JP3476902B2 - Suture tool - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [0001] BACKGROUND OF THE INVENTION The present invention relates to a method for observing the inside of a body cavity with an endoscope.
Suturing and ligating threads in an environment where surgery is performed
Related to fittings. [0002] 2. Description of the Related Art In recent years, surgery has been performed while observing the inside of a body cavity with an endoscope.
Surgery is often performed. Endoscope like this
Limit movement while watching a two-dimensional image from the monitor
Have to operate special tools in the body cavity
In such an environment, suturing and ligating a thread is not possible.
Always difficult. For this reason, tools and tools that easily
Many laws have been developed. [0003] At present, generally used suture and ligation methods are used.
There are extracorporeal ligation and internal ligation. Here, extracorporeal ligation is
Once the thread is inserted through the living tissue in the body cavity,
Take the end out of the body, tie the knot outside the body, this knot
Again with a special tool for sending
It is said. An example of a tool for tying a thread in a similar manner is
It is described in U.S. Pat. No. 5,144,961. This
This is done in advance with one end of the thread with the needle (the side
End) is wrapped around a hollow rod and tied on this hollow rod
Eyes are formed. And in the body cavity, wrap this rod
After inserting only the thread and needle in the unattached area and sewing
Take the thread out of the body and pass it through the inner hole of the hollow rod.
Then remove the knot from the bar and push the hollow bar forward
It sends a knot into the body cavity. [0005] On the other hand, when ligating the body, laparoscopic hand
As with normal laparotomy, the man is used with two surgical forceps.
-Female knot (double ligature) or male-female-male knot (triple ligature)
Ligation). More about such ligations
It will be described later. [0006] It also simplifies the task of knotting in the body.
A method is shown in US Pat. No. 5,234,445.
There is something like that. This is almost a lasso in the middle of the thread with the needle
To form a knot with a loop-shaped loop
It passes through the inside of an empty stick. [0007] In this case, the knot does not enter this rod.
No. Then insert the rod into the body cavity and attach it to the tip
Insert the loop and needle thread into the body cavity and hold the needle with another forceps.
After sewing the tissue, pass the forceps through the loop
Grab the needle thread and pull the needle thread into the loop.
At the same time, push the hollow rod to send the knot. This
And the generally lasso-like loops tighten to form a knot. In addition, the ligature is ligated in the body cavity with two forceps.
In some methods, for example, the tools used can be used for laparoscopic surgery.
Forceps (see FIGS. 9 and 10 (A), (B)),
By operating two such forceps, a normal laparotomy is performed as described above.
Perform a man-female knot or a man-female-man knot like surgery
U. As an example of the procedure at this time, first,
Take one end (a end) of the thread with A forceps and wind it around the other B forceps.
Squeak. Subsequently, the A forceps holding the a-end of the thread is
Is held in a gripped state and the yarn is wound
The other end (b end) of the thread is grasped with the B forceps. [0010] Here, the A forceps are moved toward the distal end of the B forceps.
And move the wound loop of the thread over the B forceps to the b end of the thread.
Bring it up. In this condition, hold both forceps in the opposite direction.
Pull in the direction and tighten the loop of the wound thread to form a knot
You. Note that a man-female knot, a man-female-man knot, etc.
Is the same two or three times with the winding direction reversed.
And is repeated. By the way, man-woman knot
If performed, the knot is as shown in FIG. [0012] The knot thus obtained is strong and strong
Yes, and the two ends of the thread with two forceps around the knot
Tighten the thread securely by pulling it right and left in the opposite direction
Becomes possible. Adjusting the tightening condition etc. by doing in this way
Easy to do. [0013] SUMMARY OF THE INVENTION
In the case of a conventional structure, when knotting outside the body
It is necessary to pull out both ends of the thread that has been guided inside the body
There is a lot of forceps movement in and out,
It is troublesome. In addition, a relatively wide range of biological
When suturing tissue, it is necessary to repeat the suturing operation several times
There is a problem that makes the task even more difficult.
You. Also, since both ends of the thread are taken out of the body,
Since a long thread is required, the thread will penetrate
The living tissue may be rubbed long by this thread.
In addition, special tools are needed to send the knot into the body.
And costly, and in this way
The method of sending the knot from outside the body to the body hardens the knot
It can be difficult to tighten. In addition, two laparoscopic surgical forceps are used.
When performing ligation within the body,
Because it is a work in a special environment, it is necessary to
Operation has a very difficult problem. In particular, wrap the thread around the forceps
Is difficult and requires skill and skill.
You. In addition, here too, the body
When repeating the suturing operation multiple times to suturing the tissue
Are more time-consuming and more difficult
There is a title. [0016] In addition, the substantially lasso-shaped loop makes
In the method of tying the other end to make a knot,
Relatively weak, the knot may be loosened. What
Attach a roughly lasso-shaped loop to the tip of the rod and insert it into the body cavity
Perform normal sewing work, such as when inserting
Two holes are provided on the patient's body for inserting two forceps.
Hole for inserting this rod in addition to
Must be newly added to the patient's surface.
May increase the burden on the user. Furthermore, in this case as well,
When suturing several stitches, it is necessary to insert and remove the forceps every time.
The problem is that the work becomes complicated.
You. The present invention has been made by focusing on the above circumstances.
The purpose is to cover a relatively wide range of body tissues in the body cavity.
For suturing that can efficiently perform the work to sew the weave
To provide tools. [0018] SUMMARY OF THE INVENTION The present invention provides a knot loop.
A cylindrical member for arranging a plurality of sutures forming a loop;
The cylindrical member is loosely inserted, and has a hole for accommodating the loop,
A locking portion for locking at least one portion of the suture
Means for individually distinguishing the plurality of sutures;
Is provided. [0019] Function: A plurality of sutures are previously applied to a part of the sutures, for example, for ligating.
Each loop is formed, and each loop is held on a cylindrical member
As well as the thread extension that extends from each loop
Part. Then, forceps into the space inside each loop
Through a surgical tool such as a child, the cylindrical member holding each loop
Place on the outer circumference of the surgical tool. Insert this into the body cavity
Then, after passing the thread through the required biological tissue, with another forceps, etc.
Remove the first loop from the surgical tool and ligate with this loop
You. Next, the next thread was selected and a second ligation was performed in the same manner.
