesive, brazing, soldering, laser processing, or the like. You may form a convex part by joining.
　ジョー部材５２と同様に、ジョー部材５５の開閉方向の外側には、中心軸線Ｃ１とほぼ平行に延びるように組織穿通部材６１が取り付けられている。ジョー部材５５の他端部５５ｂには、管状に形成された組織穿通部材６１が固定されている。組織穿通部材６１の先端側は、ジョー部材５２の他端部５２ｂに向けて湾曲され、組織穿通部材６１の先端の開口と組織穿通部材５８の先端の開口とが対向するように構成されている。組織穿通部材６１は、内腔に細長糸状部材２４の先端部材２７を収容可能であって、内径が組織穿通部材５８の外径とほぼ等しく設定されている。 Similarly to the jaw member 52, a tissue penetrating member 61 is attached to the outside of the jaw member 55 in the opening / closing direction so as to extend substantially parallel to the central axis C1. A tissue penetrating member 61 formed in a tubular shape is fixed to the other end portion 55 b of the jaw member 55. The distal end side of the tissue penetrating member 61 is curved toward the other end 52b of the jaw member 52, and the opening at the distal end of the tissue penetrating member 61 and the opening at the distal end of the tissue penetrating member 58 are configured to face each other. . The tissue penetrating member 61 can accommodate the distal end member 27 of the elongated thread-like member 24 in the lumen, and the inner diameter is set to be approximately equal to the outer diameter of the tissue penetrating member 58.
　組織穿通部材６１は、先端の開口から組織穿通部材６１の軸方向の所定の長さにわたり、スリット６１ａを有している。スリット６１ａの幅は、スリット５８ａと同様に設定されている。組織穿通部材６１の先端部の縁部には、スリット６１ａが形成された部分を除く全周にわたり、組織を穿通するための切刃６２が設けられている。 The tissue penetrating member 61 has a slit 61 a extending from the opening at the tip to a predetermined length in the axial direction of the tissue penetrating member 61. The width of the slit 61a is set in the same manner as the slit 58a. A cutting edge 62 for penetrating the tissue is provided at the edge of the distal end portion of the tissue penetrating member 61 over the entire circumference except the portion where the slit 61a is formed.
　組織穿通部材６１の内腔には、プッシャー６３が備えられている。プッシャー６３は、組織穿通部材６１の内腔で進退可能に配置され、組織穿通部材６１内に収容された先端部材２７を開口から押し出す。また、組織穿通部材６１の先端側の内周面には、凸部５８ｂと同様の構成の凸部６１ｂが形成されている。 A pusher 63 is provided in the lumen of the tissue penetrating member 61. The pusher 63 is disposed so as to be able to advance and retreat in the lumen of the tissue penetrating member 61, and pushes the distal end member 27 accommodated in the tissue penetrating member 61 from the opening. A convex portion 61b having the same configuration as the convex portion 58b is formed on the inner peripheral surface on the distal end side of the tissue penetrating member 61.
　このように構成された組織穿通部材５８は、鉗子操作ワイヤ３６を牽引してジョー部材５２、５５を閉じさせることで、組織穿通部材５８の先端が組織穿通部材６１の内腔に入り込んで、組織穿通部材５８の内腔と組織穿通部材６１の内腔とが連通した連通位置（図８参照）に移動させることができる。また、組織穿通部材６１は、鉗子操作ワイヤ３６を押し込んでジョー部材５２、５５を開かせることで組織穿通部材５８、６１の開口が互いに離間した離間位置（図１３参照）に移動させることができる。 The tissue penetrating member 58 configured in this manner pulls the forceps operation wire 36 to close the jaw members 52 and 55, so that the tip of the tissue penetrating member 58 enters the lumen of the tissue penetrating member 61, and the tissue The lumen of the penetrating member 58 and the lumen of the tissue penetrating member 61 can be moved to a communicating position (see FIG. 8). Further, the tissue penetrating member 61 can be moved to a spaced position (see FIG. 13) where the openings of the tissue penetrating members 58 and 61 are separated from each other by pushing the forceps operation wire 36 to open the jaw members 52 and 55. .
　そして、組織穿通部材５８、６１の開口の間に組織を挟んだ状態で組織穿通部材５８、６１を連通位置に配置したとき、切刃５９、６２で組織のうち開口の間に挟まれた部分を切開することができる。 When the tissue penetrating members 58 and 61 are disposed at the communication position in a state where the tissue is sandwiched between the openings of the tissue penetrating members 58 and 61, a portion of the tissue sandwiched between the openings by the cutting blades 59 and 62 An incision can be made.
　図９および図１０に示すように、切替部材（回転部材）６７は略円筒状に形成され、先端保持部３５の外周面上に回転可能に配置されている。ここで、図１０では、構造説明を行いやすくするために、先端カバー４０の外周面に取り付けられたピン６８の位置を、図９におけるピン６８の位置に対して中心軸線Ｃ１回りに９０°ずらして表記している。さらに、詳しく図示をしていないが、切替部材６７は、先端保持部３５に対して着脱可能となるように構成されている。切替部材６７には、プッシャー６０、６３の基端部６０ａ、６３ａがそれぞれ当接する接触面６９ａ、６９ｂ、６９ｃが中心軸線Ｃ１回りに連続的に形成されている。なお、図９の、接触面６９ａ、６９ｂ、６９ｃに対する先端保持部３５の反対側の部分にも図示しない接触面が形成されている。 As shown in FIGS. 9 and 10, the switching member (rotating member) 67 is formed in a substantially cylindrical shape and is rotatably disposed on the outer peripheral surface of the tip holding portion 35. Here, in FIG. 10, in order to facilitate explanation of the structure, the position of the pin 68 attached to the outer peripheral surface of the tip cover 40 is shifted by 90 ° around the central axis C1 with respect to the position of the pin 68 in FIG. Is written. Furthermore, although not shown in detail, the switching member 67 is configured to be attachable to and detachable from the tip holding portion 35. Contact surface 69a, 69b, 69c which the base end parts 60a and 63a of pusher 60 and 63 contact | abut, respectively is continuously formed in the switching member 67 around the center axis line C1. In addition, the contact surface which is not shown in figure is formed also in the part on the opposite side of the front-end | tip holding | maintenance part 35 with respect to contact surface 69a, 69b, 69c of FIG.
　また、図９および図１０に示すように、切替部材６７の内周面にはカム溝７０が形成され、ピン６８は、カム溝７０内で摺動可能にカム溝７０に係合している。 Further, as shown in FIGS. 9 and 10, a cam groove 70 is formed on the inner peripheral surface of the switching member 67, and the pin 68 engages with the cam groove 70 so as to be slidable within the cam groove 70. .
　カム溝７０は、中心軸線Ｃ１に略平行に形成された平行カム溝７０ａと、中心軸線Ｃ１に対して方向Ｄ１に回るほど基端側に移動する傾斜カム溝７０ｂと、を中心軸線Ｃ１回りに交互に連結して構成されている。
　本実施形態では、たとえば、中心軸線Ｃ１回りに等角度おきに配置された４つの平行カム溝７０ａと、４つの傾斜カム溝７０ｂとが交互に連結されている。 The cam groove 70 includes a parallel cam groove 70a formed substantially parallel to the central axis C1 and an inclined cam groove 70b that moves toward the proximal end as it rotates in the direction D1 with respect to the central axis C1 around the central axis C1. It is configured to be connected alternately.
In the present embodiment, for example, four parallel cam grooves 70a and four inclined cam grooves 70b arranged at equal angles around the central axis C1 are alternately connected.
　更に、切替部材６７の先端側と基端側には、複数の山状体７１、７２が切替部材６７と一体的に設けられている。山状体７１，７２は、中心軸線Ｃ１回りに等角度ごとに山形に連続的に形成されている。本実施形態では、切替部材６７に４つの平行カム溝７０ａが形成されている。そのため、山状体７１、７２は、たとえば、４の倍数である１２ずつ中心軸線Ｃ１回りに等角度ごとに設けられている。このため、隣り合う山状体７２の頂部７２ａが中心軸線Ｃ１回りになす角度は３０°となる。 Furthermore, a plurality of mountain-shaped bodies 71 and 72 are provided integrally with the switching member 67 on the distal end side and the proximal end side of the switching member 67. The mountain-shaped bodies 71 and 72 are continuously formed in a mountain shape around the central axis C1 at equal angles. In the present embodiment, four parallel cam grooves 70 a are formed in the switching member 67. Therefore, the mountain-shaped bodies 71 and 72 are provided, for example, at equal angles around the central axis C1 by 12 that is a multiple of 4. For this reason, the angle which the top part 72a of the adjacent mountain-shaped body 72 makes around the central axis C1 is 30 °.
　また、先端保持部３５にも、山状体７１、７２に対向する位置に、山状体７１、７２に対応する山形に形成された山状体７３、７４が中心軸線Ｃ１回りに等角度ごとに連続的に形成されている。
　山状体７２の頂部７２ａに係合する山状体７４の谷部７４ａは、山状体７２の頂部７２ａから中心軸線Ｃ１方向の基端側に移動した位置から、中心軸線Ｃ１の方向Ｄ１回りに所定の角度移動した位置に配置されている。山状体７４も中心軸線Ｃ１回りに３０°ごとに設けられているため、所定の角度は、たとえば、３０°の半分よりも小さい値である８°を用いることができる。 Further, in the tip holding portion 35, the mountain- like bodies 73 and 74 formed in a mountain shape corresponding to the mountain- like bodies 71 and 72 at positions opposite to the mountain- like bodies 71 and 72 are equiangularly around the central axis C1. Are formed continuously.
