WO2003065903A1

WO2003065903A1 - Suture insrument for biological use

Info

Publication number: WO2003065903A1
Application number: PCT/JP2003/000627
Authority: WO
Inventors: Jiro Kanie
Original assignee: Jiro Kanie
Priority date: 2002-02-04
Filing date: 2003-01-23
Publication date: 2003-08-14
Also published as: JP3331215B1; AU2003203378A1; JP2003225240A

Abstract

To improve the handling properties of an instrument for fixing stomach wall whereby a suture inserted into the body is captured in the body and taken out from the body, the instrument for fixing stomach wall is provided with a holder (12), a fixed hollow tapping needle (14) which is held by the holder and has the suture (32) inserted in the inner pathway thereof, a hollow outer tube (16) which is located in parallel to the fixed tapping needle and held by the holder and through which the suture is passed, a movable tapping needle (not shown in the figure) which is inserted into the inner pathway of the outer tube in a selective and movable manner, and a suture drawer (100). When the movable tapping needle attains the forward limit in the outer tube, the sharp end thereof sticks out from the end of the outer tube. The suture drawer has an elastic and deformable snare at the end thereof. When the drawer attains the forward limit in the outer tube, the snare sticks out from the end of the outer tube and thus captures the suture.

Description

Specification

Technical field for living body sutures

The present invention relates to a suturing tool for a living body used for suturing a plurality of scheduled suturing sites separated from each other in a living body with a suture, and particularly to a technique for improving the usability thereof. Background art

In some cases, it is necessary to sew a plurality of scheduled suture sites separated from each other in a living body with a suture. For example, there is a case where a gastrostoma is to be endoscopically constructed in a patient as a living body.

In this example, a through-hole is formed through the patient's abdominal wall and stomach wall prior to the construction of the gastrostomy, and the abdominal wall and stomach wall are punctured with a puncture needle to form the through-hole. You. Prior to the puncture with the puncture needle, it is common practice to suture the abdominal wall and the stomach wall with a suture in order to temporarily fix the movable stomach wall to the abdominal wall.

Various tools for performing such suturing have been proposed, and one of them is described as a medical device in Japanese Patent Publication No. Hei 6-244533. This medical device

(a) a hollow suture insertion puncture needle having an internal passage into which the suture is inserted;

(b) a hollow suture grasping puncture needle arranged parallel thereto and used to grasp the suture;

(c) a stylet slidably inserted into the suture grasping puncture ^ "and (d) a suture inserting puncture needle and a suture grasping puncture needle at their respective proximal ends. Fixing member to fix It is configured to include.

In this conventional medical device, the stylet has at its distal end an annular member made of an elastic material that can be stored in the internal passage of the suture grasping puncture needle. The annular member is used for inserting a suture such that the central axis of the suture insertion puncture needle or an extension thereof passes through the inside of the annular member when the annular member protrudes from the tip of the suture grasping puncture needle. It is configured to extend toward the puncture needle.

According to the publication, the conventional medical device is used as follows.

When the living body is punctured by the suture insertion needle and the suture grasping needle, the stylet and the annular member are inserted into the suture grasping needle from the rear end thereof. The annular member is projected from the distal end of the suture grasping puncture needle.

In this state, the suture is inserted into the suture insertion needle from the rear end thereof, and as a result, a part of the suture is exposed from the distal end of the suture insertion needle. In this state, the suture is captured by the annular member, and thereafter, until the suture reaches the tip of the suture grasping puncture needle, that is, the suture is grasped by the suture grasping puncture needle. Until the stylet is retracted within the suture grasping needle.

When the suture is grasped by the suture grasping puncture needle by retreating, the suture insertion puncture needle, the suture grasping puncture needle, the stylet, and the annular member are physically in vivo. Retreated from With this retreat, the leading part of the suture is pulled out of the body by the suture grasping needle, and the succeeding part of the same suture passes through the suture inserting needle and enters the body. Drawn into. Disclosure of the invention

The conventional medical devices described above are considered to have the following disadvantages in use.