U. If you want to add more, tie them sequentially using the next thread.
This is to perform ligation. [0020] FIG. 1 to FIG. 1 show a first embodiment of the present invention.
This will be described with reference to FIG. FIG. 1 shows a thread holding member 1 of a suturing tool.
FIG. The thread holding member 1 has
A cylinder 2 and an outer cylinder 3 into which the inner cylinder 2 is loosely inserted are provided.
I have. The outer diameter of the inner cylinder 2 is
An inner cylinder that is formed to have substantially the same diameter as the cylinder 3 and is not housed in the outer cylinder 3
A grip 4 is provided. Further, the rear end of the inner cylinder 2
3B is inserted into the outer cylinder 3 as shown in FIG.
A thread winding portion 5 having a tapered tapered surface is provided.
Between the inner cylinder gripping part 4 and the thread winding part 5
In between, fixed to the inner peripheral wall of the outer cylinder 3 to fix the inner cylinder 2
A fixing unit 6 is provided. And winding the thread around the inner cylinder 2
The part 5 has a plurality of windings shown in FIG.
Now, the four sutures 7A, 7B, 7C, 7D
The loop 7L of the triple ligature that is wound and knotted
Each is formed. In addition, the sutures 7A to 7D are outside.
Anything that can be used for department surgery
No. Also, as shown in FIG.
Is provided with a closing portion 2b on the inner cylinder gripping portion 4 side. So
Then, this lumen 2a is closed by a closing portion 2b on the distal end side of the inner cylinder 2.
It is designed to terminate. Furthermore, the lumen of this inner cylinder 2
2a is the yarn holding member 1 having an inner diameter of the yarn winding portion 5.
Forceps used in combination with, for example, the forceps 2 shown in FIG.
1 is set to be larger than the diameter of the insertion portion 21a.
ing. Here, the forceps 21 are close to the insertion portion 21a.
The operation part 21b is connected to the end on the side of
The tip of 21a is opened by the operation of the operation unit 21b.
A grip portion 21c to be closed is provided. Also, as shown in FIG.
On one end side, a small-diameter forceps fixing portion 8 is formed.
The thread other than the fixed part 8 has a larger diameter than the forceps fixing part 8.
A storage section 9 is formed. Here, the length of the thread storage section 9 is fixed to the inner cylinder 2.
The length is approximately the sum of the length of the fixed part 6 and the thread winding part 5
They are set to the same length. Furthermore, the thread storage 9
The inner diameter is large enough to fit into the fixed part 6 of the inner cylinder 2
Is set to The inner diameter of the forceps fixing portion 8 is the same as that of the thread holding portion.
The insertion part 21a of the forceps 21 used in combination with the material 1
The dimensions are set to fit lightly. Further
In addition, the forceps fixing portion 8 is provided outside the outer cylinder 3 through the inner hole.
Radial radially arranged at equal intervals in the circumferential direction toward the circumference
Cut grooves 10 are formed, and when inserting forceps,
The portion between the cut grooves 10 is relatively easily deformed and the forceps 2
The first insertion portion 21a is securely fixed. The end of the outer cylinder 3 has a thread wound on the inner cylinder 2.
The four sutures 7A and 7B wound around the attachment portion 5,
A total of 8 to lock both ends of 7C, 7D
Of thread locking grooves 11A-11D, 11A'-11D '
Have been. These eight thread locking grooves 11A to 11D,
11A 'to 11D' are provided at the tip of the outer cylinder 3 in the circumferential direction.
They are arranged at equal intervals. In this case,FIG. 3 (B)Outer cylinder 3 as shown in
Lock located at the radially opposite position at the tip of the thread
Grooves 11A and 11A ', 11B and 11B', 11C and 11
C ′, 11D and 11D ′ are set to the same length, respectively.
ing. Further, the thread locking grooves 11A and 11A '
11B, 11B ', 11C with the shortest axial length
And 11C ', 11D and 11D' in order of length
It is set as follows. Each of the thread locking grooves 11A to 11D, 11A
Indication indicating the position of the groove behind " 11D "
For example, dot display sections 12A to 12D are formed. this
These dot display sections 12A to 12D are provided with respective thread locking grooves 11A to 11D.
Depending on the length of 11D, 11A'-11D '
1, 2, 3, and 4 dots are sequentially added. An example
For example, one dot is formed in the thread locking grooves 11A and 11A '.
Shaded dot display sections 12A are formed. Further, the yarn is wound around the yarn winding portion 5 of the inner cylinder 2.
A suture needle 13 is provided at one end of each of the four threads 7A to 7D.
Each is connected. Furthermore, the thread winding of the inner cylinder 2
In the yarn 7D wound around the rearmost position of the portion 5
A end 7a which is the end on the needle 13 side and B end which is the other end
The portion 7b is a thread locking groove 11 having the longest groove of the outer cylinder 3 respectively.
D and 11D '(dot display section 12D with 4 dots)
Locked. Similarly, the yarn winding portion 5 of the inner cylinder 2
Yarn wound at the second position from the trailing end position
Both ends of 7C are thread locking grooves 11C and 11C of outer cylinder 3, respectively.
′, From the rear end position of the yarn winding portion 5 of the inner cylinder 2
Both ends of the second thread 7B are thread engaging grooves 11B of the outer cylinder 3, respectively.
And 11B ', the rear end position in the yarn winding portion 5 of the inner cylinder 2
Both ends of the fourth thread 7A from the position are thread-locked to the outer cylinder 3, respectively.
Locked in grooves 11A and 11A '. Here, the sutures 7A, 7B, 7
Although C and 7D are yarns with needles, even yarns without needles 13 can be used.
Good. Further, the types of the suture threads 7A, 7B, 7C, 7D
What is absorbent, non-absorbable, natural or synthetic
It may be something. Next, the yarn is wound around the yarn winding portion 5 of the inner cylinder 2.
How to wind each suture thread 7A (7B, 7C, 7D)
explain about. First, as shown in FIG.
The suture thread 7A (7B, 7B)
C, 7D) once, and the first loop 7L₁ (Roux
Step 1) is formed. Subsequently, as shown in FIG.
To the thread winding portion 5 so as to be symmetrical with respect to the dotted line portion A.