The valley 74a of the mountain 74 that engages the top 72a of the mountain 72 is around the direction D1 of the central axis C1 from the position moved from the top 72a of the mountain 72 to the proximal end in the direction of the central axis C1. It is arranged at a position moved by a predetermined angle. Since the mountain-shaped body 74 is also provided around the central axis C1 every 30 °, the predetermined angle can be 8 °, which is a value smaller than half of 30 °, for example.
　山状体７３も、山状体７１に対する中心軸線Ｃ１方向の位置が、中心軸線Ｃ１回りに所定の角度移動した位置に配置されている。
　そして、ピン６８がカム溝７０内を移動することで、切替部材６７が方向Ｄ１回りに間欠的に回転するように形成されている。以下では、説明の便宜のため、中心軸線Ｃ１回りに切替部材６７が回転するのでなく、ピン６８側が回転するものとして説明する。 The mountain-like body 73 is also disposed at a position where the position in the direction of the central axis C1 relative to the mountain-like body 71 is moved by a predetermined angle around the central axis C1.
Then, as the pin 68 moves in the cam groove 70, the switching member 67 is formed to rotate intermittently around the direction D1. Hereinafter, for convenience of explanation, it is assumed that the switching member 67 does not rotate around the central axis C1, but the pin 68 side rotates.
　すなわち、図９において、切替部材６７は、ピン６８が平行カム溝７０ａにおいて矢印Ａ１に示すように基端側に移動する時は回転しない。そして、ピン６８が平行カム溝７０ａ内の位置Ｑ１に達し、後述するように切替部材６７とともに基端側に移動して山状体７２と山状体７４とが係合すると、ピン６８は、切替部材６７に対して中心軸線Ｃ１に対して方向Ｄ１とは反対の方向Ｄ２回りに８°回転して、位置Ｑ２に達する。なお、実際には、切替部材６７が方向Ｄ１に回転する。この後で、ピン６８が矢印Ａ２に示すように先端側に移動すると、ピン６８が傾斜カム溝７０ｂに当接することで、切替部材６７が方向Ｄ１に回転する。 That is, in FIG. 9, the switching member 67 does not rotate when the pin 68 moves to the proximal end side as indicated by the arrow A1 in the parallel cam groove 70a. Then, when the pin 68 reaches the position Q1 in the parallel cam groove 70a and moves to the base end side together with the switching member 67 as will be described later, the mountain body 72 and the mountain body 74 are engaged, The switch member 67 is rotated by 8 ° around the direction D2 opposite to the direction D1 with respect to the central axis C1, and reaches the position Q2. Actually, the switching member 67 rotates in the direction D1. Thereafter, when the pin 68 moves to the tip end side as indicated by the arrow A2, the switching member 67 rotates in the direction D1 by the pin 68 coming into contact with the inclined cam groove 70b.
　このように、切替部材６７が中心軸線Ｃ１回りに回転することで、プッシャー６０の基端部６０ａが当接する接触面の中心軸線Ｃ１方向の位置が変化する。その結果、プッシャー６０の組織穿通部材５８の内腔に沿った位置が変化する。プッシャー６３についても同様である。 Thus, when the switching member 67 rotates around the central axis C1, the position of the contact surface with which the proximal end portion 60a of the pusher 60 abuts changes in the direction of the central axis C1. As a result, the position of the pusher 60 along the lumen of the tissue penetrating member 58 changes. The same applies to the pusher 63.
　カム溝７０およびピン６８で、切替部材６７を中心軸線Ｃ１で回りに回転させるカム機構を構成する。そして、切替部材６７およびカム機構で、プッシャー６０、６３を交互に進退させる切替機構を構成する。なお、山状体７１～７４は、切替部材６７が中心軸線Ｃ１の同一方向回りに回転するように規制する回転補助機構を構成する。 The cam groove 70 and the pin 68 constitute a cam mechanism that rotates the switching member 67 around the central axis C1. The switching member 67 and the cam mechanism constitute a switching mechanism for alternately moving the pushers 60 and 63 back and forth. The mountain-like bodies 71 to 74 constitute a rotation assist mechanism that restricts the switching member 67 to rotate around the same direction of the central axis C1.
　図４に示すように、挿入部４は、可撓性を有して管状に形成されたシース８０を有している。シース８０の先端には、前述の先端保持部３５が取り付けられる。シース８０内には、鉗子操作ワイヤ３６が進退可能に挿通されている。 As shown in FIG. 4, the insertion portion 4 has a sheath 80 that is flexible and formed in a tubular shape. The aforementioned distal end holding portion 35 is attached to the distal end of the sheath 80. A forceps operation wire 36 is inserted into the sheath 80 so as to be able to advance and retreat.
　次に、図１１を用いて縫合器５の操作部２３について説明する。シース８０の基端部は、略棒状の操作部ボディ８４の先端側に接続されている。操作部ボディ８４には、ワイヤ操作スライダ８６が進退可能に取り付けられている。ワイヤ操作スライダ８６には、鉗子操作ワイヤ３６の基端部が取り付けられている。 Next, the operation unit 23 of the suturing device 5 will be described with reference to FIG. The proximal end portion of the sheath 80 is connected to the distal end side of the substantially rod-shaped operation portion body 84. A wire operation slider 86 is attached to the operation portion body 84 so as to be able to advance and retract. A proximal end portion of the forceps operation wire 36 is attached to the wire operation slider 86.
　操作部２３はラチェット機構を有している。ボタン８７を図１１に示すように押込んだ状態にすると、ラチェット機構が解除された状態になる。すると、操作部ボディ８４に形成された刻み目部材９１からボタン８７に形成された係止部８７ａが離間して、ワイヤ操作スライダ８６を操作部ボディ８４に対して自由に進退させることができる。 The operation unit 23 has a ratchet mechanism. When the button 87 is pushed in as shown in FIG. 11, the ratchet mechanism is released. Then, the locking portion 87 a formed on the button 87 is separated from the notch member 91 formed on the operation portion body 84, and the wire operation slider 86 can be freely advanced and retracted with respect to the operation portion body 84.
　また、ボタン８７に形成されたストッパー８８をワイヤ操作スライダ８６に形成された係合部８９から外して、ボタン８７を引出した状態にスライドさせる。すると、バネ９０によって径方向に付勢されていた係止部８７ａが径方向に移動し、係止部８７ａが操作部ボディ８４の刻み目部材９１と係合し、ワイヤ操作スライダ８６は、操作部ボディ８４に対して基端側にのみ移動可能となる。これにより、ジョー部材５２、５５は開く方向に移動できなくなる。 Further, the stopper 88 formed on the button 87 is removed from the engaging portion 89 formed on the wire operation slider 86, and the button 87 is slid into the pulled-out state. Then, the locking portion 87a urged in the radial direction by the spring 90 moves in the radial direction, the locking portion 87a engages with the notch member 91 of the operation portion body 84, and the wire operation slider 86 is It can move only to the base end side with respect to the body 84. Thereby, the jaw members 52 and 55 cannot move in the opening direction.
　次に、この実施形態の内視鏡システム１を用いた手技について説明する。なお、以下においては、胃壁に形成された開口を縫合する場合を説明する。しかし、ターゲット部位は、これに限定されず、たとえば、食道、十二指腸、小腸、大腸、子宮、膀胱などの管腔器官でも良い。また、内視鏡３を挿入する自然開口は、口に限定されずに鼻や肛門でも良い。さらに、潰瘍による穿孔部、粘膜欠損部の縫縮、消化管の憩室などの治療や、止血に用いても良い。 Next, a procedure using the endoscope system 1 of this embodiment will be described. In the following, a case where an opening formed in the stomach wall is sutured will be described. However, the target site is not limited to this, and may be a luminal organ such as the esophagus, duodenum, small intestine, large intestine, uterus, and bladder. Further, the natural opening into which the endoscope 3 is inserted is not limited to the mouth but may be the nose or the anus. Furthermore, it may be used for the treatment of hemorrhage such as perforation due to ulcer, mucosal defect part, digestive tract diverticulum and the like.
　図１に示すように、術者は、内視鏡３の鉗子チャンネル２に縫合器５の挿入部４を挿通して、内視鏡３に縫合器５を装着する。そして、内視鏡３とともに縫合器５を患者の口から胃内に挿入する。ここで、内視鏡３に外付けのチャンネルを設け、その外付けチャンネルを介して縫合器５を胃内に挿入しても、内視鏡３に直接縫合器５を固定して使用してもよい。 As shown in FIG. 1, the surgeon inserts the insertion unit 4 of the suture device 5 into the forceps channel 2 of the endoscope 3 and attaches the suture device 5 to the endoscope 3. Then, the suture device 5 is inserted into the stomach through the patient's mouth together with the endoscope 3. Here, even if an external channel is provided in the endoscope 3 and the suturing device 5 is inserted into the stomach through the external channel, the suturing device 5 is directly fixed to the endoscope 3 and used. Also good.