When using this conventional medical device, as described above, the The suture thus obtained is gripped at its distal end by the suture grasping puncture needle, and the distal end of the suture grasping puncture needle is sharp.

Therefore, in this conventional medical device, when the suture is brought into contact with the tip of the suture grasping puncture needle by retraction of the stylus, if the contact is performed with an unnecessarily large force, the suture is unscheduled. May be disconnected.

Against this background, the present invention provides a living body suturing instrument of the type in which a suture inserted into the body is captured in the body and pulled out of the body, and has improved usability. This was done as an issue.

The following aspects are obtained by the present invention. Each mode is divided into sections, each section is numbered, and the numbers of other sections are quoted as necessary. This is to facilitate understanding of some of the technical features described in the present specification and some of the combinations thereof, and the technical features and the combinations thereof described in the present specification have the following aspects. It should not be construed as limited.

(1) A biological suturing tool used for suturing a plurality of scheduled suture sites separated from each other in a living body with a suture,

Honoreda,

A hollow fixed puncture needle having a sharp tip held by the holder, wherein the suture is passed through an internal passageway thereof, and

A hollow outer cylinder, which is held by the holder in a lateral direction along with the fixed puncture needle and has a non-sharp tip, wherein the suture is passed through and used in an internal passage thereof;

A movable puncture needle and a suture traction tool which are selectively removably inserted into the internal passage of the outer cylinder;

Including, power,

The movable puncture needle has a sharp tip, and when the movable puncture needle is inserted into the outer cylinder from the rear end thereof and reaches the advance limit, the sharp tip projects from the tip of the outer cylinder. To do

The suture traction tool has, at its tip, an elastically deformable snare, which in a free state extends radially outward from the suture traction tool, and the suture is elastically deformed with the snare. When the thread retractor is inserted into the outer cylinder from the rear end thereof and reaches the advance limit, the snare projects from the front end of the outer cylinder and returns to the free state, whereby the A living body suture tool wherein the snare is positioned at a planned capturing position where a portion exposed from the tip of the fixed puncture needle is scheduled to be captured.

According to this fastener, the inner passage of the outer cylinder functions as a passage through which a suture is inserted, a function as a passage through which a movable puncture needle is inserted, and a suture traction tool is inserted. It functions as a passage.

According to the suturing tool, when the movable puncture needle is inserted into the outer cylinder, the tip of the movable puncture needle protruding from the distal end of the outer cylinder despite the tip of the outer cylinder is not sharp. The sharpness fulfills the function of puncturing the living body.

Further, according to this suture tool, when the suture traction tool is inserted into the outer tube in place of the movable puncture needle, the portion of the suture exposed from the tip of the fixed puncture needle is the suture traction bow I. If the suture traction tool is retracted within the outer tube after being captured by the snare at the tip of the device, the suture enters the outer tube through the blunt tip of the outer tube and then is sutured. It is pulled by a thread pulling tool.

Therefore, according to the suture tool, when the suture inserted into the body is captured in the body and pulled out of the body, the suture does not have to pass through a sharp part. Therefore, according to the suturing tool, it is not indispensable to perform the suturing of the living body with care not to cut the suture, and as a result, a suturing tool with improved usability is provided.

In this section, the “plurality of scheduled sutures separated from each other” is, for example, a plurality of planned sutures arranged in a plane along the surface of each planned suture, It is possible to have a plurality of scheduled suture portions arranged in a stack along the thickness direction of the position.

In this section, “fixed puncture needle” is “fixed” to distinguish it from a movable puncture needle that is relatively movable with respect to the outer cylinder from the viewpoint of the force that can move relative to the outer cylinder. It is assumed that the term is attached.

(2) The internal passage of the fixed puncture needle guides the suture in one direction from a rear end of the fixed puncture needle toward a distal end thereof,

When the internal passage of the outer cylinder is pulled by the suture traction tool in a state where the suture is captured by the snare, the suture is moved in one direction from the distal end to the rear end of the outer cylinder. The living body suture tool according to the above mode (1), which is used for guiding.