The suture thread 7A (7B, 7C, 7D) is wound and the second
Loop 7L_Two (Loop 2) is formed. Further, as shown in FIG.
Is symmetrical with respect to the dotted line B (that is, loop 1
And the suture thread 7A (7
B, 7C, 7D), the third loop
7L_Three (Loop 3) is formed. Thus, the triple knot for the knot shown in FIG.
A loop portion 7L for ligating is formed. Then, in FIG.
As shown by the arrow in FIG. 7, the suture thread 7A (7B, 7C, 7D)
(A-end) 7a of these three loops 7L₁ ~ 7L_Three
When threaded inside, the thread 7A (7B, 7C,
7D) and each loop 7L of the loop section 7L.₁ ~ 7L_Three With
The relationship of the entanglement is represented by the male-female-male knot shown in FIG.
This is the same as triple ligation. That is, the loop 7L
₁ , Loop 7L_Two , Loop 7L_Three Are 3 in FIG.
For single ligature o, double ligature p and triple ligature q of heavy ligature
Each corresponds, the difference in the direction of winding of loop 2 is male
-Corresponding to the female knot in the female-male knot. In addition, thread 7A ~
7D winding method is particularly limited to that of the present embodiment.
Not anything that can be ligated.
No. Then, the inner cylinder 2, the outer cylinder 3,
As shown in FIG. 3B, four sutures 7A to 7D are used in advance.
Sutures 7A to 7D are wound around the thread winding portion 5 of the inner cylinder 2.
And form a loop portion 7L of a triple ligature for each knot.
After completion, the loop portion 7L of the suture threads 7A to 7D was wound.
Insert the thread winding section 5 into the thread storage section 9 of the outer cylinder 3
You. At this time, the yarns 7D to 7C, 7
B, 7A in order of the thread locking grooves corresponding to each of the outer cylinders 3
11D, 11D 'to 11A, 11A' sandwiched and fixed sequentially
Finally, the fixing part 6 of the inner cylinder 2 is fitted into the outer cylinder 3 to secure it.
Is to be specified. Next, the operation of the above configuration will be described.
Here, the yarn holding member 1 of the present embodiment is shown in, for example, FIG.
Assembled with forceps 21 (hereinafter, this forceps 21 is referred to as A forceps)
Used in combination, as shown in FIG.
Woven wound site H₀ Tissue H on both sides of₁ , H_Two Ligating between
The case will be described. First, insertion of the A forceps 21 as shown in FIG.
The inner cylinder 2, the outer cylinder 3, and the sutures 7A to 7D are assembled to the portion 21a.
The forceps fixing portion 8 at the rear end of the outer cylinder 3 of the thread holding member 1
Insert into the lumen. Here, the A forceps 21 is inserted deeply.
When the distal end of the insertion portion 21a of the A forceps 21
It is inserted into the lumen 2 a of the winding part 5. From this state, the A forceps 21 are further pushed forward.
And the distal end of the A forceps 21 is the closing portion 2 of the lumen 2a of the inner cylinder 2.
b, the closing portion 2b is held by the A forceps 21
The inner tube 2 is pressed in the insertion direction of the A forceps 21 so that the outer tube 3
Extruded from. At this time, the thread winding portion 5 of the inner cylinder 2
The loop portion 7L of the yarns 7A to 7D wound around
As the inner cylinder 2 is pushed out of the outer cylinder 3,
Remove the thread from the thread winding portion 5 of the inner cylinder 2 while maintaining the same shape.
And is wound around the A forceps 21 inserted in place of the inner cylinder 2.
Attached. In addition, it came off from the thread winding part 5 of the inner cylinder 2.
The inner cylinder 2 is removed from the A forceps 21. The outer cylinder 3 is held by the forceps fixing portion 8 with A forceps.
21 and is fixed in a tightly fitted state. At this time,
Due to the elasticity of the material of the outer cylinder 3 and the cut grooves 10, the outer cylinder 3
Can be moved in the axial direction on the A forceps 21 with an appropriate amount of force
Function, and as shown in FIG.
It is held in a state where it is arranged at an appropriate position. As described above, the outside of the A forceps 21 and the thread holding member 1
After the assembly work with the cylinder 3 is completed, the thread holding member 1
A forceps 21 with the outer cylinder 3 of
To ligate the living tissue. Here, for example, the wound site H₀ Pair on both sides of
Woven H₁ , H_Two When suturing in between, one dot is
The position of the attached dot display section 12A (the shortest
I) Needle with thread 7A locked in one thread locking groove 11A
Is held by the A forceps 21. Next, as shown in FIG.₀ of
Tissues H on both sides₁ , H_Two Needle 13 is stabbed in between to lay thread 7A
H₁ , H_Two Through the A end 7a of the thread 7A.
Grasp again with A forceps 21. In this state, another forceps (hereinafter referred to as B forceps)
Child) 22, the dot is the other of the one dot display section 12A
B end 7 of thread 7A fixed to thread locking groove 11A '
Grab b. Then, the B forceps 22 are pulled up, and the B end of the thread 7A is
The thread 7 is pulled out of the outer cylinder 3 as shown in FIG.
After removing the loop part 7L of A, the tip direction of the A forceps 21
To pull. When this is further pulled, the loop portion 7L of the thread 7A
Is disengaged from the A forceps 21 and, as shown in FIG.
The A end 7a of the thread 7A passes through L. In this state,
Then, the A forceps 21 and the B forceps 22 are pulled strongly, as shown in FIG.
By strongly tightening the knot of the loop 7L
, Wound site H₀ Tissue H on both sides of₁ , H_Two Sutures between lines
Be done. Subsequently, when it is desired to sew another stitch,
(The length is 2nd)
(Short eyes) are locked in the thread locking grooves 11B and 11B '.
A similar suturing operation is performed using the needle thread 7B. Less than
After that, it is sequentially held in a groove with a large number of dots and a long length.
A similar suturing operation is performed using the needle-attached threads 7C and 7D.
Will be And in this embodiment, up to four stitches
Can operate. Therefore, the following effects are obtained with the above configuration.
Play a fruit. That is, the thread winding of the inner cylinder 2 of the thread holding member 1
Four sutures 7A, 7B, 7C, and 7D are attached to the attaching portion 5.