　次に、縫合に先立って胃内でジョー部材５２、５５を開いておく。具体的には、術者は、図１１に示す操作部２３のワイヤ操作スライダ８６を操作部ボディ８４に対して押し込んで前進させる。すると、鉗子操作ワイヤ３６が前進して、ロッド４４に連結されたリンク部材４９、５０がジョー部材５２、５５をピン５３回りに回転させる。これにより、図１２に示すようにジョー部材５２、５５が開き、組織穿通部材５８、６１の開口が互いに離間した離間位置に配置される。操作部２３の位置や向きを調節し、開いたジョー部材５２、５５を夕－ゲット部位である患者Ｐの開口Ｗ１に近接させる。その後、ジョー部材５２、５５で開口Ｗ１に対する一方側の組織Ｗ２を挾み込むようにしてワイヤ操作スライダ８６を牽引して後退させる。 Next, the jaw members 52 and 55 are opened in the stomach prior to suturing. Specifically, the surgeon pushes the wire operation slider 86 of the operation unit 23 shown in FIG. Then, the forceps operation wire 36 moves forward, and the link members 49 and 50 connected to the rod 44 rotate the jaw members 52 and 55 around the pin 53. Thereby, as shown in FIG. 12, the jaw members 52 and 55 are opened, and the openings of the tissue penetrating members 58 and 61 are arranged at spaced apart positions. The position and orientation of the operation unit 23 are adjusted, and the opened jaw members 52 and 55 are brought close to the opening W1 of the patient P that is the evening-getting part. Thereafter, the wire operation slider 86 is pulled back so as to squeeze the tissue W2 on one side with respect to the opening W1 by the jaw members 52 and 55.
　すると、鉗子操作ワイヤ３６がリンク部材４９、５０とともに後退して、ジョー部材５２、５５がピン５３回りに回動して閉じる。そして、ジョー部材５２、５５に固定された組織穿通部材５８、６１が、それぞれの開口の間に組織Ｗ２を挟んだ状態で連通位置に移動して組織Ｗ２に刺入され、組織穿通部材５８、６１の内腔が連通する。なお、縫合対象が開口形態ではなく、平面部である場合も同じ動作で穿刺することができる。 Then, the forceps operation wire 36 is retracted together with the link members 49 and 50, and the jaw members 52 and 55 are rotated around the pin 53 and closed. Then, the tissue penetrating members 58 and 61 fixed to the jaw members 52 and 55 are moved to the communication position with the tissue W2 sandwiched between the respective openings and inserted into the tissue W2, and the tissue penetrating member 58, 61 lumens communicate with each other. It should be noted that puncture can be performed with the same operation even when the suture target is not an opening shape but a flat portion.
　次に、細長糸状部材２４の先端部材２７が、組織Ｗ２を穿刺した後に、組織穿通部材５８と組織穿通部材６１の間を交互に移動する動作について説明する。 Next, the operation in which the distal end member 27 of the elongated thread-like member 24 alternately moves between the tissue penetrating member 58 and the tissue penetrating member 61 after puncturing the tissue W2 will be described.
　ジョー部材５２、５５が完全に閉じたとき、又は完全に閉じる直前に、先端カバー４０の筒部４０ａ内に引き込まれたロッド４４の解除部材４７のテーパー面が、ピン３７を押し上げる。ピン３７が押し上げられると、筒部４０ａと、先端保持部３５との係合が解除される。その結果、先端保持部３５に対して先端カバー４０が中心軸線Ｃ１方向に移動可能になる。更に、このまま鉗子操作ワイヤ３６を牽引すると、先端カバー４０がコイルバネ４１を圧縮しながら基端側に移動し、先端カバー４０にピン５３で連結されたジョー部材５２、５５が後退する。このとき、図１０に示すように、ロッド４４と一体になって中心軸線Ｃ１方向に移動する先端カバー４０に固定されているピン６８が基端側に移動する（図９の矢印Ａ１の方向）。この移動に伴ってプッシャー６３は、自身の基端部６３ａが接触面６９ａに当たることで中心軸線Ｃ１方向の位置が固定される。それにより図１３および図１４に示すように、先端部材２７が組織穿通部材６１の先端から飛び出る。これにより、図１５に示すように、先端部材２７は、組織穿通部材６１から組織穿通部材５８に移動し、組織Ｗ２を糸状本体部２９が通過する。このとき、プッシャー６０の基端部６０ａは、接触面６９ａ、６９ｂ、６９ｃに当たらないため、プッシャー６０は組織穿通部材５８の内部の同じ位置にいる。 When the jaw members 52 and 55 are completely closed or immediately before they are completely closed, the taper surface of the release member 47 of the rod 44 drawn into the cylindrical portion 40a of the tip cover 40 pushes up the pin 37. When the pin 37 is pushed up, the engagement between the cylindrical portion 40a and the tip holding portion 35 is released. As a result, the tip cover 40 can move in the direction of the central axis C <b> 1 with respect to the tip holding portion 35. Further, when the forceps operation wire 36 is pulled in this state, the distal end cover 40 moves to the proximal end side while compressing the coil spring 41, and the jaw members 52 and 55 connected to the distal end cover 40 by the pins 53 are retracted. At this time, as shown in FIG. 10, the pin 68 fixed to the distal end cover 40 which moves integrally with the rod 44 and moves in the direction of the central axis C1 moves to the proximal end side (direction of arrow A1 in FIG. 9). . Along with this movement, the position of the pusher 63 in the direction of the central axis C1 is fixed by the base end 63a of the pusher 63 coming into contact with the contact surface 69a. Thereby, as shown in FIGS. 13 and 14, the distal end member 27 pops out from the distal end of the tissue penetrating member 61. As a result, as shown in FIG. 15, the distal end member 27 moves from the tissue penetrating member 61 to the tissue penetrating member 58, and the filamentous main body 29 passes through the tissue W2. At this time, since the proximal end portion 60a of the pusher 60 does not contact the contact surfaces 69a, 69b, 69c, the pusher 60 is at the same position inside the tissue penetrating member 58.
　一方、切替部材６７は、ピン６８が矢印Ａ１方向に移動した時は中心軸線Ｃ１回りに回転しないが、ピン６８がカム溝７０の基端部に達した時には、ピン６８がカム溝７０に係止することで、ピン６８と切替部材６７が一体となって基端側に移動する。この移動により山状体７２と山状体７４が接触し、切替部材６７は、図９の方向Ｄ１に所定の角度回転する。その後、ピン６８の移動方向が、矢印Ａ１から矢印Ａ２の方向に切り替わる。また、この状態では、ボール４５は、解除部材３９を越えて大径部４０ｇに入り込み、筒部４０ａとロッド４４とが連結されているため、ジョー部材５２、５５は開くことができない。なお、図４は筒部４０ａとロッド４４とが連結されている状態を示している。 On the other hand, the switching member 67 does not rotate around the central axis C1 when the pin 68 moves in the direction of the arrow A1, but when the pin 68 reaches the proximal end of the cam groove 70, the pin 68 is engaged with the cam groove 70. By stopping, the pin 68 and the switching member 67 are integrally moved to the proximal end side. By this movement, the mountain-shaped body 72 and the mountain-shaped body 74 come into contact with each other, and the switching member 67 rotates by a predetermined angle in the direction D1 of FIG. Thereafter, the moving direction of the pin 68 is switched from the arrow A1 to the arrow A2. Further, in this state, the ball 45 enters the large-diameter portion 40g beyond the release member 39, and the cylindrical portion 40a and the rod 44 are connected, so that the jaw members 52 and 55 cannot be opened. FIG. 4 shows a state in which the cylindrical portion 40a and the rod 44 are connected.
　続いて、ジョー部材５２、５５を開く動作を説明する。ワイヤ操作スライダ８６を押し込むことで、一体となった先端カバー４０とロッド４４が先端側に移動する。それに伴い、ピン６８とカム溝７０のカム構造により、切替部材６７は図９の方向Ｄ１に回転し、その回転によりプッシャー６３の基端部６３ａの接触面が、接触面６９ａから接触面６９ｃに、接触面６９ｂを経由しながら切り替わる。このときに、切替部材６７が中心軸線Ｃ１回りに回転する角度は一般に９０°回転が良いが、使用状況により９０°以外でもよい。更に、ピン６８はカム溝７０の先端側に達し、それによりピン６８と切替部材６７が一体となって先端側に移動する。この移動により山状体７３と山状体７１が接触し、切替部材６７は方向Ｄ１に所定の角度回転し、ピン６８はカム溝７０のうち不図示の部分に係合する。また、この動作とほぼ同時に、ボール４５は、解除部材３９により押し上げられ、ロッド４４と先端カバー４０の係合が解除され、ジョー部材５２、５５が開く。また、この動作のほぼ同時か直後に、解除部材４７が中心軸線Ｃ１に平行に基端側に移動する。この結果、ピン３７が先端保持部３５の孔３５ａを通って先端カバー４０に形成されたスリット４０ｃの基端部４０ｆに入り込み、先端カバー４０と先端保持部３５とが一体化する。 Subsequently, the operation of opening the jaw members 52 and 55 will be described. By pushing in the wire operation slider 86, the integrated tip cover 40 and rod 44 move to the tip side. Accordingly, due to the cam structure of the pin 68 and the cam groove 70, the switching member 67 rotates in the direction D1 in FIG. 9, and the contact surface of the proximal end portion 63a of the pusher 63 is changed from the contact surface 69a to the contact surface 69c by the rotation. , Switching through the contact surface 69b. At this time, the angle at which the switching member 67 rotates about the central axis C1 is generally 90 ° rotation, but may be other than 90 ° depending on use conditions. Further, the pin 68 reaches the distal end side of the cam groove 70, whereby the pin 68 and the switching member 67 move together to the distal end side. Due to this movement, the mountain-shaped body 73 and the mountain-shaped body 71 come into contact with each other, the switching member 67 rotates by a predetermined angle in the direction D1, and the pin 68 engages with a portion (not shown) of the cam groove 70. At substantially the same time as this operation, the ball 45 is pushed up by the release member 39, the engagement between the rod 44 and the tip cover 40 is released, and the jaw members 52 and 55 are opened. Further, almost simultaneously or immediately after this operation, the release member 47 moves to the proximal end side in parallel to the central axis C1. As a result, the pin 37 enters the proximal end portion 40f of the slit 40c formed in the tip cover 40 through the hole 35a of the tip holding portion 35, and the tip cover 40 and the tip holding portion 35 are integrated.