According to this suture tool, both the internal passage of the fixed puncture needle and the internal passage of the outer cylinder are used as suture passages.

Furthermore, according to this suture tool, the traveling directions of the suture are opposite to each other between the two internal passages.

(3) In the state where the movable puncture needle is at the advance limit, the position of the tip of the movable puncture needle and the position of the tip of the fixed puncture needle are shifted in the extending direction thereof. The living body suture tool according to (1) or (2).

In the suturing tool according to the above (1) or (2), when the movable puncture needle is at the forward limit, the position of the tip of the movable puncture needle and the position of the tip of the fixed puncture needle are the same. It is possible to carry out in a manner that they coincide with each other in the direction of extension.

In this embodiment! When trying to puncture the skin of a living body with the movable puncture needle and the fixed puncture needle, the tip of the movable puncture needle and the tip of the fixed puncture needle simultaneously come into contact with the skin of the living body, A large reaction force from the skin is simultaneously generated on the movable puncture needle and the fixed puncture needle.

Then, the operator using the suture tool receives the reaction force generated by the movable puncture needle and the fixed puncture needle together. Therefore, the worker punctures the living body Therefore, it is necessary to operate the suture tool with a large force.

On the other hand, in the suturing tool according to this aspect, when the movable puncture needle is at the advance limit, the position of the tip of the movable puncture needle and the position of the tip of the fixed puncture needle are shifted from each other in the direction in which they extend. ing.

As a result, according to this suture instrument, when trying to puncture the skin of a living body with the movable puncture needle and the fixed puncture needle, the tip of the movable puncture needle and the tip of the fixed puncture needle are different from each other at different times. A large reaction force from the skin is generated at the movable puncture metal + and the fixed puncture needle at different times.

Therefore, according to this suturing tool, the operator who wants to puncture the living body using the suturing tool can fix the required operating force required to act on the suturing tool at each time with the position of the tip of the movable puncture needle. It is easier to reduce the puncture needle than in the case where the positions of the tips of the puncture needles coincide with each other in the direction in which they extend.

As a result, according to the suturing tool, usability can be easily improved by reducing the required operation force.

(4) The holder according to any one of (1) to (3), wherein the holder holds the fixed puncture needle and the outer cylinder in parallel with each other and at one of each position. Biological suture.

When the suturing tool according to any one of the above (1) to (3) is used, the parallelism of the puncture needles is maintained during the operation of puncturing the living body with the fixed puncture needle and the movable puncture needle. It is desirable to be done.

When the suturing tool according to any one of the above (1) to (3) is used, the living body is punctured by the movable puncture needle while being inserted into the outer cylinder. The outer cylinder also functions as an element that withstands the reaction force from the living body.

Therefore, according to the suturing tool according to any one of the above items (1) to (3), the ability to withstand the reaction force from the living body is more improved by using the outer cylinder than by using the movable puncture needle alone. Can be improved more easily than if they were received at This means that This means that the form of the puncture needle and the outer cylinder can be easily held, and that the parallelism between the movable puncture needle and the fixed puncture needle can also be easily held.

On the other hand, in the suturing tool according to any one of the above (1) to (3), the function of maintaining the distance between the holder force movable puncture needle and the fixed puncture needle and the function of maintaining the parallelism between the two are provided. Can play. If the shape retention of the movable puncture needle is not sufficient, the holder may be provided with a plurality of movable puncture needles and fixed puncture needles in order to maintain the parallelism between the movable puncture needle and the fixed puncture needle. It is necessary to keep it in position.

As described above, in the suture tool according to any one of the above (1) to (3), the form of the movable puncture needle and the outer cylinder can be easily held, and the movable puncture needle The parallelism with the fixed puncture needle can be easily maintained. Therefore, the holder does not have to be so strongly required to perform the function of maintaining the parallelism between the movable puncture needle and the fixed puncture needle.

Based on the findings described above, in the suture tool according to this item, the holder holds the fixed puncture needle and the outer cylinder in parallel with each other and at one position.