Wrap each and tie the loop part 7L of the triple ligature for the knot
Formed, and the thread holding member 1 is combined with the A forceps 21.
Wrapped around the thread winding part 5 of the inner cylinder 2
The inner tube 2 forms the outer tube with the loop portion 7L of the thread 7A to 7D.
Maintain the shape as it is pushed out from 3
A forceps 21 inserted in place of inner cylinder 2
So that it is inserted into the body cavity
A plurality of needles without pulling out the A forceps 21 from inside the body cavity to outside the body
Can be easily and reliably performed. For this reason, wounds of living tissue in the body of a patient
Rank H₀ Tissue H on both sides of₁ , H_Two Like ligating between
To suturing living tissue over a relatively wide area in a body cavity
Work can be performed efficiently. The eight thread locking grooves 1 at the tip of the outer cylinder 3
1A to 11D and 11A 'to 11D', the thread locking groove 1
1A and 11A 'have the shortest axial length of the outer cylinder 3,
11B and 11B ', 11C and 11C', 11D and 11D
In order of ', set the length to be longer and
Behind the thread locking grooves 11A to 11D and 11A 'to 11D'
Form dot display portions 12A to 12D indicating the positions of the grooves
The four wires wound around the thread winding portion 5 of the inner cylinder 2
The order of use of the yarns 7A to 7D
Work efficiency can be improved. Further, eight thread locking grooves at the tip of the outer cylinder 3
11A to 11D, 11A 'to 11D', four yarns 7
A to 7D are locked at both ends.
Then, the A forceps 21 to which the outer cylinder 3 of the thread holding member 1 is attached is
Four threads when inserting into body cavity via trocar etc.
The mounting position of 7A to 7D is shifted, and the loop portion 7L is
There is no risk of detachment from the child 21. The eight thread locking grooves 1 at the tip of the outer cylinder 3
1A to 11D, 4A locked to 11A 'to 11D'
The yarns 7A to 7D are provided with respective yarn locking grooves 11A to 11D and 11A 'to
Simply pull in the direction of the tip along 11D '
Can be removed. Further, the outer cylinder 3 of the thread holding member 1 is
1 and the loop portions 7 of the respective yarns 7A to 7D.
Since L is covered by the outer cylinder 3, each of the yarns 7 </ b> A to 7 </ b> D
The loop portion 7L moves on or off the A forceps 21,
Or, when the A forceps 21 is being inserted into the body cavity, the surrounding interference
There is no danger of getting caught on the like. The yarn holding member 1 is provided with a yarn winding portion 5.
Since the inner cylinder 2 provided with the
Loop part 7L does not collapse when assembling to outer cylinder 3 of holding member 1
And placed on the outer peripheral surface of the A forceps 21 as it is
Can be. Further, the thread holding member 1 of the suturing tool is assembled.
In the case of using, four sutures 7A, 7B, 7
Wrap the loop 7L of C and 7D and insert it into the outer cylinder 3.
Therefore, the work of assembling the yarn holding member 1 can be facilitated.
Can be. Further, the wound site H₀ Tissue H on both sides of₁ ,
H_Two When suturing the gap between the A forceps 21 and the B forceps 22,
With two forceps, each suture thread 7A (or 7B, 7C, 7
D), pull each suture 7A (or 7B, 7C,
It is possible to strongly tighten the knot of the loop 7L of 7D)
Can form a strong, tight knot,
A reliable ligation operation can be performed. The inner cylinder 2 of the yarn holding member 1 of the embodiment described above.
Sutures 7 wound around the thread winding portion 5
A, 7B, 7C, 7D
You may. In this manner, the four suture threads 7A having different colors,
7B, 7C and 7D are wound around the yarn winding portion 5 of the inner cylinder 2.
By using the sutures 7A, 7B, 7C, 7
D can be quickly identified, so sutures of living tissue
When performing the work, several threads may be
Even if there is, the desired sutures 7A, 7B, 7C, 7D
Simply distinguishable. FIG. 13 shows a first modification of the first embodiment.
This is an example. This is because each suture thread 7A, 7B,
At the B end 7b opposite to the needle 13 side in 7C and 7D
The number which is the number of the thread counted from the tip side of the outer cylinder 3 is attached.
Display plates 31A, 31B, 31C, 31D
It is provided. In this case, the sutures 7A, 7B, 7
Table of B end 7b on the side opposite to needle 13 side in C and 7D
View the display plates 31A, 31B, 31C, 31D
Thereby, the suture thread 7A (or 7
(B, 7C, 7D). Further, the intended suture thread 7A (or 7
B, 7C, 7D), when grasping the B end portion 7b, each suture thread
Each display panel having a larger surface area than 7A, 7B, 7C, 7D
You can grab the rates 31A, 31B, 31C, 31D
Wear. Therefore, each suture thread 7A, 7B, 7C, 7D
The intended suture thread 7A (or 7
B, 7C, 7D). FIG. 14 shows a second modification of the first embodiment.
This is an example. This is because each thread locking groove 11 of the outer cylinder 3
A to 11D and 11A 'to 11D'
It is in the form of a number that is the order of the yarn counted from the end side.
You. Also in this case, each of the thread locking grooves 11A to 11D
Use by observing the shape of 1A 'to 11D'
Position of the desired suture 7A (or 7B, 7C, 7D)
I understand immediately. FIG. 15 shows a third modification of the first embodiment.
This is an example. This is because each suture thread 7A (or
7B, 7C, 7D)
It is formed. That is, here, each suture thread 7
A (or 7B, 7C, 7D) A end 7a
As shown by the arrow in FIG.
Multiple loops, eg 5 turns, 5 loops 7M₁ ~ 7
M_Five After forming the A, the A end 7a is
Loop 7M_Three , 7M_Two , 7M₁ Tighten it inside
In a configuration that forms a knot called a loose loader knot
It was done. FIG. 16A shows the fourth embodiment of the first embodiment.
This shows a modification of the first embodiment. This is the suture thread 7A
(Or 7B, 7C, 7D) winding style was further changed
This is one in which a loop portion 7N is formed. That is, here
Is used to connect each suture thread 7A (or 7B, 7C, 7D) to the inner cylinder 2.
16 (A) is wound twice from the right in FIG.