　続いて、図１６に示すように、縫合器５を中心軸線Ｃ１回りに約１８０°回転させた後、ジョー部材５２、５５で開口Ｗ１を挟んで組織Ｗ２と対向する組織Ｗ３を挾み込むようにしてジョー部材５２、５５を閉じる。そして、上記と同様に、プッシャー６３を中心軸線Ｃ１方向に固定した状態で、ロッド４４および先端カバー４０が基端側に移動することで、図１７に示すように、先端部材２７が組織穿通部材５８の先端から飛び出て組織穿通部材６１に移動する。 Subsequently, as shown in FIG. 16, after the suture instrument 5 is rotated about 180 ° around the central axis C1, the jaw members 52 and 55 sandwich the opening W1 and swallow the tissue W3 facing the tissue W2. The jaw members 52 and 55 are closed. Similarly to the above, when the pusher 63 is fixed in the direction of the central axis C1, the rod 44 and the distal end cover 40 move to the proximal end side, so that the distal end member 27 becomes a tissue penetrating member as shown in FIG. It jumps out from the tip of 58 and moves to the tissue penetrating member 61.
　以上のように、プッシャー６０とプッシャー６３との突出を繰り返して交互に切り替えることで、先端部材２７が組織穿通部材５８と組織穿通部材６１との間を交互に移動する。これにより、開口Ｗ１に対する一方側の組織Ｗ２と他方側の組織Ｗ３を、細長糸状部材２４により交互に縫合することができる。
　この縫合の後で、さらに図１８に示すように、縫合器５を基端側に移動させて開口Ｗ１を閉じてもよい。 As described above, the protrusions of the pusher 60 and the pusher 63 are repeatedly switched alternately so that the distal end member 27 moves alternately between the tissue penetrating member 58 and the tissue penetrating member 61. Thereby, the tissue W2 on one side and the tissue W3 on the other side with respect to the opening W1 can be alternately sutured by the elongated thread-like member 24.
After the suturing, as shown in FIG. 18, the opening 5 may be closed by moving the suturing device 5 to the proximal end side.
　本実施形態の内視鏡システム１によれば、先端部材２７は略球形状をしておいる。ゆえに、たとえば、先端部材２７が脱落したとしても、従来の縫合器のように、針状の部材が脱落して周囲の組織を傷つけることを防止することができる。また、組織穿通部材５８、６１の間で先端部材２７を繰り返して受渡しすることで、組織を連続的に縫合することができる。 According to the endoscope system 1 of the present embodiment, the tip member 27 has a substantially spherical shape. Therefore, for example, even if the distal end member 27 falls off, it is possible to prevent the needle-like member from dropping off and damaging the surrounding tissue as in a conventional suture instrument. Further, the tissue can be continuously sutured by repeatedly delivering the tip member 27 between the tissue penetrating members 58 and 61.
　そして、細長糸状部材２４は、先端部材２７と、先端部材２７より外径の小さな糸状本体部２９を有しているので、先端部材２７を組織に穿通して形成した孔に、糸状本体部２９を確実に挿通させることができる。 The elongated thread-like member 24 has a tip member 27 and a thread-like main body portion 29 having an outer diameter smaller than that of the tip member 27. Therefore, the thread-like main body portion 29 is formed in a hole formed by penetrating the tip member 27 into the tissue. Can be reliably inserted.
　組織穿通部材５８はジョー部材５２に、組織穿通部材６１はジョー部材５５にそれぞれ固定されている。このため、ジョー部材５２、５５を互いに接近、離間させることで、組織穿通部材５８、６１を連通位置と離間位置との間で位置を容易に移動させ、細長糸状部材２４による縫合を容易に行うことができる。 The tissue penetrating member 58 is fixed to the jaw member 52, and the tissue penetrating member 61 is fixed to the jaw member 55. For this reason, by moving the jaw members 52 and 55 closer to and away from each other, the position of the tissue penetrating members 58 and 61 can be easily moved between the communication position and the separation position, and the elongated thread-like member 24 can be easily sutured. be able to.
　組織穿通部材５８は、細長糸状部材２４の糸状本体部２９が挿入可能なスリット５８ａを有している。これにより、組織穿通部材５８、６１を連通位置に配置した場合であっても、組織穿通部材５８の内腔に収容した先端部材２７に接続された糸状本体部２９をスリット５８ａを通して組織穿通部材５８の外部に導く。その結果、組織穿通部材５８の内腔での先端部材２７の移動を糸状本体部２９が妨げるのを防止することができる。 The tissue penetrating member 58 has a slit 58a into which the thread-like main body portion 29 of the elongated thread-like member 24 can be inserted. As a result, even when the tissue penetrating members 58 and 61 are arranged at the communication position, the tissue penetrating member 58 passes through the slit-like body portion 29 connected to the distal end member 27 accommodated in the lumen of the tissue penetrating member 58 through the slit 58a. Lead outside. As a result, it is possible to prevent the filamentous main body 29 from interfering with the movement of the distal end member 27 in the lumen of the tissue penetrating member 58.
　また、縫合器５はプッシャー６０、６３を備えているので、組織穿通部材５８、６１内の先端部材２７を開口から容易に押し出すことができる。 Further, since the suture instrument 5 includes the pushers 60 and 63, the distal end member 27 in the tissue penetrating members 58 and 61 can be easily pushed out from the opening.
　組織穿通部材５８の内周面には凸部５８ｂが形成されているため、組織穿通部材５８の内腔における凸部５８ｂより基端側に収容された先端部材２７が、誤って組織穿通部材５８の先端側から脱落するのを防止する。そして、必要に応じてプッシャー６０で先端部材２７を押し出すことで、先端部材２７を組織穿通部材５８の先端側から飛び出させることができる。 Since the convex portion 58 b is formed on the inner peripheral surface of the tissue penetrating member 58, the distal end member 27 accommodated on the proximal end side from the convex portion 58 b in the lumen of the tissue penetrating member 58 is mistakenly inserted into the tissue penetrating member 58. Prevents falling off from the tip side of the. Then, if necessary, the distal end member 27 can be ejected from the distal end side of the tissue penetrating member 58 by pushing the distal end member 27 with the pusher 60.
　縫合器５は切替機構を備えるため、プッシャー６０、６３を組織穿通部材５８、６１の内腔に沿って容易に進退させることができる。
そして、切替機構は、切替部材６７とカム機構とを有するため、カム機構により切替部材６７を中心軸線Ｃ１回りに回転させるだけで、プッシャー６０、６３を進退させることができる。
　切替機構は、切替部材６７が中心軸線Ｃ１の同一方向回りに回転するように規制する回転補助機構を有するため、切替部材６７が回転する動きを安定させることができる。 Since the suturing device 5 includes a switching mechanism, the pushers 60 and 63 can be easily advanced and retracted along the lumens of the tissue penetrating members 58 and 61.
Since the switching mechanism includes the switching member 67 and the cam mechanism, the pushers 60 and 63 can be advanced and retracted only by rotating the switching member 67 around the central axis C1 by the cam mechanism.
Since the switching mechanism has a rotation assist mechanism that restricts the switching member 67 to rotate about the same direction of the central axis C1, the movement of the switching member 67 can be stabilized.
　また、組織穿通部材５８の先端部には切刃５９が設けられ、組織穿通部材６１の先端部には切刃６２が設けられている。したがって、組織穿通部材５８、６１を連通位置に配置したときに、組織穿通部材５８と組織穿通部材６１との間に挟んだ組織を、切刃５９、６２により容易に穿通することができる。 Further, a cutting edge 59 is provided at the distal end portion of the tissue penetrating member 58, and a cutting edge 62 is provided at the distal end portion of the tissue penetrating member 61. Therefore, when the tissue penetrating members 58 and 61 are disposed at the communication position, the tissue sandwiched between the tissue penetrating member 58 and the tissue penetrating member 61 can be easily penetrated by the cutting blades 59 and 62.
　そして、細長糸状部材２４の糸状本体部２９は組織固定部材３１よりも引張り強度の高い材料で形成されているため、外径を組織固定部材３１の外径より小さく設定できる。これにより、縫合時に組織の間を行き来する部材である先端部材２７を小さく設計することができる。ゆえに、先端部材２７と連携して動作をする組織穿通部材５８、６１も小型化することができる。その結果、縫合器５の処置部２２や挿入部４を実質的に小型化、かつ細径化することが可能となる。
　また、組織を組織穿通部材５８、６１で把持しながら縫合するため、組織穿通部材５８、６１により、組織における縫合したい部位を選択的に把持することができる。 Since the filamentous main body 29 of the elongated thread-like member 24 is formed of a material having a higher tensile strength than the tissue fixing member 31, the outer diameter can be set smaller than the outer diameter of the tissue fixing member 31. Thereby, the tip member 27 which is a member which moves back and forth between tissues at the time of suturing can be designed small. Therefore, the tissue penetrating members 58 and 61 that operate in cooperation with the distal end member 27 can also be reduced in size. As a result, the treatment portion 22 and the insertion portion 4 of the suturing device 5 can be substantially reduced in size and diameter.
In addition, since the tissue is sutured while being grasped by the tissue penetrating members 58 and 61, the tissue penetrating members 58 and 61 can selectively grasp a site to be sutured in the tissue.
　組織穿通部材５８の先端が組織穿通部材６１の内腔に入り込んで嵌合するように構成されているため、組織穿通部材５８、６１は、組織が組織穿通部材５８、６１から脱落することなく、組織を確実に穿通することができる。
　また、糸状本体部２９は金属で形成されているため、手技中に糸状本体部２９が切断されるのを防止することができる。 Since the distal end of the tissue penetrating member 58 is configured to enter and fit into the lumen of the tissue penetrating member 61, the tissue penetrating members 58 and 61 are configured so that the tissue does not fall off the tissue penetrating members 58 and 61. The tissue can be reliably penetrated.
Moreover, since the thread-like main body 29 is made of metal, it is possible to prevent the thread-like main body 29 from being cut during the procedure.
　組織固定部材３１は樹脂で形成されているため、縫合した組織の形状に沿って、組織固定部材３１を湾曲させることができる。
　そして、先端部材２７は略球状に形成されているため、先端部材２７が誤って脱落したときに、周囲の組織に与える侵襲を低減させることができる。 Since the tissue fixing member 31 is made of resin, the tissue fixing member 31 can be bent along the shape of the sutured tissue.
Since the tip member 27 is formed in a substantially spherical shape, it is possible to reduce the invasion given to surrounding tissues when the tip member 27 is accidentally dropped.
　また、内視鏡システム１は、縫合器５と内視鏡３とを備えるため、内視鏡３の観察ユニット１４で前方を観察しながら、縫合器５で組織を縫合することができる。 Further, since the endoscope system 1 includes the suturing device 5 and the endoscope 3, the tissue can be sutured with the suturing device 5 while observing the front with the observation unit 14 of the endoscope 3.
　なお、本実施形態では、細長糸状部材２４に代えて、図１９に示す細長糸状部材９４を用いてもよい。細長糸状部材９４は、細長糸状部材２４の先端部材２７に代えて先端部材９５を備えている。先端部材９５は、糸状本体部２９にほぼ直交する方向に延びる略円柱形に形成され、先端部材９５の両端に針状に尖った部分、より詳しくは円錐形の尖端部９５ａ、９５ｂが形成されている。 In the present embodiment, an elongated thread-like member 94 shown in FIG. 19 may be used instead of the elongated thread-like member 24. The elongated thread-like member 94 includes a distal end member 95 instead of the distal end member 27 of the elongated thread-like member 24. The tip member 95 is formed in a substantially cylindrical shape extending in a direction substantially orthogonal to the thread-like main body portion 29, and needle-pointed portions, more specifically conical pointed portions 95a and 95b, are formed at both ends of the tip member 95. ing.
　細長糸状部材９４は、細長糸状部材２４と同様の方法で縫合器５に装填される。細長糸状部材９４をこのように構成することで、縫合器５による組織穿刺時に組織穿通部材５８、６１が組織を貫通し、組織穿通部材５８、６１の内腔が連通している際に、尖端部９５ａ、９５ｂにより組織を穿刺しやすくなる。 The elongated thread-like member 94 is loaded into the suturing device 5 in the same manner as the elongated thread-like member 24. By configuring the elongated thread-like member 94 in this way, when the tissue penetrating members 58 and 61 penetrate the tissue at the time of tissue puncture by the suturing device 5 and the lumens of the tissue penetrating members 58 and 61 communicate with each other, the apex It becomes easy to puncture the tissue by the portions 95a and 95b.
　なお、尖端部は先端部材９５の一方の端部にのみ形成されていてもよい。
　また、図２０に示すように、組織穿通部材６１における凸部６１ｂより基端側の内径が、組織穿通部材５８における凸部５８ｂより先端側の内径とほぼ等しくなるように構成してもよい。このように構成することで、先端部材２７が更にスムーズに組織穿通部材５８と組織穿通部材６１との間を移動することができる。 The pointed portion may be formed only at one end of the tip member 95.
Further, as shown in FIG. 20, the inner diameter of the tissue penetrating member 61 on the proximal side from the convex portion 61b may be substantially equal to the inner diameter of the tissue penetrating member 58 on the distal side from the convex portion 58b. With this configuration, the distal end member 27 can move between the tissue penetrating member 58 and the tissue penetrating member 61 more smoothly.
（第２実施形態）
　次に、本発明の第２実施形態について、図２１から図３４を参照して説明するが、前記実施形態と同一の部位には同一の符号を付してその説明は省略し、異なる点についてのみ説明する。 (Second Embodiment)
Next, a second embodiment of the present invention will be described with reference to FIGS. 21 to 34. The same reference numerals are given to the same portions as those of the above-described embodiment, and the description thereof will be omitted, and different points will be described. Only explained.
　本実施形態の内視鏡システムは、上記実施形態の内視鏡３と、図２１に示す細長糸状部材１０５と、上記実施形態の縫合器５と、図２６に示すプッシャーチューブ１１３とを備えている。 The endoscope system of this embodiment includes the endoscope 3 of the above embodiment, the elongated thread-like member 105 shown in FIG. 21, the suturing device 5 of the above embodiment, and the pusher tube 113 shown in FIG. Yes.
　細長糸状部材１０５は、縫合器５の処置部２２に着脱可能に取付けられる。細長糸状部材１０５は、図２１に示すように、細長糸状部材２４の仲介部３０に代えて仲介部１０６を備えるとともに、組織固定部材３１に固定可能な糸係止部材１０７を備えている。 The elongated thread-like member 105 is detachably attached to the treatment portion 22 of the suturing device 5. As shown in FIG. 21, the elongated thread-like member 105 includes a mediating part 106 instead of the mediating part 30 of the elongated thread-like member 24, and a thread locking member 107 that can be fixed to the tissue fixing member 31.
　仲介部１０６には、組織固定部材３１側の端部から自身の長手方向に沿って、所定の長さのスリット１０６ａが形成されている。スリット１０６ａは、組織固定部材３１の軸線回りに複数設けられている。仲介部１０６における糸状本体部２９側の部分には、糸状本体部２９側に向かうにしたがって外径が小さくなる先細り部１０６ｂが形成されている。 In the mediation portion 106, a slit 106a having a predetermined length is formed along the longitudinal direction from the end on the tissue fixing member 31 side. A plurality of slits 106 a are provided around the axis of the tissue fixing member 31. A taper portion 106b whose outer diameter decreases toward the thread-like main body portion 29 side is formed in the portion on the thread-like main body portion 29 side in the mediation portion 106.
　糸係止部材１０７は、糸固定部１０８、１０９と、折り畳み部１１０とを有している。糸固定部１０８、１０９は、筒状に形成され、互いに所定距離離間して配置され内部に組織固定部材３１が挿通されている。折り畳み部１１０は、両端部が糸固定部１０８、１０９に接続されている。折り畳み部１１０は、組織固定部材３１の軸線回りに複数設けられている。また、折り畳み部１１０は、図２１および図２２に示すように、折り畳み部１１０の中心付近に形成された屈曲部１１０ａで、折り畳み部１１０を軸線方向に、軸線方向に直交する方向に対して幅広となるように折りたたむことができる。 The thread locking member 107 has thread fixing parts 108 and 109 and a folding part 110. The thread fixing portions 108 and 109 are formed in a cylindrical shape, are arranged at a predetermined distance from each other, and the tissue fixing member 31 is inserted therein. Both ends of the folding unit 110 are connected to the thread fixing units 108 and 109. A plurality of folding sections 110 are provided around the axis of the tissue fixing member 31. 21 and 22, the folding part 110 is a bent part 110a formed near the center of the folding part 110. The folding part 110 is wide in the axial direction and in the direction orthogonal to the axial direction. It can be folded so that
　図２３に示すように、糸固定部１０８には、組織固定部材３１側に折れ曲がった舌状のストッパー１０８ａが形成されている。そして、ストッパー１０８ａの先端が組織固定部材３１の外周面に当接することで、組織固定部材３１に対して糸固定部１０８は、先端部材２７側からバー３２側には移動することができるが、バー３２側から先端部材２７側には移動することができないように構成されている。糸固定部１０９にも糸固定部１０８と同様にストッパー１０９ａが形成されていて、糸固定部１０９の組織固定部材３１に対する動きを同様に規制している。
　また、図２４および図２５に示すように、仲介部１０６に形成されたスリット１０６ａに、糸固定部１０９に一体的または別体的に形成された凸部１０９ｂが嵌入できるように構成されている。 As shown in FIG. 23, the thread fixing portion 108 is formed with a tongue-shaped stopper 108a bent toward the tissue fixing member 31 side. Then, the tip of the stopper 108a contacts the outer peripheral surface of the tissue fixing member 31, so that the thread fixing portion 108 can move from the tip member 27 side to the bar 32 side with respect to the tissue fixing member 31, It is configured not to move from the bar 32 side to the tip member 27 side. A stopper 109a is also formed in the thread fixing portion 109 similarly to the thread fixing portion 108, and the movement of the thread fixing portion 109 with respect to the tissue fixing member 31 is similarly restricted.
Further, as shown in FIGS. 24 and 25, a convex portion 109 b formed integrally or separately with the thread fixing portion 109 can be fitted into the slit 106 a formed in the mediating portion 106. .
　更に、仲介部１０６と糸係止部材１０７とが容易に外れないように、図示しない止め具を用いたり、スリット１０６ａに凸部１０９ｂを嵌入するときに圧入するように構成してスリット１０６ａと凸部１０９ｂとの間で摩擦抵抗を生じさせたりしている。 Further, a stopper (not shown) is used so that the mediating portion 106 and the thread locking member 107 are not easily detached, or a press-fitting is performed when the convex portion 109b is inserted into the slit 106a so that the slit 106a and the convex portion are not convex. Friction resistance is generated between the portion 109b and the like.
　本実施形態の縫合器５は、上記第１実施形態の縫合器５に加えて、糸係止部材１０７を緊縛するデバイスとして、図２６に示すプッシャーチューブ１１３、および図２７に示すように操作部２３に配置されたプッシャーチューブ操作部８５を備えている。 In addition to the suturing device 5 of the first embodiment, the suturing device 5 of the present embodiment includes a pusher tube 113 shown in FIG. 26 and an operation unit as shown in FIG. 23 is provided with a pusher tube operation section 85 arranged at 23.
　プッシャーチューブ１１３は、長尺の管状に形成されたプッシャー本体１１４と、プッシャー本体１１４の先端に固定されたリング状のプッシャー先端部１１５とを有している。図２８に示すように、プッシャー先端部１１５には、プッシャー先端部１１５の内周面から互いに一定距離離間して内方に突出する一対の突出部１１６が設けられている。一対の突出部１１６の間には、中心軸線Ｃ１に沿うとともに、細長糸状部材１０５の糸状本体部２９が通過可能なスリット１１７が形成される。一対の突出部１１６の前面には、互いに離間して先端側に突出した複数の凸部１１８（本実施形態では３つの凸部１１８）が形成されている。 The pusher tube 113 has a pusher main body 114 formed in a long tubular shape, and a ring-shaped pusher front end portion 115 fixed to the front end of the pusher main body 114. As shown in FIG. 28, the pusher tip portion 115 is provided with a pair of projecting portions 116 that project inward from the inner peripheral surface of the pusher tip portion 115 with a certain distance from each other. A slit 117 is formed between the pair of protruding portions 116 along the central axis C1 and through which the thread-like main body 29 of the elongated thread-like member 105 can pass. A plurality of convex portions 118 (three convex portions 118 in the present embodiment) are formed on the front surfaces of the pair of projecting portions 116 so as to be spaced apart from each other and project toward the distal end side.
　このように構成された細長糸状部材１０５およびプッシャーチューブ１１３は、まず、細長糸状部材１０５の仲介部１０６に糸係止部材１０７を嵌合させた状態で、図２８に示すように、糸状本体部２９をスリット１１７に配置するとともに仲介部１０６を糸状本体部２９の先端側に配置しておく。そして、糸状本体部２９を基端側に所定の強さで牽引することで、先細り部１０６ｂにより、仲介部１０６を一対の突出部１１６の間に自動的に挿入させることができる。さらに、糸状本体部２９を前述の所定の強さを超えて牽引すると、図２２に示すように、仲介部１０６から糸係止部材１０７が分離されて、仲介部１０６がプッシャーチューブ１１３内に引き込まれる。これに伴って凸部１１８の間に凸部１０９ｂが嵌入することで糸係止部材１０７の糸固定部１０９がプッシャー先端部１１５に係止される。 The elongated thread-like member 105 and the pusher tube 113 configured as described above are, as shown in FIG. 28, the thread-like main body part with the thread locking member 107 fitted to the mediating part 106 of the elongated thread-like member 105. 29 is disposed in the slit 117, and the mediating portion 106 is disposed on the distal end side of the filamentous main body portion 29. Then, by pulling the thread-like main body portion 29 toward the proximal end with a predetermined strength, the mediating portion 106 can be automatically inserted between the pair of protruding portions 116 by the tapered portion 106b. Further, when the thread-like main body 29 is pulled beyond the above-mentioned predetermined strength, the thread locking member 107 is separated from the mediation portion 106 and the mediation portion 106 is pulled into the pusher tube 113 as shown in FIG. It is. Along with this, the protrusion 109 b is inserted between the protrusions 118, whereby the thread fixing portion 109 of the thread locking member 107 is locked to the pusher tip 115.
　そして、糸状本体部２９を更に強く牽引すると、プッシャー先端部１１５に対して糸固定部１０９が固定された状態で、固定部１０８が縫合器５の基端側に移動する。これにより、折り畳み部１１０が折りたたまれ、糸固定部１０９に糸固定部１０８が当接する。 Then, when the thread-like main body portion 29 is pulled more strongly, the fixing portion 108 moves to the proximal end side of the suture instrument 5 in a state where the yarn fixing portion 109 is fixed to the pusher tip portion 115. As a result, the folding part 110 is folded, and the thread fixing part 108 comes into contact with the thread fixing part 109.
　図２７に示すように、プッシャーチューブ操作部８５は、操作部ボディ８４に進退可能に取り付けられている。プッシャーチューブ操作部８５には、プッシャーチューブ１１３の基端部が取り付けられている。 As shown in FIG. 27, the pusher tube operation unit 85 is attached to the operation unit body 84 so as to be able to advance and retreat. A proximal end portion of the pusher tube 113 is attached to the pusher tube operation portion 85.
　次に、この実施形態の内視鏡システムを用いた手技について説明する。
本実施形態の内視鏡システムを用いた手技は、上記第１実施形態における手技と組織Ｗ２、Ｗ３を交互に縫合する手順までは同一であるため、それ以降の手順について説明する。 Next, a procedure using the endoscope system of this embodiment will be described.
Since the procedure using the endoscope system of the present embodiment is the same up to the procedure in the first embodiment and the procedure of alternately suturing the tissues W2 and W3, the subsequent procedure will be described.
　まず、術者は、図２７、図２９および図３０に示すように、本実施形態の縫合器５のプッシャーチューブ操作部８５に対して操作部ボディ８４を牽引することで、処置部２２をプッシャーチューブ１１３内に収容する。術者は、さらに操作部２３を操作して、プッシャーチューブ１１３の一対の突出部１１６の間に細長糸状部材１０５の糸状本体部２９を配置する。そして、図３１に示すように、操作部ボディ８４を基端側にさらに牽引して、仲介部１０６に糸係止部材１０７を嵌合させるとともに、仲介部１０６を一対の突出部１１６の間に挿入する。 First, as shown in FIGS. 27, 29, and 30, the surgeon pulls the operation portion body 84 against the pusher tube operation portion 85 of the suturing device 5 of the present embodiment to push the treatment portion 22 into the pusher. It is accommodated in the tube 113. The operator further operates the operation portion 23 to place the thread-like main body portion 29 of the elongated thread-like member 105 between the pair of protrusions 116 of the pusher tube 113. Then, as shown in FIG. 31, the operation portion body 84 is further pulled to the proximal end side, the thread engaging member 107 is fitted to the mediation portion 106, and the mediation portion 106 is interposed between the pair of projecting portions 116. insert.
　ここで、操作部ボディ８４に対してプッシャーチューブ操作部８５を押し込むと、図３２に示すように、仲介部１０６がプッシャーチューブ１１３内に引き込まれる。これに伴い、糸係止部材１０７がプッシャー先端部１１５に係止され、折り畳み部１１０が折りたたまれた糸係止部材１０７とバー３２により組織Ｗ２、Ｗ３が緊縛される。これと同時に、組織固定部材３１に対する糸係止部材１０７の位置が、糸固定部１０８、１０９により固定される。 Here, when the pusher tube operation portion 85 is pushed into the operation portion body 84, the mediation portion 106 is pulled into the pusher tube 113 as shown in FIG. Along with this, the thread locking member 107 is locked to the pusher tip portion 115, and the tissues W2 and W3 are tightly bound by the thread locking member 107 and the bar 32 in which the folded portion 110 is folded. At the same time, the position of the thread locking member 107 with respect to the tissue fixing member 31 is fixed by the thread fixing portions 108 and 109.
　続いて、プッシャーチューブ操作部８５を牽引して、図３３に示すように処置部２２をプッシャーチューブ１１３から露出させ、ワイヤ操作スライダ８６を押し込むことで、図３４に示すようにジョー部材５２、５５を開かせる。そして、組織穿通部材５８、６１から先端部材２７を取り外し、組織Ｗ２、Ｗ３を緊縛した細長糸状部材１０５を患者Ｐの体内に留置する。 Subsequently, the pusher tube operation portion 85 is pulled to expose the treatment portion 22 from the pusher tube 113 as shown in FIG. 33, and the wire operation slider 86 is pushed in, so that the jaw members 52, 55 are shown in FIG. Open. Then, the distal end member 27 is removed from the tissue penetrating members 58 and 61, and the elongated thread-like member 105 to which the tissues W2 and W3 are bound is placed in the body of the patient P.
　この後で、必要な処置、たとえば、図示しない一般的な糸切り用の鋏鉗子などで、細長糸状部材１０５のうち不要な部分を切り取って、一連の手技を終了する。 After that, unnecessary parts of the elongated thread-like member 105 are cut off by a necessary treatment, for example, a general thread trimming forceps (not shown), and the series of procedures is completed.
　以上説明したように、本実施形態の内視鏡システムによれば、組織を傷つけることを防止しつつ、組織を連続的に縫合することができる。本実施形態では説明の都合上、１ステッチ（縫い目）分しか説明したり図示したりしていないが、一度に複数のステッチを縫合可能であることは言うまでもない。 As described above, according to the endoscope system of the present embodiment, the tissue can be continuously sutured while preventing the tissue from being damaged. In the present embodiment, for convenience of explanation, only one stitch (seam) is described or illustrated, but it goes without saying that a plurality of stitches can be stitched at a time.
　さらに、細長糸状部材１０５は、組織固定部材３１に固定可能な糸係止部材１０７を有するため、組織固定部材３１により縫合された組織を糸係止部材１０７で緊縛した状態にして固定することができる。 Further, since the elongated thread-like member 105 has a thread locking member 107 that can be fixed to the tissue fixing member 31, the tissue sutured by the tissue fixing member 31 can be fixed in a state of being tightly bound by the thread locking member 107. it can.
　また、糸係止部材１０７の折り畳み部１１０が組織固定部材３１の軸線方向に直交する方向に対して幅広となるように折りたたまれるため、組織が糸係止部材１０７側から外れるのが防止される。なお、本実施形態では、糸固定部１０８、１０９は、複数の折り畳み部１１０と一体に形成するように構成してもよい。 Further, since the folded portion 110 of the thread locking member 107 is folded so as to be wide with respect to the direction orthogonal to the axial direction of the tissue fixing member 31, the tissue is prevented from coming off from the thread locking member 107 side. . In the present embodiment, the thread fixing portions 108 and 109 may be formed integrally with the plurality of folding portions 110.
　以上、本発明の好ましい実施例を説明したが、本発明はこれら実施例に限定されることはない。本発明の趣旨を逸脱しない範囲で、構成の付加、省略、置換、およびその他の変更が可能である。
　例として、上記第１実施形態および第２実施形態において、図３５および図３６に示すように、ジョー部材５２、５５に指標１２１を設けるとともに、先端カバー４０にも指標１２２を設けてもよい。そして、ジョー部材５２、５５を閉じて組織穿通部材５８、６１の開口が互いに連通した連通位置になったときに、指標１２１と指標１２２とが同一直線上に並ぶなどして組織穿通部材５８、６１の位置を確認することができるように構成してもよい。 The preferred embodiments of the present invention have been described above, but the present invention is not limited to these embodiments. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit of the present invention.
As an example, in the first embodiment and the second embodiment, as shown in FIGS. 35 and 36, the index 121 may be provided on the jaw members 52 and 55, and the index 122 may be provided on the tip cover 40. When the jaw members 52 and 55 are closed and the openings of the tissue penetrating members 58 and 61 are in the communicating position with each other, the index 121 and the index 122 are aligned on the same straight line. You may comprise so that the position of 61 can be confirmed.
　指標１２１は、ジョー部材５２、５５に、刻印されたり、印刷されたりすることで設けられたり、ジョー部材５２、５５と一体に形成されたりすることで設けられたりすることができる。指標１２２も同様な方法で先端カバー４０に設けられる。
　このように構成することで、組織穿通部材５８、６１が連通位置と離間位置との間で移動したときに、指標１２１が連動して移動する。 The index 121 can be provided by being stamped or printed on the jaw members 52 and 55, or can be provided by being integrally formed with the jaw members 52 and 55. The index 122 is also provided on the tip cover 40 in the same manner.
With this configuration, when the tissue penetrating members 58 and 61 move between the communication position and the separation position, the index 121 moves in conjunction with each other.
　本変形例において、指標１２１と指標１２２とで組となる指標セットは、組織穿通部材５８、６１が連通位置になったときに同一直線上に並ぶ。このため、指標１２１と指標１２２とが同一直線上に並んだときに組織穿通部材５８と組織穿通部材６１との間で先端部材２７を移動させることで、先端部材２７を安全かつ確実に移動させることができる。 In this modification, the index set that is a set of the index 121 and the index 122 is aligned on the same straight line when the tissue penetrating members 58 and 61 are in the communication position. For this reason, the tip member 27 is moved safely and reliably by moving the tip member 27 between the tissue penetrating member 58 and the tissue penetrating member 61 when the indicator 121 and the indicator 122 are aligned on the same straight line. be able to.
　なお、本変形例では、たとえば患者の体腔内などの、縫合器の処置部２２が直接視認できない場所で使用される場合には、鉗子チャンネル２に縫合器を挿通して縫合器を内視鏡３に装着したときに、指標セットが内視鏡３の視野範囲Ｒ内に位置するように設定する。このように構成することで、処置部２２に設けられた指標セットを内視鏡３の観察ユニット１４で観察することができる。 In this modified example, when used in a place where the treatment unit 22 of the suture instrument cannot be directly visually recognized, such as in a body cavity of a patient, the suture instrument is inserted into the forceps channel 2 and the suture instrument is inserted into the endoscope. 3 is set so that the index set is positioned within the field-of-view range R of the endoscope 3. With this configuration, the index set provided in the treatment unit 22 can be observed by the observation unit 14 of the endoscope 3.
　また、本変形例では指標セットを２か所設けている。しかし、指標セットは１か所に設けても良いし、あるいは、指標セットを操作部２３の操作部ボディ８４、プッシャーチューブ操作部８５およびワイヤ操作スライダ８６などに設けても良い。
　また、上記第１実施形態では、細長糸状部材２４に代えて、図３７に示すような細長糸状部材１２５を用いてもよい。 In this modification, two index sets are provided. However, the index set may be provided in one place, or the index set may be provided in the operation unit body 84, the pusher tube operation unit 85, the wire operation slider 86, and the like of the operation unit 23.
In the first embodiment, an elongated thread member 125 as shown in FIG. 37 may be used instead of the elongated thread member 24.
　細長糸状部材１２５は、細長糸状部材２４の仲介部３０に代えて仲介部１２６を、組織固定部材３１に代えて市販の縫合糸である組織固定部材１２７をそれぞれ備えている。 The elongated thread-like member 125 includes a mediating part 126 in place of the mediating part 30 of the elongated thread-like member 24, and a tissue fixing member 127 that is a commercially available suture instead of the tissue fixing member 31.
　図３８に示すように、仲介部１２６には、組織固定部材１２７を通すための孔１２６ａが形成されている。組織固定部材１２７の端部は、結び目１２７ａなどで仲介部１２６に固定されている。 38, the mediation portion 126 has a hole 126a through which the tissue fixing member 127 is passed. The end portion of the tissue fixing member 127 is fixed to the mediation portion 126 with a knot 127a or the like.
　また、仲介部１２６には、少なくとも１か所の段差１２６ｂが形成され、段差１２６ｂにより、仲介部１２６に固定された組織固定部材１２７の穿刺抵抗を軽減することができる。更に、仲介部１２６には、穿刺時の組織抵抗を軽減する目的で、端部に向かうほど外径が細くなるテーパー部１２６ｃ、１２６ｄが形成されている。 Further, at least one step 126b is formed in the mediation portion 126, and the puncture resistance of the tissue fixing member 127 fixed to the mediation portion 126 can be reduced by the step 126b. Further, the mediation portion 126 is formed with tapered portions 126c and 126d whose outer diameters become thinner toward the end portion for the purpose of reducing tissue resistance during puncturing.
　以上の構成により、細長糸状部材１２５の一部として市販の糸である組織固定部材１２７を用いることが可能となり、汎用性向上、およびコスト軽減が図れる。 With the above configuration, it is possible to use a tissue fixing member 127, which is a commercially available thread, as a part of the elongated thread-like member 125, so that versatility can be improved and cost can be reduced.
　以上説明した縫合器５および細長糸状部材の構成部品の材料は、一般的に知られている材料でできている。すなわち、金属系材料であればステンレス、チタン、チタン合金、Ｎｉ－Ｔｉ系金属、βチタン合金、アルミニウム、金、銅、真鍮などで構成される。樹脂系材料であれば、生体適合性のある樹脂、たとえば、ポリイミド、ポリエーテルエーテルケトン、ポリサルフオン、液晶ポリマー、ポリアミドで構成される。セラミック系材料であれば、生体適合性のあるアルミナ、窒化ケイ素等で構成される。 The materials of the component parts of the suturing device 5 and the elongated thread-like member described above are made of generally known materials. That is, as long as it is a metal material, it is made of stainless steel, titanium, titanium alloy, Ni—Ti metal, β titanium alloy, aluminum, gold, copper, brass, or the like. If it is a resin material, it is comprised with biocompatible resin, for example, a polyimide, polyetheretherketone, polysulfone, a liquid crystal polymer, and polyamide. In the case of a ceramic material, it is composed of biocompatible alumina, silicon nitride or the like.
　この他、本発明は前述した説明によって限定されることはなく、添付のクレームの範囲によってのみ限定される。 In addition, the present invention is not limited by the above description, and is limited only by the scope of the appended claims.
　本発明によれば、従来の縫合器のように針状の部材が脱落して周囲の組織を傷つけることを防止することができる。また、組織を連続的に縫合することができる。 According to the present invention, it is possible to prevent the needle-like member from falling off and damaging the surrounding tissue like a conventional suture instrument. In addition, the tissue can be continuously sutured.
１　内視鏡システム
２　鉗子チャンネル
３　内視鏡
５　縫合器
２４　細長糸状部材
２７　先端部材
２９　糸状本体部
３０　仲介部
３１　組織固定部材
５８　組織穿通部材 DESCRIPTION OF SYMBOLS 1 Endoscope system 2 Forceps channel 3 Endoscope 5 Suture device 24 Elongated thread-like member 27 Tip member 29 Threaded main-body part 30 Mediation part 31 Tissue fixing member 58 Tissue penetration member

Claims (18)

  1. 細長糸状部材と、
    前記細長糸状部材を着脱可能とするとともに前記細長糸状部材を用いて組織を縫合するための縫合器と、
    を備える縫合システムであって、
    前記細長糸状部材は、
    先端部材と、
    一端が前記先端部材に接続され、自身の外径が前記先端部材の外径より小さく設定された糸状本体部と、
    前記糸状本体部の他端に接続された仲介部と、
    一端が前記仲介部に接続されるとともに前記糸状本体部の反対側に配置され、外径が前記糸状本体部の外径より大きく設定された組織固定部材と、
    を有し、
    前記縫合器は、前記先端部材を収容可能な内腔および前記内腔に連通する開口を有する一対の組織穿通部材を有し、
    一対の前記組織穿通部材は、一方の前記組織穿通部材の一部が他方の前記組織穿通部材の内腔に入り込んで互いの前記内腔が連通した連通位置と、一対の前記組織穿通部材が互いに離間した離間位置と、に相対移動可能に設けられている縫合システム。     An elongated thread-like member;
    A suturing device for detaching the elongated thread-like member and suturing tissue using the elongated thread-like member;
    A suturing system comprising:
    The elongated thread-like member is
    A tip member;
    One end is connected to the tip member, and the outer diameter of the thread-shaped main body is set smaller than the outer diameter of the tip member;
    An intermediary part connected to the other end of the thread-like body part;
    A tissue fixing member having one end connected to the mediating portion and disposed on the opposite side of the filamentous main body, and having an outer diameter set larger than the outer diameter of the filamentous main body;
    Have
    The suturing device has a pair of tissue penetrating members having a lumen capable of accommodating the tip member and an opening communicating with the lumen,
    The pair of tissue penetrating members include a communication position where a part of one tissue penetrating member enters the lumen of the other tissue penetrating member and the lumens communicate with each other, and the pair of tissue penetrating members are mutually connected. A suturing system which is provided so as to be relatively movable to a separated position.
  2. 請求項１に記載の縫合システムであって、
    前記組織穿通部材は、互いに接近、離間する一対のジョー部材にそれぞれ固定されている縫合システム。     The suturing system according to claim 1,
    The suturing system, wherein the tissue penetrating member is fixed to a pair of jaw members that approach and separate from each other.
  3. 請求項１に記載の縫合システムであって、
    前記組織穿通部材は、前記糸状本体部が挿入可能なスリットを有している縫合システム。     The suturing system according to claim 1,
    The suturing system, wherein the tissue penetrating member has a slit into which the thread-like main body portion can be inserted.
  4. 請求項１に記載の縫合システムであって、
    前記組織穿通部材の前記内腔に進退可能に配置され、前記組織穿通部材内に収容された前記先端部材を前記開口からから押し出す一対の取外し部材を備えている縫合システム。     The suturing system according to claim 1,
    A suturing system comprising a pair of detachment members that are movably disposed in the lumen of the tissue penetrating member and push out the tip member housed in the tissue penetrating member from the opening.
  5. 請求項４に記載の縫合システムであって、
    前記組織穿通部材の内周面には、前記内周面から突出して前記細長糸状部材の前記先端部材が前記開口側に移動するのを係止するとともに、前記取外し部材により前記先端部材を押し出すことで変形され、前記先端部材が乗り越えることができる凸部が形成されている縫合システム。     The suturing system according to claim 4,
    The inner peripheral surface of the tissue penetrating member protrudes from the inner peripheral surface to stop the distal end member of the elongated thread-like member from moving to the opening side, and pushes the distal end member by the removing member. The suturing system is formed with a convex portion that can be deformed by the tip member and can be overcome.
  6. 請求項１に記載の縫合システムであって、
    前記縫合器は、前記一対の取外し部材を前記組織穿通部材の前記内腔に沿って交互に進退させる切替機構を備える縫合システム。     The suturing system according to claim 1,
    The suturing device includes a switching mechanism that alternately moves the pair of detaching members forward and backward along the lumen of the tissue penetrating member.
  7. 請求項６に記載の縫合システムであって、
    前記切替機構は、所定の軸線回りに回転されることにより、前記組織穿通部材の前記内腔における前記取外し部材の前記内腔に沿った位置を変化させる回転部材と、
    前記回転部材を前記所定の軸線回りに回転させるためのカム機構と、
    を有する縫合システム。     The suturing system according to claim 6,
    The switching mechanism rotates around a predetermined axis, thereby changing a position along the lumen of the removal member in the lumen of the tissue penetrating member; and
    A cam mechanism for rotating the rotating member around the predetermined axis;
    A suturing system.
  8. 請求項７に記載の縫合システムであって、
    前記回転部材が前記所定の軸線の同一方向回りに回転するように規制する回転補助機構をさらに有する縫合システム。     The suturing system according to claim 7,
    A suturing system further comprising a rotation assisting mechanism for restricting the rotating member to rotate about the same direction of the predetermined axis.
  9. 請求項１に記載の縫合システムであって、
    前記組織穿通部材には、前記一対の組織穿通部材が互いの前記開口の間に前記組織を挟んだ状態で前記連通位置に位置したときに、前記組織のうち前記開口の間に挟まれた部分を切開可能な刃部が設けられている縫合システム。     The suturing system according to claim 1,
    The tissue penetrating member includes a portion of the tissue sandwiched between the openings when the pair of tissue penetrating members are positioned at the communication position with the tissue sandwiched between the openings. A suturing system provided with an incisable blade.
  10. 請求項１に記載の縫合システムであって、
    前記糸状本体部は前記組織固定部材よりも引張り強度の高い材料で形成されている縫合システム。     The suturing system according to claim 1,
    The suture system in which the thread-like main body is formed of a material having a higher tensile strength than the tissue fixing member.
  11. 請求項１に記載の縫合システムであって、
    前記細長糸状部材の前記糸状本体部は金属で形成されている縫合システム。     The suturing system according to claim 1,
    The suturing system in which the thread-like main body portion of the elongated thread-like member is formed of metal.
  12. 請求項１に記載の縫合システムであって、
    前記細長糸状部材の前記組織固定部材は樹脂で形成されている縫合システム。     The suturing system according to claim 1,
    A suturing system in which the tissue fixing member of the elongated thread-like member is formed of resin.
  13. 請求項１に記載の縫合システムであって、
    前記細長糸状部材の前記先端部材は、略球状に形成されている縫合システム。     The suturing system according to claim 1,
    The suturing system in which the tip member of the elongated thread-like member is formed in a substantially spherical shape.
  14. 請求項１に記載の縫合システムであって、
    前記細長糸状部材の前記先端部材は、少なくとも一部が針状に尖っている縫合システム。     The suturing system according to claim 1,
    The suturing system in which at least a part of the tip member of the elongated thread-like member is pointed like a needle.
  15. 請求項１に記載の縫合システムであって、
    前記細長糸状部材は、前記組織固定部材に固定可能な糸係止部材を有する縫合システム。     The suturing system according to claim 1,
    The suturing system, wherein the elongated thread-like member includes a thread locking member that can be fixed to the tissue fixing member.
  16. 請求項１から１５のいずれか一項に記載の縫合システムと、
    内部に前記縫合器が挿通可能な鉗子チャンネルが形成され、所定の視野範囲内を観察可能な内視鏡と、
    を備える内視鏡システム。     The suturing system according to any one of claims 1 to 15,
    A forceps channel through which the suturing device can be inserted is formed, and an endoscope capable of observing within a predetermined visual field range;
    An endoscope system comprising:
  17. 請求項１６に記載の内視鏡システムであって、
    前記縫合器には、前記一対の組織穿通部材が前記連通位置にあることを確認可能な指標が設けられ、
    前記鉗子チャンネルに前記縫合器を挿通して前記縫合器を前記内視鏡に装着したときに、前記指標が前記内視鏡の前記視野範囲内に位置するように設定されている内視鏡システム。     The endoscope system according to claim 16, comprising:
    The suturing device is provided with an indicator capable of confirming that the pair of tissue penetrating members are in the communication position,
    An endoscope system in which the index is set so as to be positioned within the visual field range of the endoscope when the suture instrument is inserted into the forceps channel and the suture instrument is attached to the endoscope. .
  18. 請求項１７に記載の内視鏡システムであって、
    前記指標は、前記組織穿通部材が前記連通位置と前記離間位置との間で移動したときに連動して移動する内視鏡システム。     The endoscope system according to claim 17,
    The endoscope system is an endoscope system in which the tissue penetrating member moves in conjunction with movement of the tissue penetrating member between the communication position and the separation position.
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