Therefore, according to the suturing tool, the holder can be easily downsized and the structure can be simplified as compared with a case where the holder holds the fixed puncture needle and the outer cylinder at a plurality of positions.

(5) A guide member for guiding a selected one of the movable puncture needle and the suture traction tool into the internal passage of the outer cylinder is provided at a rear end of the outer cylinder; A member having an opening formed at the rear end of the outer cylinder and having a diameter larger than that of the inner passage of the outer cylinder; and a tapered taper extending from the opening to the tip of the outer cylinder. The living body suture tool according to any one of (1) to (4), which has a hole.

In the suture tool according to any one of the above (1) to (4), the movable puncture needle And the selected suture traction tool is inserted into the outer cylinder from its rear end. In the suturing tool according to this aspect, a guide member for guiding a selected one of the movable puncture needle and the suture torsion I into the internal passage of the outer cylinder is provided at the rear end of the outer cylinder. Have been. The guide member has an insertion hole that opens at the rear end of the outer cylinder and has a larger diameter than the internal passage of the outer cylinder, a tapered tapered hole that extends from the insertion hole toward the distal end of the outer cylinder. have.

Therefore, according to this suture tool, when the selected one of the movable puncture needle and the suture traction tool is inserted into the outer cylinder from the rear end thereof, first, the larger than the inner passage of the outer cylinder. Since it is inserted into the insertion hole of the diameter, the work for the insertion can be simplified more easily than in the case where it is inserted into the internal passage of the outer cylinder from the beginning.

Furthermore, according to this suture tool, the selected one of the movable puncture needle and the suture traction tool is inserted into the tapered hole after being inserted into the insertion hole, and is movable by the slope of the tapered hole. The tip of the selected one of the puncture needle and the suture traction tool is automatically guided toward the internal passage of the outer cylinder.

Therefore, according to this suture tool, the operation of inserting the selected one of the movable puncture needle and the suture traction tool into the internal passage of the outer cylinder can be easily simplified even by the tapered hole.

(6) The living body includes a patient, the plurality of scheduled suturing sites include two overlapping portions of the patient's abdomen and the stomach wall, and the living body suturing device fixes the stomach wall to the abdomen. The biological suture according to any one of (1) to (5), which functions as a stomach wall fixing device. ¹

According to this suture tool, the operation of fixing the stomach wall to the abdominal wall in the patient can be easily performed.

(7) A method using the living body suture tool according to any one of the above items (1) to (6):

The movable puncture needle is inserted into the outer cylinder from its rear end to the advance limit. A puncture needle insertion step,

In a state where the movable puncture needle is located at the advance limit in the outer cylinder, the main body including the fixed puncture needle and the outer cylinder is held by the holder together with the movable puncture needle. An advancing step toward the living body by puncturing the living body with the fixed puncture needle and the movable puncture needle;

A movable puncture needle removing step of removing the movable puncture needle from the outer cylinder in a state where the living body is punctured by the fixed puncture needle and the movable puncture needle;

After withdrawal of the movable puncture needle, insert the suture traction tool into the outer cylinder from the rear end thereof to the advance limit, thereby positioning the snare at the expected capture position. Input process,

Inserting a suture from a rear end of the fixed puncture needle into an internal passage of the fixed puncture needle until a part of the suture is exposed from a distal end of the fixed puncture needle;

While the portion of the suture exposed from the tip of the fixed puncture needle is captured by the snare, the suture is pulled from the outer tube while the suture is being pulled by the suture traction tool. Suture traction tool removal process,

A step of withdrawing the fixed puncture needle and the outer tube from the living body by retracting the main body from the living body;

A method for using a living body suture tool comprising: '

According to this method, there is provided a method of suitably using the biological suturing device according to any one of the above (1) to (6). BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a front sectional view showing a main body 10 of a gastric wall fixing device according to an embodiment of the present invention.

FIG. 2 is a front sectional view showing the movable puncture needle 80 in the gastric wall fixing device. FIG. 3 is a front sectional view showing the main body 10 of FIG. 1 with the movable puncture needle 80 of FIG. 2 inserted therein.