Double loop 7N₁ , 7N_Two Loop 1 consisting of
After forming the left loop 7N_Two To the right end
Loop 7N₁ Crossed with the beginning of
In the state, the loop 7N is wound once around the yarn winding portion 5._Three
(Loop 2). Then, each suture thread 7A (or 7B, 7B)
C, 7D) to the left as shown by the arrow in FIG.
A end 7 when tightened from the direction through loops 1 and 2
a each suture thread 7A (or 7B, 7C, 7D) on the
Thread 7A (or 7B, 7C, 7
As shown in FIG. 16B, the positional relationship of D)
It is similar to what is called a family knot. FIGS. 17A to 20 show the present invention.
9 shows a second embodiment. This is the first embodiment
A part of the configuration of the yarn holding member 1 is changed as follows.
It is. In other words, in this case, each suture
Needle holding holes 51A to 51 for holding the needles 13 of the yarns 7A to 7D
D is provided. Each of the needle holding holes 51A to 51D
Divide the circumferential direction of the outer cylinder 3 at equal intervals of 1/4
It is located in the position where. Further, a pair of adjacent ones is
Between the needle holding holes 51A and 51B, between 51B and 51C, 51
In the middle position between C and 51D and between 51D and 51A
The thread locking grooves 52A, 52B, 52C, 52D are respectively shaped.
Has been established. The diameter of each of the needle holding holes 51A to 51D is
The diameter is set slightly larger than the diameter of the needle 13. Soshi
The needle 13 is inserted from the rear end into each of the needle holding holes 51A to 51D.
The needle 13 is inserted into each of the needle holding holes 51A to 51D.
For each suture connected to the rear end of this needle 13 with its end
The A ends 7a of the threads 7A to 7D are inserted together.
The needle 13 is inserted into each of the needle holding holes 51A to 51D from the rear end.
And the A end 7a of each of the suture threads 7A to 7D has been inserted.
At this time, the needle 13 and each suture are inserted into each of the needle holding holes 51A to 51D.
A end 7a of thread 7A to 7D fits with moderate strength
It is set as follows. Further, each needle holding hole 51 is formed on the outer peripheral surface of the outer cylinder 3.
Positions near A to 51D and after thread locking grooves 52A to 52D
Each suture counted from the tip side of the outer cylinder 3 at a position near the end position
The numbers to indicate the order of the thread 7A, 7B, 7C, 7D
A display unit 53 displaying 1 to 4 is provided. Here, for example, the suture at the rearmost position of the inner cylinder 2
Needle 13 for thread 7D is inserted into the 4th needle holding hole 51D.
The B end 7b of the suture thread 7D is
D is locked. Subsequently, the yarns 7C and 7 on the rear end side of the inner cylinder 2
B, 7A are displayed in the order of 3, 2, 1
The needle 13 is inserted into each of the needle holding holes 51A to 51C.
Sutures in the thread locking grooves 52A to 52C indicated by their numbers
The B ends 7b of the yarns 7C, 7B, 7A are locked, respectively.
It has become so. Also, the inner tube grip 4 at the tip of the inner tube 2
Of the suture needle 13 inserted into each of the needle holding holes 51A to 51D.
Four escape grooves 54 to avoid interference with the tip projection
Is formed. Next, the operation of the above configuration will be described.
First, an example of the usage of the yarn holding member 1 of the second embodiment will be described.
Will be described. This is similar to the A forceps 21 shown in FIG.
Used in combination with shaped forceps. A forceps 2
1 is any kind of forceps, especially if it has a gripping function
I don't know. First, as shown in FIG.
The insertion part 21a is a forceps fixing part at the rear end of the outer cylinder 3 of the thread holding member 1.
8 and the A forceps 21 in the same manner as in the first embodiment.
The outer cylinder 3 of the thread holding member 1 is assembled. As described above, the outside of the A forceps 21 and the thread holding member 1
After the assembly work with the cylinder 3 is completed, the thread holding member 1
A forceps 21 with the outer cylinder 3 of
To ligate the living tissue. As shown in FIG. 19, forceps different from A forceps 21
A child (hereinafter B forceps) 22 is inserted into the body. This B forceps 2
2 is a needle holder. Further, as shown in FIG.
21 is tilted at an appropriate angle, and the B forceps 22
Needle 1 held in first needle holding hole 51A
3 is taken with the B forceps 22. Subsequently, the wound site H is₀ Both sides of
Organization H₁ , H_Two Needle 13 is inserted in between, and tissue H₁ , H_Two
After passing the thread 7A in between, the A forceps 21 as shown in FIG.
With this, the A end 7a of the thread 7A on the needle 13 side is gripped. Sa
Further, the first thread engaging member of the thread holding member 1 is operated by the B forceps 22.
The B end 7b of the thread 7A in the stop groove 52A is gripped. After this
Thereafter, the ligature is ligated in the same manner as in the first embodiment. Therefore, the following effects are obtained with the above configuration.
Play a fruit. That is, the needle 13 of each of the suture threads 7A to 7D
Are held in the needle holding holes 51A to 51D on the distal end surface of the outer cylinder 3.
Needle 13 that is not in use
Low risk of contact with internal organs. Further, the needles 13 of the sutures 7A to 7D are
Needle holding holes 51A to 51D formed on the distal end surface of outer cylinder 3
Since they are held together, each of the suture threads 7A to 7D
There is no possibility that the needles 13 are left in a dispersed state.
No. Therefore, the needle 13 of each of the suture threads 7A to 7D is
It does not hinder the work. In addition, in the needle holding holes 51A to 51D,
Since the needles 13 of the sutures 7A to 7D are fixed,
There is also an effect that the needle 13 can be easily taken. FIG. 21 shows a first modification of the second embodiment.
This is an example. This is because the outer cylinder 3 has a needle holding hole 51A.
Outer peripheral surface of outer cylinder 3 corresponding to that part instead of through 51D
Forming magnet mounting grooves 61A-61D recessed inside
Then, the magnet 6 for holding the needle is inserted into each of the magnet mounting grooves 61A to 61D.
2A to 62D are fitted respectively. Soshi
The suture thread 7 is driven by the magnetic force of the magnets 62A to 62D.
A to 7D needles 13 are attracted. Therefore, in the above configuration, the last
When the needle 13 is removed from the body cavity after performing the suture,
The used needle 13 can be easily formed by the magnets 62A to 62D.
Hold and recover. FIGS. 22A and 22B show the second embodiment.
9 shows a second modification of the example. This is the outer cylinder 3
Between a pair of thread locking grooves 52A, 52B adjacent to the tip end face;
Between 2B and 52C, between 52C and 52D, between 52D and 52A
To the outside, with moderate elasticity.
In addition to providing the girder needle holding portion 71, the outer cylinder 3
A sheath 72 slidable in the axial direction.
You. Here, the outer cylinder 3 of the thread holding member 1 is assembled.
A forceps 21 inserted into the body cavity via a trocar or the like
At this time, as shown in FIG.
A position covering the entire needle 13 held in the holding holes 51A to 51D.
The sheath 72 is covered on the outer peripheral surface of the outer cylinder 3 up to the position.
Then, after insertion into the body cavity, as shown in FIG.
By sliding the sleeve 72 toward the rear end of the outer cylinder 3,
The needle holding portion 71 extends outward. That
Therefore, in this case, each of the sutures 7A
There is an effect that the 7D needle 13 can be easily taken. FIG. 23 shows a third modification of the second embodiment.
This is an example. This is because the outer cylinder 3 of the thread holding member 1
The forceps insertion port 82 is inserted into the main body 81 so that the shaft 82
Arranged eccentrically from the center position and needle holding
The holes 51A to 51D are oriented in the direction opposite to the eccentric direction of the forceps insertion port 82.
It is arranged in the state where it was collected. So this
In this case, the sutures 7A to 7A are inserted through the needle holding holes 51A to 51D.
There is an effect that the needle 13 of D becomes easy to take. FIG. 24 shows a fourth modification of the second embodiment.
This is an example. This is the needle holding hole of the second embodiment.
51A to 51D are provided on the rear end surface of the outer cylinder 3 and each of the suture threads 7
The needles 13 of A to 7D are pointed backward to the needle holding holes 51A to 51D.
And hold it. like this
With this configuration, each suture thread 7A is provided on the front surface of the thread holding member 1.
Since the needle 13 of ~ 7D is not protruded, the normal forceps operation is interrupted.
It does not become evil. FIG. 25 shows a fifth modification of the second embodiment.
This is an example. This is because four outer circumferential surfaces of the outer cylinder 3
The needle holding groove 91 is aligned with the shape of the needle 13 of each of the suture threads 7A to 7D.
And each groove 91 is used to prevent the needle 13 from coming off.
Are provided. Needle 1
3 is held so as to fit into the groove 91. This
With such a configuration, the tip of the needle 13 does not protrude outside.
The risk of organ damage in the body cavity due to contact with the needle 13
There is little nature. FIG. 26 to FIG. 30B show the present invention.
9 shows a third embodiment. FIG. 26 shows a suture tool thread.
2 shows a schematic configuration of a holding member 101. This thread
Holding member 101Inner cylinder 102And attached to and detached from this inner cylinder 102
Linked as possibleOuter cylinder 103Are provided. Here, the tip of the inner cylinder 102 has an outer diameter dimension.
Is formed to have substantially the same diameter as the outer cylinder 103 and is housed in the outer cylinder 103.
An inner cylinder gripping portion 104 is provided. further,
As shown in FIG. 27, an outer cylinder
Yarn having a tapered tapered surface inserted into 103
A winding portion 105 is provided, and the inner cylinder is gripped.
Of the outer cylinder 103 between the portion 104 and the yarn winding portion 105.
A fixing portion 106 that fits on the inner peripheral wall surface and fixes the inner cylinder 102
Is provided. Then, the yarn winding section 105 of the inner cylinder 102
FIG. 28 shows a plurality of windings, and in this embodiment, six windings.
The suture thread 107 is wound around each of the loop portions 10.
7L are formed. FIG. 2 shows the loop 107L.
Knot le, which is later wound into a knot as shown in Figure 8
Loop 107L₁ (This part is the same as the winding method in FIG. 4)
Thread-wound part 107 wound around the rest
L_Two Are provided. In addition, too much thread winding part 1
07L_Two A needle 115 is provided at the tip (A end) 107a of
Have been. Also, as shown in FIG.
The cavity 102a has a closing part 102b on the inner cylinder gripping part 104 side.
Is provided. And this lumen 102a is the inner cylinder 10
2 ends at the closing portion 102b on the tip side.
I have. Further, the lumen 102a of the inner cylinder 102 is
The inside diameter of the attaching portion 105 is set with the thread holding member 101.
Forceps used together, for example, forceps 21 shown in FIG.
It is set to be larger than the diameter of the insertion portion 21a.
You. FIG. 27 shows the inside of the outer cylinder 103.
A small diameter forceps fixing portion 108 is formed on one end side as
Parts other than the forceps fixing portion 108 include the forceps fixing portion 1
A thread storage portion 109 having a diameter larger than 08 is formed. Here, the length of the thread storage portion 109 is
02 of the fixing portion 106 and the thread winding portion 105
It is set to almost the same length as the added length. further,
The inner diameter of the thread storage portion 109 is the fixed portion 106 of the inner cylinder 102.
The size is set to fit lightly. What
Note that the forceps fixing portion 108 has a forceps insertion port.
The diameter is as light as the outer diameter of the forceps 21 used in combination with this.
It is set to a size that is tight enough to keep it tight.
I have. The outer circumferential surface of the outer cylinder 103 is provided with a thread passage groove 1.
11 is provided in parallel with the axial direction of the outer cylinder 103. This
The groove 111 is provided with a thread gripping groove obliquely rearward of the outer cylinder 103.
A plurality (six) 112 are provided. Further, a yarn passage is provided near the distal end of the outer cylinder 103.
A needle escape portion 113 connected to the groove 111 is provided.
You. This is the outer cylinder 103 with the lower half cut
At that portion, the cross section of the outer cylinder 103 is a semicircle. Also, the yarn holding groove 112 is wound around the inner cylinder 102.
B end 107 of each thread 107 on the opposite side to the needle 115 side
b is held. Further, at the tip of the outer cylinder 103,
Outer cylinder 1 so that thread locking groove 114 is connected to needle escape portion 113;
03 is provided diagonally in the direction of the tip. The outer cylinder 10
3, the inner cylinder 102 is housed.
07 is stored in the outer cylinder 103 every needle 115.
You. Next, the operation of the above configuration will be described.
In a suturing tool having such a configuration, a forceps as shown in FIG.
The child 21 is used in combination. And this forceps (hereinafter
Lower, A forceps) 21 after the outer cylinder 103 as shown in FIG.
Insert from the end and push out the inner cylinder 102. At this time, the outer cylinder
103 is an outer peripheral surface of the A forceps 21 by a forceps fixing portion 108.
And is fixed with a light interference fit. Subsequently, the A forceps 21 are connected to a trocar or the like.
Through the body cavity. At this time, the trocar and the thread
The contact portion of the holding member 101 is kept airtight, and
The gap between the thread holding members 101 is also tightened by the forceps fixing portion 108
It is fitted and airtight. Next, another forceps as shown in FIG.
The child (B forceps) 22 is inserted into the body cavity. And B forceps
At 22, the B end of the first thread 107 from the tip of the outer cylinder 103
107b is gripped and removed from the thread gripping groove 112. As shown in FIG. 30B, B forceps
The thread 107 is pulled by the child 22 and the loop 107
L, slide the B end 1 into the thread locking groove 114.
07b is hooked and held. In this state, the A forceps 21
Is slightly shaken, the thread winding portion 10 of the loop portion 107L is
7L_Two Can be easily unwound. At this time, knot loop part 1
07L₁ Can not be easily unwound due to the complexity of the entanglement
No. Thereafter, as in the first embodiment, 1
Stitch the needle. In addition, when adding one stitch,
Next, the B forceps are applied from the thread 107 nearer to the tip of the outer cylinder 103.
22 grasps the B end 107b, and performs 1 by the same procedure as described above.
Repeat needle stitching. Therefore, in the case of the above structure, the yarn 10
7 needle 115 is completely housed in the outer cylinder 103.
Is safe. In addition, in cases requiring insufflation
And airtightness is maintained. FIG. 31 shows a modification of the third embodiment.
It is something. This is because the forceps fixing portion 108 of the outer cylinder 103
Is slightly larger than the outer diameter of the forceps 21 used.
O-ring 121 is mounted in the lumen
I have. Then, the forceps 21 are inserted from the forceps insertion port, and
The tube 103 is clamped by the O-ring 121 so that the forceps 21
Is fixed to the outer peripheral surface of. In such a configuration, the O-ring
Due to 121, the airtightness with the forceps 21 is completely maintained. FIG. 32 shows a sewing machine according to a fourth embodiment of the present invention.
6 shows a fitting 131. This is the third embodiment
The forceps member 132 is replaced with the forceps member 132 of the third embodiment.
It is incorporated in the outer cylinder 103. In this case, forceps
The member 132 is fixed by the forceps fixing portion 108 of the outer cylinder 103.
ing. The forceps member 132 is
An operation unit 135 is connected to the original side.
5 gripper 1 at the tip of insertion portion 134 by opening / closing lever 5
36 is opened and closed. In the suturing tool 131 having such a configuration,
Is inserted as it is into a trocar, etc.
It can be used similarly. Therefore, the forceps 21 are attached and detached.
You can save time and effort. It can also be used as normal forceps
You. The present invention is limited to the above embodiments.
The present invention is not intended to limit the scope of the present invention.
Of course, it can be implemented in a form. Next, other features of the present invention will be described.
Significant technical matters are added as follows. Note (Appendix 1) For multiple sutures forming a loop in part
A yarn and a yarn holding member, and a part of the yarn
Loop holding part for holding the loop formed in
A thread fixing part that holds at least a part at least
For suturing, characterized in that a means for distinguishing a thread is provided.
Utensils. (Additional Item 2) In the additional item 1, the yarn holding
At least some of the components can be attached to and detached from surgical tools such as forceps
A suture tool that is capable. (Additional Item 3) In the additional item 1, a part of the thread holding member may be used.
Suture tool with gripping function. (Additional Item 4) In the additional items 2 and 3, the yarn
The holding member is provided with a means for determining a suture thread.
Suture tool. (Supplementary note 5) In Supplementary notes 2 and 3, discriminated as suture thread
A suturing tool provided with a means. (Additional Item 6) In the additional item 4, a plurality
The same number of thread locking parts to lock the suture thread of
Characterized in that the shape of the thread locking part of the sewing machine is different
Fittings. (Additional Item 7) In the additional item 4, a plurality
The same number of thread locking parts to hold the suture
Characterized by different markings near the thread locking portion of the sewing machine
Fittings. (Additional Item 8) In the additional item 6, the thread locking
A suturing tool with a groove as the part and different groove lengths. (Additional Item 9) In the additional item 7, there is a different
Suturing tool. (Additional Item 10) In the additional item 7, the yarn
Characterized by adding different numbers of dots near the stop
Suture tool. (Additional Item 11) In the additional item 5, the yarns
Suturing tools with different colors. (Additional Item 12) In the additional item 5, the yarn
Suture tools with different markings. (Supplementary note 13) In Supplementary note 4, a plurality of sutures
Provide the same number of thread locking sections to lock, and the thread locking sections are in order
Suture tools characterized by being lined up. (Additional Item 14) In Additional Items 1, 2, and 3
The thread has a needle, and a part of the needle or the needle
A suturing tool provided with a means for housing all. (Additional Item 15) In the additional item 14, a needle storage in which a needle enters.
Suture tool with holes. (Additional Item 16) In Additional Item 14, the needle
Suture tool with a needle storage groove for storing (Additional Item 17) In Additional Item 14, the magnet to which the needle is attached
Suture tools provided. (Additional Item 18) In the additional item 14, the needle
Suturing tool provided with a needle discriminating means in the vicinity of the accommodating portion. (Additional Item 19) In Additional Item 14, the needle may be provided with a discriminating means.
Suture tools provided. (Additional Item 20) In the additional item 14, the needle
A suturing tool provided with a movable means. (Additional Item 21) In Additional Item 1, the yarn holding member is a cylinder.
The loop is housed inside the cylinder, and the loop is
A suturing tool characterized by being arranged in a line in a direction. [0115] According to the present invention, a loop for a knot is formed.
A cylindrical member for arranging a plurality of sutures, and a cylindrical member.
It has a hole for loosely inserting and storing the loop,
An outer cylinder with a locking part that locks at least one location, and multiple
Means for individually identifying the sutures of the body
Streamlines the task of suturing living tissue over a relatively wide area
Can do well.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a perspective view showing a thread holding member according to a first embodiment of the present invention. FIG. 2 is a side view of the yarn holding member according to the first embodiment, partially cut away. 3A is a perspective view showing an assembled state of a thread holding member, FIG. 3B is a perspective view showing a state in which an inner cylinder of the thread holding member is removed from an outer cylinder, and FIG. FIG. FIG. 4 is an explanatory view for explaining a method of winding a suture thread wound around a thread winding portion of the inner cylinder. 5A is a side view showing a first loop formed by wrapping a suture thread once in the distal direction of the inner cylinder, and FIG. 5B is a view around the dotted line A with respect to the first loop. FIG. 3C is a side view showing a state in which the suture is wound around the inner tube so as to be symmetrical, and a second loop is formed. FIG. 4C is symmetrical about the dotted line B with respect to the second loop. The side view showing the state where the 3rd loop was formed by winding the suture thread around the inner cylinder. FIG. 6 (A) is a schematic configuration diagram showing a state in which the A-end of the suture thread is passed through the first to third three loops, and FIG. 6 (B) is a triple ligature of a suture thread, male-female-male knot. The schematic block diagram which shows a state. FIG. 7 is a side view showing a schematic configuration of the forceps. FIG. 8 is a longitudinal sectional view showing a state in which the A forceps is inserted into the lumen of the forceps fixing portion at the rear end of the outer cylinder and the inner cylinder is pushed out of the outer cylinder. FIG. 9: A suture thread is passed between tissues on both sides of a wound site of a living tissue by A forceps, and a suture thread B by B forceps.
The perspective view showing the state where the end was grasped. FIG. 10 is a perspective view showing a state where a loop portion of a suture thread is pulled out by B forceps. FIG. 11 is a perspective view showing a state in which the A-end portion of the suture thread is pulled through the loop by the A forceps. FIG. 12 is a perspective view showing a state in which a suture thread is pulled by A forceps and B forceps to tighten a knot by a loop portion. FIG. 13 is a perspective view showing a thread holding member according to a first modification of the first embodiment. FIG. 14 is a perspective view showing a thread holding member according to a second modification of the first embodiment. FIG. 15 is a perspective view showing a third variation of the first embodiment in a state in which a suture is wound. FIG. 16 shows a fourth modification of the first embodiment, in which (A) is a perspective view showing a wound state of a suture thread,
(B) is a schematic block diagram showing a method of winding a suture thread called a surgical knot. FIG. 17 shows a second embodiment of the present invention.
(A) is a perspective view showing a thread holding member, (B) is an exploded perspective view showing a state before an inner cylinder of a thread holding member is inserted into an outer cylinder. FIG. 18 is a perspective view showing a state where the A forceps is inserted into the outer cylinder. FIG. 19 is a perspective view showing a state in which a suture needle is pulled out of the needle holding hole by the B forceps. FIG. 20 is a perspective view showing a state in which a suture is passed between tissues on both sides of a wound portion of a living tissue by A forceps, and a B end of the suture is grasped by B forceps. FIG. 21 is a perspective view showing a thread holding member according to a first modification of the second embodiment. FIGS. 22A and 22B show a second modified example of the second embodiment, in which FIG. 22A is a perspective view showing a main part of the thread holding member, partially cut away, and FIG. FIG. 5 is a perspective view showing a state in which the outer side of the sheath is projected. FIG. 23 is a perspective view showing a thread holding member according to a third modification of the second embodiment. FIG. 24 is a perspective view showing a thread holding member according to a fourth modification of the second embodiment. FIG. 25 is a perspective view showing a thread holding member according to a fifth modification of the second embodiment. FIG. 26 is a perspective view showing a thread holding member according to a third embodiment of the present invention. FIG. 27 is a side view of the yarn holding member of the third embodiment, partially cut away. FIG. 28 is an explanatory diagram for explaining a method of winding a suture thread wound around a thread winding portion of the inner cylinder. FIG. 29 is a side view showing a state where the A forceps is inserted into the outer cylinder. 30A is a side view showing a state in which the B end of the first thread is grasped from the distal end of the outer cylinder with the B forceps and removed from the thread grasping groove, and FIG. The side view showing the state where the loop part was slid and the B end of the thread was hooked and held in the thread fixing groove. FIG. 31 is a perspective view showing a main configuration of a first modification of the third embodiment. FIG. 32 is a perspective view showing a suturing tool according to a fourth embodiment of the present invention. [Description of Signs] 2 ... Inner cylinder (cylindrical member), 3 ... Outer cylinder (locking means), 7A,
7B, 7C, 7D: suture, 7L: loop part, 9: thread storage part (hole), 12A to 12D: dot display part (determination means).

──────────────────────────────────────────────────続 き Continuation of the front page (72) Inventor Minoru Tsuruta 2-43-2 Hatagaya, Shibuya-ku, Tokyo O-limpus Optical Industry Co., Ltd. (72) Inventor Naoki Uchiyama 2-43-2 Hatagaya, Shibuya-ku, Tokyo O-Limpus Optical Industry Co., Ltd. (72) Kunihide Kaji, Inventor 2-43-2 Hatagaya, Shibuya-ku, Tokyo O-Limpus Optical Industry Co., Ltd. (56) References JP-A-6-54855 (JP, A) JP-A-5-88507 (JP, U) JP-A-6-502354 (JP, A) U.S. Pat. No. 5,312,423 (US, A) U.S. Pat. No. 5,548,820 (US, A) (58) Fields investigated (Int. Cl. ⁷ , (DB name) A61B 17/04

Claims (1)

(57) [Claim 1] A cylindrical member for looping a plurality of sutures forming a knot loop, and a hole for loosely inserting the cylindrical member and accommodating the loop. A suturing tool comprising: an outer cylinder having a locking portion for locking at least one portion of the suture; and means for individually identifying the plurality of sutures.