FIG. 4 is a front sectional view showing the suture traction tool 100 in the gastric wall fixing device. FIG. 5 is a front sectional view showing the main body portion 100 of FIG. 1 in a state where the suture traction tool 100 of FIG. 4 is inserted.

FIG. 6 is a flowchart showing a method of using the gastric wall fixing device.

FIG. 7 is a front sectional view for explaining S2 in FIG.

FIG. 8 is another front sectional view for explaining S3 in FIG.

FIG. 9 is a front sectional view for explaining S4 in FIG.

FIG. 10 is another front sectional view for explaining S4 of FIG.

FIG. 11 is a front sectional view for explaining S5 in FIG.

FIG. 12 is a front sectional view for explaining S6 of FIG.

FIG. 13 is another front sectional view for explaining S6 of FIG.

FIG. 14 is a front sectional view for explaining S7 of FIG.

FIG. 15 is another front sectional view for explaining S7 of FIG.

FIG. 16 is a front cross-sectional view for explaining a state in which the suture 32 in FIG. 15 is ligated at two portions of the suture 32 exposed outside the body. BEST MODE FOR CARRYING OUT THE INVENTION

Hereinafter, one of more specific embodiments of the present invention will be described in detail with reference to the drawings.

FIG. 1 is a front sectional view showing a main body 10 of a gastric wall fixing device according to an embodiment of the present invention. The main body 10 is configured to include a holder 12, a fixed puncture needle 14, and an outer cylinder 16. The holder 12 is made of synthetic resin, whereas the fixed puncture needle 14 and the outer cylinder 16 are both made of metal.

The holder 12 holds the fixed puncture needle 14 and the outer cylinder 16 at a constant distance therebetween. And a function of holding them so as to be parallel to each other. In order to fulfill the function, the holder 12 has a structure for holding the fixed puncture needle 14 and the outer cylinder 16 at one position.

In the present embodiment, each holding position of the holder 12 is substantially the center of the fixed puncture needle 14 and the outer cylinder 16 in the axial direction. Thus, the fixed puncture needles 14 and the outer cylinder 16 are closer to the holding positions of the holders 12 than the end positions in the axial direction of the fixed puncture needles 14 and the outer cylinder 16. The relative positional relationship between and can be efficiently maintained.

Furthermore, in the present embodiment, each holding position of the holder 12 is adjustable in the axial direction of the fixed puncture needle 14 and the outer cylinder 16.

The tip of the fixed puncture needle 14 is designed to be convenient. In the present embodiment, the distal end of the fixed puncture needle 14 has a shape in which the cylindrical member is cut in one plane obliquely intersecting the axis thereof. The sharpness of the tip of the fixed puncture needle 14 provides a good function of puncturing the patient's abdominal wall 20 and stomach wall 22 (see FIG. 7). The fixed puncture needle 14 has a hollow structure, and an internal passage 30 extending coaxially therewith is used as a passage through which a suture thread 32 (see FIG. 11) passes. The internal passage 30 is a passage for guiding the suture 32 in one direction from the rear end to the distal end of the fixed puncture needle 14.

At the rear end of the fixed puncture needle 14, a hollow block 40 is attached. This block 40 is made of a synthetic resin. The block 40 has a stepped hole 46 in which the small-diameter portion 42 and the large-diameter portion 44 are coaxially arranged. The small diameter portion 42 is fitted to the rear end of the fixed puncture needle 14 such that the rear end surface of the fixed puncture needle 14 abuts the shoulder surface 48 (an example of a forward facing surface) of the stepped hole 46. ing.

The outer tube 16 also has a hollow structure like the fixed puncture needle 14, and the internal passage 50 extending coaxially therewith is used as a passage through which the suture thread 32 passes. This internal passage 50 is oriented in the opposite direction to the internal passage 30 of the fixed puncture needle 14, that is, the outer cylinder 1 6 is a passage for guiding the suture 32 in one direction from the front end to the rear end. At least a portion of the outer cylinder 16 that comes into contact with the suture thread 32 is not sharp. In particular, the portion that bends when the suture thread 32 is inserted into the outer cylinder 16, that is, the tip of the outer cylinder 16 is not sharp. Specifically, the edge existing at the tip is made not to have an acute angle, and it is desirable that the edge be chamfered on the C plane or the R plane.

A hollow guide member 60 is attached to the rear end of the outer cylinder 16. The guide member 60 is made of synthetic material. A stepped hole 66 in which the fitting hole 62 and the guide hole 64 are coaxially arranged penetrates the guide member 60. The fitting hole 62 is fitted to the rear end of the outer cylinder 16 so that the rear end surface of the outer cylinder 16 contacts the shoulder surface 68 (an example of a front surface) of the stepped hole 66. I have. The guide member 60 is non-rotatably attached to the outer cylinder 16. The structure of the guide hole 64 will be described later in detail.

FIG. 2 is a front sectional view of the movable puncture needle 80 of the gastric wall fixing device. The movable puncture needle 80 is solid and made of metal. The tip of the movable puncture needle 80 is made sharp, so that the function of puncturing the abdominal wall 20 and the stomach wall 22 of the patient can be performed well.

At the rear end of the movable puncture needle 80, a stopper 84 is attached. The stopper 84 has a stepped shape and is made of synthetic resin. When the movable puncture needle 80 is inserted into the outer cylinder 16 from the rear end thereof, the stopper 84 is formed on the shoulder surface 86 (an example of a forward facing surface) of the stopper 84 by the guide member 60. By contacting the rear end face, it has a function of defining the advance limit of the movable puncture needle 80 in the outer cylinder 16.

Further, the stopper 84 is engaged with the guide member 60 so as to be relatively rotatable. This prevents the movable puncture needle 80 from rotating with respect to the outer cylinder 16 at its forward limit.

In FIG. 3, the movable puncture needle 80 is inserted into the outer cylinder 16 from the rear end thereof, and is moved forward. Degrees have been reached. In this state, the tip of the movable puncture needle 80 protrudes from the tip of the outer cylinder 16. The position of the tip of the movable puncture needle 80 and the position of the tip of the fixed puncture needle 14 are displaced from each other in the axial direction.

In the present embodiment, the tip of the movable puncture needle 80 which is sharper than the fixed puncture needle 14 and apparently higher than that of the fixed puncture needle 14 is located forward of the tip of the fixed puncture needle 14, and the movable puncture needle 8 0 comes in contact with the abdominal wall 20 before the fixed puncture needle 14. The apparent rigidity of the movable puncture needle 80 is higher than that of the fixed puncture needle 14 because the movable puncture needle 80 is inserted into the outer cylinder 16 and is supported by the outer cylinder 16. is there.

FIG. 4 shows a front cross-sectional view of the suture retraction device 100 of the gastric wall fixing device. The suture traction tool 100 is configured to include a rod 102 and a snare 104 attached to the distal end thereof. The rod 102 is solid and made of metal.

The snare 104 is made of an elastic wire as an elastically deformable material. The snare 104 naturally extends from the distal end of the rod 102 radially outward as shown in FIG. In the present embodiment, the snare 104 is formed of an annular natural wire, which has a good function of hooking a portion of the suture 32 exposed from the distal end of the fixed puncture 14. Well done.

The suture traction tool 100 is inserted into the outer cylinder 16 from the rear end thereof. At this time, the snare 104 is elastically deformed so as to extend coaxially with the rod 102, and is inserted through the outer cylinder 16 in this state.

A stopper 108 made of synthetic resin is attached to the rear end of the suture traction tool 100, similarly to the movable puncture needle 80. When the suture puller 100 is inserted into the outer cylinder 16 from the rear end thereof, the stopper 1108 is positioned on the shoulder surface 110 of the stopper 100 (an example of a forward facing surface). Abut the rear end face of guide member 60 Accordingly, a function of defining the advance limit of the suture traction tool 100 in the outer cylinder 16 is provided.

Further, the stopper 108 is engaged with the guide member 60 so as to be relatively rotatable. This prevents the suture traction tool 100 from rotating relative to the outer cylinder 16 at its forward limit.

FIG. 5 shows the suture traction tool 100 inserted into the outer cylinder 16 from its rear end and reaching the forward limit. In this state, the snare 104 projects from the tip of the outer cylinder 16 and is restored to its natural state. As a result, the snare 104 is positioned at a planned capturing position where the portion of the suture 32 exposed from the distal end of the fixed puncture needle 14 is scheduled.

Here, the structure of the guide hole 64 will be described in detail with reference to FIG.

In the guide hole 64, the insertion hole 120, the tapered hole 122, and the small-diameter hole 124 are arranged coaxially with the outer cylinder 16 from the rear end to the front end of the outer cylinder 16. .

The inlet hole 120 has a larger diameter than the inner passage 50 of the outer cylinder 16, whereas the smaller hole 124 has a smaller diameter than the inlet hole 120. . The tapered hole 122 has a slope whose diameter decreases as it goes from the insertion hole 120 to the small diameter hole 124. Due to the tapered holes 122, the cross section of the internal passage of the guide member 60 gradually decreases as it moves from the rear end to the front end of the outer cylinder 16, and eventually the internal passage 50 of the outer cylinder 16 becomes smaller. Substantially matches the cross section.

The diameter of the small-diameter hole 1 24 is substantially equal to the inner diameter of the outer cylinder 16, and there is a step between the small-diameter hole 124 and the hole forming the internal passage 50 of the outer cylinder 16 as much as possible. Not to do so. Thereby, the movable puncture needle 80 and the suture traction tool 100 can be easily inserted into the outer cylinder 16 from the rear end thereof.

The configuration of the gastric wall fixing device according to the present embodiment has been described above. Next, how to use the device will be described.

FIG. 6 is a flowchart showing a method of using the gastric wall fixing device. First, in step SI (hereinafter simply referred to as “S 1”, the same applies to other steps), the user inserts the movable puncture needle 80 into the outer cylinder 16 from the rear end thereof.

Next, in S2, the main body 10 with the movable puncture needle 80 is advanced in a direction to vertically approach the abdominal wall 20 of the patient, thereby, as shown in FIG. The abdominal wall 20 and the stomach wall 22 are punctured by 0 and the fixed puncture needle 14. In the present embodiment, while the main body 10 is moving forward, the movable puncture needle 80 comes into contact with and pierces the skin of the abdominal wall 20 first, and the fixed puncture needle 14 comes into contact with the skin of the abdominal wall 20 later. Pierce. Subsequently, in S3, as shown in FIG. 8, the movable puncture needle 80 is removed from the outer cylinder 16.

Thereafter, in S4, as shown in FIG. 9, the suture traction tool 100 is inserted into the outer cylinder 16 from the rear end thereof. The snare 104 is elastically deformed so as to be coaxial with the rod 102 when it is in the outer cylinder 16.

As a result of the suture traction tool 100 being further advanced in the outer cylinder 16, as shown in FIG. 10, when the snare 104 is exposed from the distal end of the outer cylinder 16, the snare 104 becomes natural. Restore to the state. In this state, the snare 104 is positioned at the expected capturing position facing the tip of the fixed puncture needle 14.

In the present embodiment, the planned capturing position is set such that the extension of the axis of the fixed puncture needle 14 passes through the annular space defined by the annular elastic wires constituting the snare 104, and the snare 1 04 is parked at its intended capture position. Subsequently, in S5, as shown in FIG. 11, the suture 32 is inserted into the fixed puncture needle 14 from its rear end. By this insertion, the leading portion of the suture 32 is exposed from the tip of the fixed puncture needle 14 and further passes through the snare 104.

Then, in S6, as shown in FIG. 12, the suture traction tool 100 is pulled out of the outer tube 16 and thereby the snare 104 The force of the fixed puncture needle 14 of the suture 3 2 The part exposed from the tip is hooked and captured, and in that state, the snare 104 is elastic It is inserted into the outer cylinder 16 with its deformation from the tip. As the suture traction tool 100 is retracted within the outer cylinder 16, the suture 32 is pulled from the leading end to the rear end of the outer cylinder 16.

The suture traction tool 100 is completely removed from the outer cylinder 16, and the leading part of the suture 32 is exposed from the rear end of the outer cylinder 16, and in this state, the snare 104 is removed. When the suture is released from the force, as shown in FIG. 13, the continuous suture 32 enters the body from outside the body via the fixed puncture needle 14, the intragastric space, and the outer cylinder 16. A state where the patient leaves the body is realized. This realization can be performed without displacing the main body 10 relative to the abdominal wall 20 and the stomach wall 22.

Subsequently, at S7, as shown in FIG. 14, the main body 10 is retracted together with the suture 32 in a direction away from the patient. After the main body 10 has been completely removed from the patient and the suture 32 has been removed from the main body 10, the continuous suture 3 2 force 1st through hole as shown in FIG. 15 A state in which the body enters the body from outside the body and exits the body through the body 140, the intragastric space, and the second through hole 142 is realized.

Then, as shown in FIG. 16, if the suture 32 force is ligated using a ligature such as a ring at two portions exposed from the abdominal wall 20, the stomach wall is urged by the suture 32. 2 2 will be fixed to the abdominal wall 20.

Thus, a series of operation methods of the gastric wall fixing device is completed.

As is apparent from the above description, in the present embodiment, two portions of the abdominal wall 20 and the stomach wall 22 that overlap each other constitute an example of the “plural scheduled suture portions” in the above section (1). It is.

Further, in the present embodiment, S 1 in FIG. 6 constitutes an example of the “movable puncture needle insertion step” in the above item (7), S 2 constitutes an example of the “advancing step”, and S 3 S4 constitutes an example of the "suture traction tool insertion step", S5 constitutes an example of the "suture insertion step", and S6 constitutes an example of the "suture insertion step". S7 constitutes an example of the "retreating process" It is.

As described above, one of the embodiments of the present invention has been described in detail with reference to the drawings. However, this is an example, and the mode described in the section of “Means for Solving the Problems and Effects of the Invention” is described. At the outset, the present invention can be implemented in other forms with various modifications and improvements based on the knowledge of those skilled in the art.

Claims

The scope of the claims

1. A living body suturing tool used for suturing a plurality of predetermined suturing sites separated from each other in a living body with a suture.

A holder,

A movable puncture needle and a suture puller selectively and removably inserted into the internal passage of the outer cylinder;

Including, and

The movable puncture needle has a sharp tip, and when the needle is inserted into the outer cylinder from the rear end thereof and reaches the advance limit, the sharp tip protrudes from the tip of the outer cylinder. ,

The suture traction tool has, at its tip, an elastically deformable snare, which in a free state extends radially outward from the suture traction tool, and the suture is elastically deformed with the snare. When the thread puller is inserted into the outer cylinder from the rear end thereof and reaches the advance limit, the snare protrudes from the front end of the outer cylinder and returns to the free state. The snare is positioned at a scheduled capturing position where a portion exposed from the tip of the fixed puncture needle is scheduled to be captured, and

A living body suture tool wherein, in a state where the movable puncture needle is at the advance limit, the position of the tip of the movable puncture needle is located forward of the position of the tip of the fixed puncture needle.

2. The edge at the tip of the outer cylinder is chamfered on the C or R surface. 2. The biological suturing tool according to claim 1, wherein the suturing tool is a suturing tool.

3. The living body suture according to claim 1, wherein the honoreda holds the fixed puncture needle and the outer cylinder in parallel with each other at one position. Utensils.

4. A guide member is provided at a rear end of the outer cylinder for guiding a selected one of the movable puncture needle and the suture traction tool into an internal passage of the outer cylinder. A member having an opening formed at the rear end of the outer cylinder and having a diameter larger than the internal passage of the outer cylinder; and a tapered tapered hole extending from the opening to the tip of the outer cylinder. 2. The biological suturing tool according to claim 1, comprising: