JP3668263B2 - Knot forming device - Google Patents

Description

[0001]
[Industrial application fields]
The present invention relates to a technique for forming a knot of a thread in a living body, and more specifically, for tying a thread to be used for suture, anastomosis, ligation of a living tissue in abdominal cavity, for example, in laparoscopic surgery. The present invention relates to a knot forming device.
[0002]
[Prior art]
In recent years, in appendicitis surgery, gallbladder resection, and the like, in addition to laparotomy, non-laparoscopic laparoscopic surgery may be performed. In this laparoscopic surgery, a plurality of tubes called trocar tubes are inserted into the abdominal cavity, the inside of the abdominal cavity is monitored by a camera inserted from one trocar tube, and a device inserted into another trocar tube, Surgery is performed in the abdominal cavity while looking at the monitor.
[0003]
By the way, in the laparoscopic surgery, when performing suturing and ligation, it takes time and effort to tie the thread. For example, the thread in the body cavity is pulled out of the body cavity from the trocar tube using a tool such as forceps, a knot is formed outside the body cavity, and then the thread is returned to the body cavity through the trocar tube to complete the suturing and ligation. It was.
[0004]
Such a procedure is not preferable because the operation takes too much time and time, and the chance of infection increases.
[0005]
In recent years, special tools for suturing and ligating have been developed in order to eliminate such troubles. For example, Japanese Patent Application Laid-Open No. 3-12126 proposes an anastomosis / suture device using a staple-like needle for anastomoses and sutures. In this case, there is a disadvantage that the stapler needle remains in the body, there is a risk that the needle is dropped into the abdominal cavity due to an operation error, and further, the strength is weaker than when sutured with a thread. was there.
[0006]
Further, in general surgery, when it is necessary to make a strong knot, such as ligation of a thick blood vessel, the yarn knot is made by entwining the yarn twice or triple. However, the stapler-like needle cannot be used for such ligatures and anastomoses, and it takes more time and labor to tie the yarn knot by the conventional method. was there.
[0007]
[Problems to be solved by the invention]
The first object of the present invention is to provide a knot-forming device capable of easily and reliably forming a knot of a thread for anastomosis, suturing, ligation and the like by remote control from outside the body in a body cavity such as the abdominal cavity. It is to provide.
[0008]
A second object of the present invention is to provide a knot-forming device that can firmly form a knot of a thread and can be brought into close contact with a living tissue.
[0009]
[Means for Solving the Problems]
In order to achieve the above object, the present invention provides:
A knot forming device for forming a knot of a thread,
An operating rod inserted into a communication tube that allows communication between the body cavity and the outside of the body,
An insertion passage formed in the operating rod and having an opening at the tip of the operating rod;
Thread introduction means for introducing a thread into the insertion path from the opening;
An operating device connected to the base end of the operating rod and operating the operating rod from outside the body;
The distal end portion of the operating rod constitutes a variable bending portion that can be changed between a linear state and a state bent in at least one direction by operation of the operating device.
[0010]
The variable bending portion is preferably bent so as to form at least a single loop.
[0011]
In this case, the operating device includes a bending operation in which at least one wire having a distal end fixed at a position eccentric from an axial center in the variable bending portion, and the variable bending portion is operated by pulling the wire to the proximal end side. A mechanism,
It is preferable that the wire is provided so as to be spirally wound around the variable bending portion from the position where the tip is fixed toward the bending operation mechanism.
Further, the operating device includes a first wire and a second wire, each of which has a tip fixed at a position facing through the axis of the variable bending portion, and one of the first wire and the second wire. A bending operation mechanism for bending the variable bending portion in a desired manner by pulling toward the base end side,
The first wire and the second wire are provided so as to be spirally wound around the variable bending portion and in opposite directions from the position where the tip is fixed toward the variable bending mechanism, respectively. It is preferable that The operating device further includes a third wire having a distal end fixed to the variable bending portion, and a posture changing mechanism that changes the posture of the loop by pulling the third wire to the proximal end side. Is preferred.
[0012]
Further, it is preferable that the variable bending portion bends so as to form a loop overlapping two or more times.
[0013]
In this case, the operation device includes a plurality of wires whose distal ends are fixed at positions deviated from the axis in the variable bending portion, and a bending operation in which the variable bending portion is operated by pulling the wires toward the base end side. A mechanism,
The tip of each wire is fixed at a predetermined interval in the axial direction of the variable bending portion, and each wire is directed to the variable bending portion from the fixed position toward the bending operation mechanism. It is preferable to be provided by being spirally wound.
[0014]
In addition, the knot forming instrument has a knot formed by a first thread introduced from the opening and passing through the insertion passage, and a second thread passing through the loop formed in the variable bending portion. Preferably formed.
[0015]
Further, the variable bending portion has a plurality of unit members having thread insertion holes, and a connecting member for oscillatingly connecting adjacent unit members,
It is preferable that the variable bending portion is configured to be bent as a whole by bending and connecting adjacent unit members with a connecting member.
[0016]
Further, the present invention is a knot forming device for forming a knot of yarn, the knot forming device,
An operating rod inserted into a communication tube that allows communication between the body cavity and the outside of the body,
An insertion passage formed in the operating rod and having an opening at the tip of the operating rod;
Thread introduction means for introducing a thread into the insertion path from the opening;
An operating device connected to the base end of the operating rod and operating the operating rod from outside the body;
The operation rod includes a variable bending portion that is provided at a distal end portion of the operation rod and that is bent in a natural state to a target shape, and a restriction member that restricts the shape of the variable bending portion to a substantially linear shape. It is an instrument.
[0017]
Further, the present invention is a knot forming device for forming a knot of yarn, the knot forming device,
A pair of operating rods inserted into a communication tube that allows communication between the body cavity and the outside of the body;
An insertion passage formed in each of the operating rods and having an opening at the tip of the operating rod;
Thread introduction means for introducing a thread into each insertion path from each opening;
An operating device connected to the base end of each operating rod and operating each operating rod from outside the body;
A bundling member for bundling the base ends of the two operating rods;
A variable bending portion in which at least one tip portion of the two operating rods can change into a substantially straight state and a bent state in at least one direction, particularly a looped state, by operation of the operating device. It is the knot forming instrument characterized by comprising.
[0018]
The variable bending portion is preferably bent so as to form at least a single loop.
[0019]
Moreover, it is preferable that the said thread | yarn introduction means is a suction means connected to the base end side of the insertion path so that it may communicate with the said insertion path.
[0020]
Moreover, it is preferable that the said knot formation instrument has a holding means to hold | maintain the thread | yarn introduced into the said insertion path. Moreover, it is preferable that the said knot formation instrument has a tension | tensile_strength means to maintain the tension | tensile_strength state of the thread | yarn introduced into the said insertion path. The tension means includes a winding shaft that winds the yarn, a rotary knob that rotates the winding shaft, a biasing member that biases the winding shaft in a predetermined rotation direction, and the biasing force. It is preferable to have a lock member that prevents rotation of the winding shaft against the biasing force of the member.
[0021]
Moreover, it is preferable that the said knot formation instrument has a rotation relaxation means which relieves rotation of the said winding shaft by the urging | biasing force of the said urging | biasing member.
[0022]
Moreover, it is preferable that the said knot formation instrument has a cutting means provided in the said operation rod, and cut | disconnects the thread | yarn located in an insertion path. The cutting means includes a scissors having a pair of blades installed at the front end portion of the operation scissors, and a scissors for operating the scissors whose front ends are bifurcated and whose branch ends are respectively fixed to the end opposite to the blades. It is preferable that the wire is constituted by a wire and a handle that is installed in the operation device and pulls the rod-operating wire.
[0023]
【Example】
Preferred embodiments of the knot forming device of the present invention will be described below in detail with reference to the accompanying drawings. FIG. 1 is an overall side view of a first embodiment of the knot forming device of the present invention. In this figure, the tip of the operating rod 3 is shown rotating about 90 ° with respect to the operating device 4.
[0024]
A knot forming device 1 according to a first embodiment of the present invention is inserted through an abdominal wall and inserted into a trocar tube (not shown) as a communication tube that communicates with the outside of the abdominal cavity, which is a part of a body cavity. , An operating rod 3 that moves the tip into the body cavity, and an operating device 4 for remotely operating the operating rod 3 from outside the body.
[0025]
The operating rod 3 has a substantially straight portion 31 and a variable bending portion 32 that are substantially straight. The base portion of the substantially straight portion 31 is rotatably connected to the main body 40 of the operating device 4, and a large diameter portion 311 is provided on the outer peripheral portion of the base end portion, and the outer peripheral surface thereof is the main body 40. Protrudes on both sides.
[0026]
The operating rod 3 can be rotated by pinching the large-diameter portion 311 with a hand and rotating it. As shown in FIG. 2, an insertion passage 30 is formed in the substantially linear portion 31 along the axial direction.
[0027]
As shown in FIG. 3, wires 51, 52, and 53, respectively, are inserted into the operation rod 3 in order to adjust the bending state of the variable bending portion 32 described later. Further, a wire 54 for operating the cutting means is inserted below the operation rod 3. Examples of the constituent material of the wire include a reinforcing yarn and a metal wire, but it is preferable to use a reinforcing yarn because the variable bending portion 32 can be easily bent without increasing its rigidity.
[0028]
On the other hand, the variable bending portion 32 is connected to the tip of the substantially straight portion 31. As shown in FIG. 2, the variable bending portion 32 includes a tubular body 33 that is a plurality of unit members, and an annular coupling member 34 that couples the tubular bodies 33. The tubular body 33 has an insertion hole 331 penetrating in the axial direction, and both end portions 332 are spherical. The connecting member 34 is located between the tube bodies 33 and is fitted on the outside of the end portions 332 of the two tube bodies 33 in a state where the end portions 332 of the tube bodies are abutted. The inner peripheral surfaces of both end portions 340 of the tubular connecting member 34 are spherical concave surfaces so that the spherical outer peripheral surfaces of the end portions 332 of the tubular body 33 can be fitted.
[0029]
In the case of the present embodiment, the tip of the substantially straight portion 31 is a connection port 312 with the variable bending portion 32. The connection port 312 is formed with a portion having a spherical concave surface into which the end portion 332 of the tube body 33 can swingably fit. The tube body 33 located at the base end of the variable bending portion 32 is formed there. The end portion 332 is fitted.
[0030]
The tubular body 33 can swing in any direction while sliding the spherical surface formed on the end portion 332 with respect to the connecting member 34. That is, since the connecting member 34 and the tube body 33 are in spherical contact, there is no particular limitation on the swinging direction of the tube body 33 with respect to the connecting member 34.
[0031]
Therefore, the variable bending portion 32 is bent substantially between the tubular bodies 33 in the connecting member 34 that forms a spherical joint by abutting the tubular body 33, so that the shape of the variable bending portion 32 itself is a substantially continuous curved shape as a whole. Can be. And it becomes possible to make arbitrary curved shapes in arbitrary directions.
[0032]
In addition, a flexible covering material 35 is sheathed on the outer periphery of the connecting member 34. Further, a lubricant such as silicone or grease may be applied to the outer surface of the wire or the inside of the covering material 35 so that the wire can move easily.
[0033]
A part of the insertion passage 30 is constituted by the insertion hole 331 of each tube 33 and the lumen of each connecting member 34. The distal end of the insertion passage 30, that is, the distal end of the variable bending portion 32 is an opening 301 that opens to the distal end of the operating rod 3.
[0034]
With the configuration as described above, the shape of the variable bending portion 32 can be changed between a substantially linear substantially straight state and a curved state curved into an arbitrary shape.
[0035]
Further, as shown in FIG. 3, the tips of the wires 51 and 52 are fixed to the tip portions at positions facing each other in the cross section (in this embodiment, left and right positions in front view of the cross section). Has been. The wires 51 and 52 are respectively wound around the outer peripheral surface of each connecting member 34 of the variable bending portion 32, inserted inside the covering material 35, and crossed near the base end portion of the variable bending portion 32. In the plane, it reaches a position opposite to the position of the tip, and further passes through the substantially straight portion 31 in parallel with the axis.
Although not shown in the drawing, a wire guiding groove for inserting each wire and smoothly moving the wire may be provided on the outer peripheral surface of the connecting member 34.
[0036]
Moreover, the wire 53 is fixed to the upper part in the cross sectional front view, and passes through the variable bending portion 32 as it is along the axis. The fixing position in the axial direction of the distal end of the wire 53 is a position that is close to the proximal end portion from the center of the variable bending portion 32.
[0037]
The shape of the variable bending portion 32 is manipulated by pulling the wires 51, 52, 53 arranged as described above. When the wire 51 or 52 is pulled, the variable bending portion 32 is bent in the direction of the pulled wire and becomes an α shape. At this time, since the wires 51 and 52 are inserted through the operation rod 3 in a state of being wound around the connecting member 34 of the variable bending portion 32, the variable bending portion 32 bends in a spiral shape to form a single loop. Form.
[0038]
Further, a cutting means for cutting the yarn is provided at the tip of the variable bending portion 32. The cutting means includes a bar 36 shown in FIG. 4 and a handle 37 for operating the bar 36 shown in FIG.
[0039]
The blades 361 and 362 constituting the flange 36 may have a shape that matches the cross-sectional shape of the variable bending portion 32, that is, a shape that curves outwardly. The tips of the wires 54 are connected to the opposite sides of the blades 361 and 362 around the fulcrum 363 of the flange 36, respectively.
[0040]
The distal end of the wire 54 is bifurcated, and each branched distal end is connected to the proximal end of the flange 36, that is, the opposite end of each of the blades 361 and 362. Such branched wires 54 are bundled together in the vicinity of the flange 36. Therefore, when the wire 54 is pulled, the branched wire pulls the proximal end portion of the flange 36 in the direction in which the flange 36 is closed. Further, when the wire 54 is slack, the flange 36 is biased in a direction in which the blades 361 and 362 are opened by a biasing member (not shown) such as a spring.
[0041]
The outer diameter of the operation rod 3 configured as described above may be a thickness that can be inserted into the trocar tube, and is, for example, about 3 to 5 mm. In laparoscopic surgery, the total length of the operating rod 3 is preferably about 350 to 400 mm, but this preferred length is slightly different depending on the site to be operated, the patient's physique, age, and the like.
[0042]
Moreover, the length of the variable bending part 32 is good in it being about 30-50 mm. If it is too short, the size of the loop to be formed becomes small, and it becomes difficult to form a knot through the thread through the loop. On the other hand, if the length is too long, a space in which the tip of the operating rod 3 moves to form a loop must be widened, which makes it difficult to operate in a narrow space inside the body.
[0043]
The operating device 4 includes a mechanism for pulling the wires 51, 52, 53, and 54, tension means for holding the thread that has been inserted through the insertion passage 30, and allowing the thread to maintain a tension state at all times. Further, suction means for taking the yarn into the insertion passage 30 is connected.
[0044]
The main body 40 of the operating device 4 has a fixed grip portion 41 at the lower portion, and a movable grip portion 42 is swingably attached to the vicinity of the base end portion of the fixed grip portion 41. A winding gear 43 is pivotally supported in the vicinity of the attachment position of the movable gripping portion 42 at the base end portion of the gripping portion 41. A winding shaft (not shown) for winding the wire 54 is integrated with the winding gear 43. By rotating the winding gear 43 by a handle operation described later, the wire 54 is wound, and the wire Pull 54 to activate the cutting means.
[0045]
On the other hand, a slit 421 is formed in the movable grip portion 42 in the vertical direction, and a pin 411 is fitted in the slit 421. The pin 411 is erected on the main body 40 and serves as a fulcrum for swinging the movable gripping portion 42.
[0046]
The movable gripper 42 swings around the pin 411, and the swing center can be changed by moving the movable gripper 42 and changing the position of the pin 411 with respect to the slit 421.
[0047]
In the movable gripping part 42, a curved contact surface 420 is formed on the side surface facing the winding gear 43 along the peripheral surface of the winding gear 43. Teeth 422 and 423 that mesh with the winding gear 43 are provided. The fixed grip portion 41, the movable grip portion 42 and the take-up gear 43 constitute handle means 37 for pulling the rod actuating wire 54.
Next, the handle operation by the handle means 37 will be described.
[0048]
When the movable gripper 42 is slid downward, the pin 411 is positioned above the slit 421, and the movable gripper 42 is swung in a direction in which the fixed gripper 41 and the movable gripper 42 are opened, the teeth 422 and the winding are wound. The take gear 43 meshes. Next, by further moving the movable gripping portion 42 in the direction in which the fixed gripping portion 41 and the movable gripping portion 42 are opened, the winding gear 43 is rotated counterclockwise in the figure by the teeth 422 and the wire 54 is loosened. By this operation, the collar 36 provided at the tip of the operation collar 3 is opened.
[0049]
Conversely, when closing the collar 36 and cutting the thread, the movable gripping portion 42 is first slid upward, the pin 411 is positioned below the slit 421, and the gripping portion 41 and the movable gripping portion 42 are moved. When the movable gripping portion 42 is swung in the closing direction, the teeth 423 and the winding gear 43 are engaged with each other. Next, by further moving the movable gripping portion 42 in the direction in which the fixed gripping portion 41 and the movable gripping portion 42 are closed, the winding gear 43 is rotated in the clockwise direction in the drawing by the teeth 423, and the wire 54 is wound around the winding gear 43. Can be rolled up. As a result, the wire 54 is pulled and the hook 36 is closed, and the thread inserted through the insertion passage 30 is cut.
[0050]
According to this operation part 37, there exists an advantage that a thread | yarn can be cut | disconnected with the operation feeling similar to a common heel.
[0051]
On the other hand, the main body 40 is provided with a passage 44 having one end connected to the insertion passage 30 of the connected operating rod 3. The other end of the passage 44 is opened at the rear part of the main body 40, and a suction nozzle 45 of a suction device (not shown) is connected to the opening as a yarn suction means.
When the suction device is operated and sucked from the suction nozzle 45, a negative pressure is generated in the passage 44 and the insertion passage 30, and the yarn is sucked from the opening 301 at the tip of the operating rod and introduced into the insertion passage 30 and the passage 44.
In addition to the device that is operated by a drive source such as a motor, the suction device is composed of, for example, a rubber balloon or bellows and a check valve, and manually sucks air by contracting the balloon or bellows. It may be.
[0052]
In the passage 44, a winding mechanism 6 as a tension means is provided between the suction nozzle 45 and the proximal end portion of the insertion passage 30 of the operating rod 3. FIG. 6 is a cross-sectional side view illustrating a configuration example of the winding mechanism 6.
[0053]
As shown in FIG. 6, the winding mechanism 6 is fitted at a position that closes the passage 44 and is rotatably attached to the main body 40, and is rotatable at the tip of the winding shaft 61. The rotary knob 62 attached to the rotary knob 62, the rotary knob 62, and the winding shaft 61, which is interposed between the rotary knob 62 and the main body 40, are attached in a predetermined rotational direction. A spring 63 that is an urging member to be urged, a connection member 64 that is connected so that the rotary knob 62 can rotate integrally with the take-up shaft 61, and a rotary knob 62 that does not rotate by the urging force of the spring 63. And a locking member 65 that locks to.
[0054]
The winding shaft 61 is formed with a hole 611 having substantially the same diameter as that of the passage 44. By rotating the winding shaft 61, the passage 44 and the hole 611 are connected (suckable state) and not connected. It is possible to switch to (a state where suction is not possible). The yarn suction operation may be performed by directly operating the suction device. The suction device is a general facility installed in a medical institution such as a normal hospital, and is versatile in that the suction means can be used as the thread introduction means in any hospital.
[0055]
A hole 612 having a substantially regular hexagonal cross-sectional shape is formed at the tip of the winding shaft 61 protruding outside the main body 40, and a rotary knob 62 is rotatably covered thereon. It has been.
[0056]
A regular hexagonal hole 621 that is substantially the same as the hole 612 is formed at the center of the rotary knob 62, and a connection member 64 is removably fitted into the hole 621 and the hole 612. The connecting member 64 has a rod-like portion 641 having substantially the same cross-sectional shape as that of the hole 621 and the hole 612, that is, the cross-section is substantially a regular hexagon, and has a knob 642 at one end thereof. By inserting the connecting member 64 into the hole 621 and the hole 612 at the same time, the rotary knob 62 and the winding shaft 61 rotate as a unit. In order to release the integral rotation of the rotary knob 62 and the winding shaft 61 so that the rotary knob 62 can freely rotate with respect to the winding shaft 61, as shown by a two-dot chain line in FIG. In addition, the connection member 64 is pulled out to the extent that the rod-like portion 641 comes out of the hole 612 by picking the knob of the connection member 64.
[0057]
One end of the spring 63 externally mounted on the winding shaft 61 is locked to the main body 40, and the other end is locked to the rotary knob 62. For this reason, when the rotary knob 62 is picked and rotated, an urging force by the spring 63 is generated in the direction opposite to the rotation direction. In this state, when the connecting member 64 is pushed in and the rotary knob 62 and the winding shaft 61 are connected, the winding shaft 61 is rotated by the urging force of the spring 63 and the yarn can be wound. Further, as shown in FIG. 7, recesses 623 are formed at equal intervals along the outer peripheral edge on the bottom of the rotary knob 62, and grooves formed in the axial direction are formed on the outer peripheral surface of the rotary knob 62. 622 is engraved in the circumferential direction at equal intervals.
[0058]
A lock member 65 is erected in the vicinity of the take-up shaft 61. The lock member 65 has an engaging portion 651 that engages with the groove 622 of the rotary knob 62 formed at the upper end portion, and an arm portion 652 that is bent into an L shape at the base end portion. The bending point of the lock member 65 is a shaft support portion 653 and is supported by the main body 40 so as to be swingable. One end of an urging member 654 inserted between the arm portion 652 and the main body 40 is in contact with the distal end portion of the arm portion 652, and urges the arm portion 652 upward. As a result, the engaging portion 651 is constantly biased in a direction to engage with the groove 622 of the rotary knob 62. When the engaging portion 651 is engaged with the groove 622 of the rotary knob 62, the rotation of the rotary knob 62 is restricted.
[0059]
In order to unlock the rotation of the rotary knob 62 by the lock member 65, the distal end portion of the arm portion 652 is pushed toward the main body 40. As a result, the lock member 65 swings, the engaging portion 651 is removed from the groove 622, and the rotation lock of the rotary knob 62 is released.
[0060]
On the other hand, a leaf spring 66 is fixed to the winding shaft 61 on the opposite side of the position where the lock member 65 is provided. As shown in FIG. 8, the leaf spring 66 is formed at a fixed end 661 for fixing to the main body 40, a hole 662 through which the take-up shaft 61 is inserted, and an end opposite to the fixed end 661. And a convex portion 663. Due to the elastic force of the leaf spring 66, the convex portion 663 contacts the concave portion 623 formed on the bottom surface of the rotary knob 62. The plate spring 66, the convex portion 663, and the concave portion 623 constitute a rotation relaxation means that reduces the rotation of the winding shaft 61 due to the urging force of the spring 63.
[0061]
When the rotary knob 62 is rotated, the convex portion 623 of the leaf spring 66 is sequentially engaged with the concave portion 623 of the rotary knob 62. When the rotary knob 62 and the take-up shaft 61 are rotated by the urging force of the spring 63, the take-up shaft 61 is accelerated at a high speed by the engagement operation of the convex portion 663 and the concave portion 623 by the leaf spring 66. The winding operation can be performed gently without rotating.
[0062]
When winding the yarn 2, the yarn 2 is drawn into the hole 611 of the winding shaft 61 by the suction means which is the yarn introducing means, and the winding shaft 61 is rotated in this state. As a result, the yarn 2 is wound around the winding shaft 61 while being positioned in the hole 611 and is held so as not to fall out of the insertion passage 30.
[0063]
Next, the bending operation mechanism 7 that operates the variable bending portion 32 of the operation rod 3 will be described.
As shown in FIGS. 1 and 3, a take-up reel 71 and a pulling reel 72 are pivotally supported by the main body 40 in the vicinity of the connection portion to which the operation rod 3 of the main body 40 is connected. It is provided so as to be rotatable.
[0064]
A wire 53 is wound around the take-up reel 71, and the variable bending portion 32 can be bent upward by winding the wire 53 and pulling the wire 53. In order to rotate the take-up reel 71, the side surface of the reel is rubbed with a finger and fed.
[0065]
The take-up reel 71 is not limited to a reel, and any mechanism that pulls the wire 53 may be used. For example, the variable bending portion 32 can be bent by operating a lever or simply pulling the wire by hand.
[0066]
The wires 51 and 52 are wound around the tension reel 72 in opposite directions. Therefore, when the pulling reel 72 is rotated in a certain direction, one of the wires 51 and 52 is pulled and the other is loosened. When the variable bending portion 32 is bent by pulling one wire, the other wire is It does not interfere with the bending operation.
[0067]
When the take-up reel 71 is rotated, the wire 53 is pulled, and the loop formed by the variable bending portion 32 is inclined with respect to the substantially straight portion 31 of the operating rod 3 by the action of the pulling reel 72. Thus, by making the loop inclined, the thread can be easily passed through the loop.
[0068]
An example of a knot forming method using the knot forming device 1 of the present invention configured as described above will be described with reference to FIGS. 9 and 10. A plurality of communication tubes called trocar tubes that allow communication between the abdominal cavity and the outside of the body are installed on the abdominal wall, and two knot forming devices 1 are used.
For example, after a living tissue is sutured by a suture device inserted through a tolocal tube, a knot is formed as follows for the two threads 2a and 2b coming out of the tissue. The yarns 2a and 2b may be two different yarns or both ends of one connected yarn.
[0069]
A knot forming instrument is inserted from a different trocar tube with the variable bending portion 32 of each operation rod 3a, 3b straightened. As described above, the rotary knob 62 and the connection member 64 are moved to operate the winding mechanism 6, and one side 2a of the medical thread 2 already passed through the living tissue is sucked using the suction means. Then, it is sucked from the tip of the operating rod 3a of one knot forming device 1a and wound up to such an extent that it is securely held by the winding mechanism 6. After winding, the lock member 65 locks the rotation of the winding mechanism 6 to hold the yarn 2a.
[0070]
The tension reel 72 in the knot forming device 1a is rotated in a predetermined direction, and the variable bending portion 32 is bent to form an α-shaped loop. Next, when the take-up reel 71 is rotated and the wire 53 is taken up, the formed loop is set to be inclined with respect to the substantially linear portion 31.
[0071]
While the tip of the other knot forming device 1b is in a substantially straight state, as shown in FIG. 1, the inside of the loop of the variable bending portion 32 formed in the α shape is passed. In this state, the other thread 2b is taken in by the suction means from the tip of the substantially linear operating rod 3b and is securely held by the winding mechanism 6.
[0072]
When the operating rod 3b inserted through the loop of the variable bending portion 32 is extracted, the thread 2b is inserted through the loop as shown in FIG. 9A. When the thread 2b is moved to the outside of the loop so as to bypass the tip of the curved variable bending portion 32 as shown in FIG. 9B, the thread 2b is removed from the operation rod 3a as shown in FIG. 9C. As shown in FIG. 9D, the yarn 2b crosses the yarn 2a exposed from the tip opening, and the first knot 21 is formed by entwining the yarn 2a. This operation may be performed by moving (moving or rotating) the operation rod 3a, that is, the operation rod on the side forming the loop.
[0073]
Next, the knot forming device 1a and / or the tensioning means of the knot forming device 1b are operated in order to bring the tied yarn into close contact with the living tissue. That is, for example, in both the knot forming devices 1 a and 1 b, after the tips are returned to the substantially straight state, the rotation restriction of the rotary knob 62 by the lock member 65 is released, and the winding shaft 61 is moved by the urging force of the spring 63. Rotate. Thereby, the yarns 2a and 2b are gradually wound up. Then, as the threads 2a and 2b are drawn into the tips of the operation rods 3a and 3b, the operation rods 3a and 3b are pushed toward the living tissue, and the first knot 21 is pressed against the tissue at the tips. It becomes possible to make a knot that is in close contact with the living tissue.
[0074]
In a ligation process in a surgical operation or the like, it is preferable to form the second knot 22 in the reverse direction in order to make it difficult to loosen the knot. In this case, first, the locks by the lock members 65 are released, and the operating rods 3a and 3b are moved backward while rotating the winding shafts 61 of the knot forming devices 1a and 1b in the direction opposite to the winding direction. Then, the wound yarns 2a and 2b are loosened to such an extent that a knot can be formed.
[0075]
Next, the winding shaft 61 of the knot forming device 1b is further reversely rotated to bring the yarn 2b drawn into the operating rod 3b into a free state as shown in FIG. To discharge the thread 2b from the operation rod 3b.
[0076]
Next, a loop opposite to the direction in which the first knot 21 is formed is formed by the operating rod 3a of the knot forming device 1a, and the tip of the operating rod 3b is inserted into this loop. The spouted yarn 2b is drawn into the tip of the operation rod 3b again by using a suction means, and the operation rod 3b is retracted and extracted from the loop to obtain the state shown in FIG. 10A. At this time, the yarns 2a and 2b are securely held by the winding mechanism 6 in both the knot forming devices 1a and 1b. Thereafter, the same operation as described above is performed to form the second knot 22 as shown in FIGS. 10B to 10D, and this is further brought into close contact with the living tissue in the same manner as described above.
[0077]
When the threads 2a and 2b are tied in this way, the movable gripping portions 42 of both the knot forming devices 1a and 1b are respectively operated, the winding gear 43 is rotated, the wire 54 is pulled, and the rod 36 is operated. The yarns 2a and 2b are cut.
[0078]
The knots of the second eye are formed by a method in which the yarn 2a is once discharged from the operation rod 3a and sucked again, or a method in which the yarns 2a and 2b are once discharged from both the operation rods 3a and 3b and then sucked again. May be performed. On the contrary, a knot may be formed by forming a loop at the tip of the operating rod 3b and inserting the operating rod 3a through the loop.
According to the operation as described above, the suture and ligation processes can be easily and quickly performed in the body cavity, and the thread is automatically wound. Therefore, when the instruments 1a and 1b are operated with the left and right hands, respectively. There will be no inconvenience of running out of hands. Further, since treatment can be performed with a thread instead of a staple, a ligation or anastomosis can be performed safely and reliably.
[0079]
Next, a second embodiment of the knot forming device of the present invention will be described. FIG. 11 is an overall side view of the knot forming device of the second embodiment of the present invention. In this figure, the tip of the operating rod 3 is shown rotated by 180 ° with respect to the operating device 4. Hereinafter, in the description of the second embodiment, the same members as those in the first embodiment are denoted by the same reference numerals, and the description of the same configuration is omitted.
[0080]
The knot forming device 1 'of the second embodiment of the present invention is inserted through the abdominal wall and inserted into a trocar tube (not shown) as a communication tube that communicates with the outside of the abdominal cavity, which is an example of a body cavity, An operating rod 3 for causing the distal end portion to enter the body cavity and an operating device 4 for operating the operating rod 3 remotely from outside the body are provided.
[0081]
The operating rod 3 has a substantially straight portion 31 and a variable bending portion 32 similar to those described above.
As shown in FIG. 12, the tip of the substantially straight portion 31 is a connection port 312 with the variable bending portion 32, and a spherical shape into which the end portion 332 of the tubular body 33 can slidably fit. A concave surface is formed, and an end portion 332 of the tubular body 33 located at the base end of the variable bending portion 32 is fitted therein. As shown in FIG. 13, the variable bending portion 32 is configured to be bent by the same structure as described above.
[0082]
As shown in FIG. 14, lower guide portions 342 and upper guide portions 343 that guide the wires 54 are alternately provided on the connecting member 34 of the variable bending portion 32. The lower guide portion 342 has a hole formed in the base portion in the axial direction of the connecting member 34, and the wire 54 is inserted into the hole. Further, a groove is formed in the upper portion of the upper guide portion 343 in the axial direction of the connecting member 34, and the wire 54 is inserted into the groove.
[0083]
As shown in FIG. 14, in the operation rod 3, the same wires 51, 52, respectively as described above provided for adjusting the bending state of the variable bending portion 32 and operating the cutting means, respectively. 53, 54, 55, 56, 57 are inserted.
[0084]
14 and 15 show the arrangement of the wires 51, 52, 53, 54, 55, and 56. FIG. The wires 51, 52, 53, and 54 are wires for bending the variable bending portion 32 into a spiral (coiled) loop, and the wire 55 is a loop of the variable bending portion 32 that forms a helical loop. The wire 56 is a wire for performing an operation of changing the direction, and the wire 56 is a wire for returning the curved variable bending portion 32 to the original state. Hereinafter, the installation positions of the respective wires will be described.
[0085]
The distal end of the wire 54 is fixed to the fixed portion 341 a at the distal end of the variable bending portion 32, and alternately passes through the lower guide portion 342 and the upper guide portion 343 of the connected connecting member 34, along the axis of the operation rod 3. The rear end is wound around a take-up reel 71 provided in the main body 40 of the operating device 4. When the wire 54 passes through the lower guide portion 342 and the upper guide portion 343, the wire 54 is refracted in order up and down as shown in FIG. The lower guide portion 342 and the upper guide portion 343 can increase the curvature of the variable bending portion 32 when bent.
[0086]
When the wire 54 is wound and pulled by the take-up reel 71, the variable bending portion 32 is bent in the same plane, and when it is further pulled, it is bent in a spiral shape (in this embodiment, two and a half turns).
[0087]
On the other hand, the distal end of the wire 51 is fixed to a fixing portion 341b provided on the peripheral surface of the connecting member 34 located at the most distal end, and is provided along the peripheral surface so as to wrap around the variable bending portion 32. The rear end is wound around a reel 72 a provided in the main body 40 of the operating device 4. In the case of the present embodiment, the length of the variable bending portion 32 around which the wire 51 is wound is about one third of the length of the variable bending portion 32, and the winding angle is about 180 °, in other words, From the position at which the tip of the wire 51 is fixed to the position on the opposite side in the cross sectional view of the variable bending portion 32. The wire 51 that has been wound is disposed parallel to the axis of the variable bending portion 32 and the substantially straight portion 31.
[0088]
By pulling the wire 51, the variable bending portion 32 is twisted, and by combining with the action of the wire 54, a spiral loop (one turn of the coil) located at the most distal end of the operating rod 3 is formed.
[0089]
Similarly, the wire 52 is provided in the same manner as the wire 51. That is, the tip of the wire 52 is fixed to the fixing portion 341c provided on the peripheral surface of the connecting member 34 at the position where the winding of the wire 51 is finished, and is wound along the peripheral surface so as to wind around the variable bending portion 32. The rear end is wound around a reel 72 b provided in the main body 40 of the operating device 4.
[0090]
Further, the wire 53 is provided in the same manner as the wire 51. That is, the tip of the wire 53 is fixed to the fixing portion 341d provided on the peripheral surface of the connecting member 34 at the position where the winding of the wire 52 is finished, and is wound along the peripheral surface so as to be wound around the variable bending portion 32. The rear end is wound around a reel 72 c provided in the main body 40 of the operating device 4.
[0091]
By operating the wires 51, 52, and 53, the variable bending portion 32 is twisted, and the spiral loop formed by the wire 54 can be deformed into a spiral shape (coil shape).
[0092]
The distal end of the wire 55 is fixed to a fixing portion 341e provided on the peripheral surface of the connecting member 34 at a position where the winding of the wire 53 is finished, and passes through an upper guide portion 343 provided on the base end side thereof, It is provided along the axis of the operation rod 3. The rear end of the wire 55 is wound around a reel 72 d provided on the main body 40 of the operating device 4.
[0093]
By operating this wire 55, as shown in FIG. 1, the spiral loop formed by the variable bending portion 32 is bent at the proximal end portion so that the distal end faces the operating device 4 side. Can be processed easily.
[0094]
The distal end of the wire 56 is fixed to the fixing portion 341 f of the distal end portion of the variable bending portion 32. The fixing portion 341f is located at a position facing the fixing portion 341b of the wire 51 with respect to the axis in the cross-sectional view of the operation rod 3. The wire 56 is wound over almost the entire length of the variable bending portion 32 in the opposite direction to the wires 51, 52, 53, and the winding angle is about 180 °. By pulling the wire 56, the variable bending portion 32 having a loop can be returned to the original substantially straight state. And if it pulls further, the reverse single loop can be formed.
[0095]
The knot forming device 1 ′ is provided with the same cutting means as described above for cutting the yarn. This cutting means has the same hook 36 shown in FIG. 6 provided at the tip of the variable bending portion 32 and an operation part 37 for operating the hook 36. In the same manner as described above, this cutting means is operated by winding the winding shaft 43 (not shown) of the winding gear 43 by operating the movable gripping portion 42 in the operating portion 37 and pulling the wire 57 to operate the hook. , Cut the yarn.
[0096]
The preferable outer diameter and overall length of the operation rod 3 configured as described above are the same as described above. Moreover, the length of the variable bending part 32 is good in it being about 30-100 mm. If it is too short, the size of the loop to be formed becomes small, and it becomes difficult to form a knot through the thread through the loop. On the other hand, if the length is too long, a space in which the tip of the operating rod 3 moves to form a loop must be widened, which makes it difficult to operate in a narrow space inside the body.
[0097]
The operating device 4 has a mechanism for pulling the wires 51, 52, 53, 54, 55, 56, and 57, tension means and suction means similar to those described above. The mechanism shown in FIGS. 6, 7 and 8 is similarly applied to the knot forming device of the second embodiment.
[0098]
Next, the bending operation mechanism 7 that operates the variable bending portion 32 of the operation rod 3 will be described.
As shown in FIGS. 11 and 14, in the vicinity of the connection portion of the main body 40 to which the operation rod 3 is connected, a take-up reel 71 similar to the above that winds the wire 54, a tension reel 72, Is pivotally supported by the main body 40 and is rotatably provided.
[0099]
By winding and pulling the wire 54 by the take-up reel 71, the variable bending portion 32 can be bent upward.
[0100]
The pulling reel 72 has reels 72a, 72b, 72c, 72d around which the wires 51, 52, 53, 55 are wound, respectively, and the wires 51, 52, 53, 55 are wound in the same direction. The wire 56 is wound around the reel 72 a around which the wire 51 is wound in the direction opposite to the wire 51.
[0101]
Accordingly, when the pulling reel 72 is rotated integrally, for example, clockwise in FIG. 14, one wire 51, 52, 53, 55 is pulled and the other wire 56 is loosened, and the one wire 51, 52, 53 is pulled. , 55 to bend the variable bending portion 32, the wire 56 is not stretched and does not interfere with the bending operation. The four reels 72a, 72b, 72c, 72d constituting the pulling reel 72 may have different diameters according to the pulling amount of each wire.
[0102]
Further, when the take-up reel 71 is rotated, the wire 54 is pulled, and by the action of the pulling reel 72, the tip of the spiral loop formed by the variable bending portion 32 faces toward the operating device 4, and the inside of the loop Make it easier to thread the thread.
[0103]
An example of a knot forming method using the knot forming device 1 ′ of the present invention configured as described above will be described with reference to FIGS. A plurality of communication tubes called trocar tubes that allow communication between the abdominal cavity and the outside of the body are installed on the abdominal wall, and two knot forming devices 1 'are used.
[0104]
For example, after a living tissue is sutured by a suture device inserted through a tolocal tube, a knot is formed as follows for the two threads 2a and 2b coming out of the tissue.
The knot forming device 1 ′ is inserted from the different trocar tubes in a state where the variable bending portions 32 of the operation rods 3a and 3b are straightened. As described above, the rotary knob 62 and the connecting member 64 are moved to operate the winding mechanism 6, and one knot 2a of the thread 2 already passed through the living tissue is attached to one knot using the suction means. The forming tool 1 ′ a is sucked from the tip of the operating rod 3 a and wound up to the extent that it is securely held by the winding mechanism 6. After winding, the rotation of the winding mechanism 6 is locked by the lock member 65.
[0105]
When the winding reel 71 in the knot forming device 1′a is rotated to wind the wire 54, the formed loop becomes a spiral shape formed in substantially the same plane.
[0106]
Next, when the tension reel 72 is rotated, the spiral loop is stretched in the direction of the vortex rotation axis to become a spiral shape (coil shape), and the base end portion of the variable bending portion 32 is curved. Thus, the tip is directed toward the operating device 4 (state shown in FIG. 11).
[0107]
While the tip of the other knot forming device 1b is in a substantially straight state, as shown in FIG. 11, the inside of the loop of the variable bending portion 32 formed in a spiral shape is passed. In this state, the other thread 2b is taken in by the suction means from the tip of the substantially linear operating rod 3b and is securely held by the winding mechanism 6.
[0108]
When the operating rod 3b inserted through the loop of the variable bending portion 32 is extracted, the thread 2b is inserted through the spiral loop as shown in FIG. 16A. When the yarn 2b is moved to the outside of the loop so as to bypass the tip of the curved variable bending portion 32 as shown in FIGS. 16B and 16C, as shown in FIGS. 16D and 17A, Similarly, when the yarns 2a and 2b intersect to form a single knot, and further bypass the tip of the variable bending portion 32 (FIG. 17B), the yarn 2b is removed from the loop, A double knot is formed (FIG. 17C).
[0109]
In this way, the first knot 21 'in which the threads 2a and 2b are twisted a plurality of times is formed. This operation is performed by moving the operating rod 3a, that is, the operating rod on the side forming the loop. You may go.
[0110]
Next, in order to bring the tied yarn into close contact with the living tissue, the tensioning means of the knot forming device 1′a and / or the knot forming device 1′b is operated. That is, for example, in both the knot forming devices 1 ′ a and 1 ′ b, after the tips are returned to a substantially straight state, the rotation restriction of the rotary knob 62 by the lock member 65 is released, and the winding force is applied by the spring 63. The taking shaft 61 is rotated. Thereby, the yarns 2a and 2b are gradually wound up. Then, as the threads 2a and 2b are drawn into the tips of the operating rods 3a and 3b, the operating rods 3a and 3b are pushed toward the living tissue, and the first knot 21 'is pressed against the tissue at the tip. Thus, it is possible to reliably make a knot that is in close contact with the living tissue.
[0111]
Further, for the same reason as described above, it is necessary to form the reverse second knot 22.
In this case, firstly, the locks by both the lock members 65 are released, and the operation rods 3a, 3b, while rotating both the winding shafts 61 of the both knot forming devices 1'a, 1'b in the direction opposite to the winding direction. 3b is retracted, and the wound yarns 2a and 2b are loosened to such an extent that a knot can be formed.
Next, the winding shaft 61 of the knot forming device 1b is further rotated in the reverse direction to bring the yarn 2b drawn into the operation rod 3b into a free state as shown in FIG. 6, and the yarn 2b is operated in the same manner as described above. Exhale from inside the tub 3b.
Next, the pulling reel 72 is rotated in the opposite direction, and the variable bending portion 32 of the operation rod 3a of the knot forming device 1'a is bent in the opposite direction by the wire 56 to form a single or more loop. Then, the tip of the operating rod 3b is inserted into this loop. The spouted yarn 2b is drawn into the tip of the operation rod 3b again by using a suction means, and the operation rod 3b is retracted and extracted from the loop to obtain the state shown in FIG. 18A. At this time, the yarns 2a and 2b are securely held by the winding mechanism 6 in both the knot forming devices 1'a and 1'b. Thereafter, the same operation as described above is performed to form the second knot 22 as shown in FIGS. 18B to 18D, and this is further brought into close contact with the living tissue in the same manner as described above.
[0112]
When the yarns 2a and 2b are tied in this way, the movable gripping portions 42 of the two knot forming devices 1'a and 1'b are respectively operated, the winding gear 43 is rotated, and the wire 57 is pulled. 36 is operated to cut the yarns 2a and 2b.
[0113]
The second knot is formed by a method in which the yarn 2a is once discharged from the operation rod 3a and sucked again, or a method in which the yarns 2a and 2b are once discharged from both the operation rods 3a and 3b and sucked again. May be. On the contrary, a knot may be formed by forming a loop at the tip of the operating rod 3b and inserting the operating rod 3a through the loop.
According to the above operation, the suture and ligation processes can be easily and quickly performed in the body cavity, and the thread is automatically wound, so that the instruments 1'a and 1'b can be operated with the left and right hands, respectively. There is no inconvenience that you run out of hands when you are. In addition, because the treatment can be performed with a thread instead of a staple, it is safe and secure, and a double or triple or more knot can be easily made with a single operation, making it stronger and more reliable. Ligation and anastomosis can be performed.
[0114]
Note that triple and quadruple knots can be formed by increasing the number of spirally formed loops, and a stronger knot can be formed. In particular, if each reel 72a, 72b, 72c, 72d constituting the tension reel 72 is configured to rotate independently, an arbitrary wire can be operated, and the number of spirals formed by the variable bending portion 32 can be reduced. You can choose between single, double, and triple. In this way, a plurality of types of knots can be made with a single knot forming device.
In addition, the second knot can be doubled or tripled by increasing the number of wires for manipulating the bending of the variable bending portion 32.
[0115]
Next, a third embodiment of the knot forming device of the present invention will be described. 19, 20 and 21 are partial perspective views of a knot forming device according to a third embodiment of the present invention. Hereinafter, in describing the third embodiment, the same reference numerals are used for the same members as in the first embodiment, and the description of the same configurations is omitted.
[0116]
The knot forming device 8 according to the third embodiment of the present invention has two operation rods 3a and 3b having the same configuration as described above, and an operation device (not shown) for remotely operating the operation rods 3a and 3b from outside the body. ing. In this case, the operating device has two sets of the handle means 37, the winding mechanism 6, the bending operation mechanism 7 and the suction means similar to those described above, the bending operation of the variable bending portion 32, and the suction operation of the yarns 2a and 2b. A winding operation, a tension operation, a cutting operation, and the like can be performed independently for each of the operation rods 3a and 3b.
[0117]
A bundling tube 9 is installed in the vicinity of the distal end of the operating device, and in the bundling tube 9, the base end portions of the operating rods 3a and 3b are accommodated so that the operating rods 3a and 3b can move in the axial direction. Has been. That is, the operating rods 3a and 3b are inserted into the bundling tube 9 and bundled, and the whole bundling tube 9 is inserted into the trocar tube and guided into the body cavity.
In the operation rods 3a and 3b of the knot forming device 8, the structure of the substantially straight portion 31 and the variable bending portion 32, the arrangement of the wires, and the like are the same as in the first embodiment.
[0118]
An example of a knot forming method using the knot forming device 8 of the present invention configured as described above will be described with reference to FIGS. A plurality of communication tubes called trocar tubes that allow communication between the abdominal cavity and the outside of the body are installed on the abdominal wall, and the operation rods 3a and 3b of the knot forming device 8 of the present invention are inserted into the substantially straight state together with the tube 8 from one of them. To do.
For example, after a living tissue is sutured by a suture device inserted through a tolocal tube, a knot is formed as follows for the two threads 2a and 2b coming out of the tissue.
[0119]
As described above, the winding mechanism 6 is operated, and as shown in FIG. 19, one end 2a of the thread 2 already passed through the living tissue is removed by using the suction means. Is taken up to the extent that it is securely held by the take-up mechanism 6, and its rotation is locked.
[0120]
As shown in FIG. 20, the variable bending portion 32 of the operating rod 3a is bent by operating the tension reel to form an α-shaped loop, and then the winding reel is operated to make the loop a substantially straight portion. Tilt to 31.
[0121]
While the variable bending portion 32 of the other operation rod 3b is kept in a substantially straight state, as shown in FIG. 21, the inside of the loop of the variable bending portion 32 formed in the α shape is passed. In this state, the other thread 2b is taken in by the suction means from the tip of the substantially linear operating rod 3b and is securely held by the winding mechanism 6. At this time, the tip of the operating rod 3b is retracted to the position extracted from the loop.
Thereafter, the first knot and the second knot are formed by the yarns 2a and 2b in the same manner as in the first embodiment.
[0122]
According to such a knot forming device 8, the operating rods 3 a and 3 b are bundled by the binding tube 9 and combined into one device, so that it is easy to handle, and only one trocar tube is used. Therefore, there is an advantage that the number of trocar tubes is reduced and the burden on the patient is reduced.
[0123]
As another application example of the knot forming device 8, at least one of the operation rods 3a and 3b is configured such that the variable bending portion 32 as in the second embodiment described above forms a spiral (coiled) loop. Are listed.
Further, one of the operation rods 3a and 3b may not have the variable bending portion 32, that is, may be in a substantially linear state in which the tip portion is not bent.
[0124]
Next, a fourth embodiment of the knot forming device of the present invention will be described. 22 to 29 are partial perspective views showing a knot forming process by the knot forming device according to the fourth embodiment of the present invention. Hereinafter, in describing the fourth embodiment, the same members as those in the third embodiment are denoted by the same reference numerals, and the description of the same configuration is omitted.
[0125]
The knot forming device 10 of the fourth embodiment of the present invention includes an operating rod 3c, 3d, an operating device (not shown) for remotely operating the operating rod 3c, 3d from outside the body, and a bundling tube 9 similar to the above. Yes.
In the binding tube 9, the base end portions of the operation rods 3c and 3d are accommodated so as to be movable in the axial direction. That is, the operating rods 3c and 3d are inserted into the bundling tube 9 and bundled, and the bundling tube 9 is inserted into the trocar tube and guided into the body cavity.
[0126]
The operating rod 3c includes an outer tube 38 made of a hard material and an inner tube 39 inserted into the outer tube 38. The distal end portion of the inner tube 39 has flexibility. A coil 391 for forming a curved state is wound around the outer periphery of the distal end portion of the inner tube 39. Due to the elastic force of the coil 391, as shown in FIGS. When in a natural state (a state in which no external force is applied), the variable bending portion 32 is bent into a desired loop shape. As shown in FIG. 22, when the inner tube 39 is moved relative to the outer tube 38 in the axial direction and the inner tube 39 is entirely inserted into the outer tube 38 up to the tip, the variable bending portion 32 is moved to the outer tube 38. The shape is restricted to be substantially linear.
[0127]
In addition, as a constituent material of the coil 391, for example, various metals such as stainless steel such as SUS304, SUS316, PH stainless steel (precipitation hardening stainless steel), superelastic alloy such as Ni-Ti alloy, polyamide, polyimide, polyethylene, Various resins such as polyarylate and polytetrafluoroethylene are exemplified.
[0128]
On the other hand, the operating rod 3d does not have the variable bending portion as described above, that is, is constituted by a substantially straight tube body in which the tip portion is not bent.
[0129]
The operating device installed on the base end side of the operating rods 3c, 3d has two sets of the winding mechanism 6, the suction means, etc., similar to those described above. A suction operation, a winding operation, a tension operation, and the like can be performed independently for each of the operation rods 3c and 3d. Furthermore, the operating device includes a bending operation mechanism that performs a bending operation of the variable bending portion 32 of the operating rod 3c. In this case, the bending operation mechanism in the knot forming device 10 moves the inner tube 39 relative to the outer tube 38 in the axial direction instead of the reels 71 and 72 as the plurality of wires and the pulling means thereof, This is a mechanism that allows the bending portion 32 of the inner tube 39 to be housed in the lumen of the outer tube 38 or to protrude from the tip of the outer tube 38.
[0130]
An example of a knot forming method using the knot forming device 10 of the present invention configured as described above will be described with reference to FIGS.
The operation rods 3c and 3d of the knot forming device 10 of the present invention are inserted together with the bundling tube 9 from one of a plurality of trocar tubes installed on the abdominal wall. At this time, the variable bending portion 32 of the operating rod 3c is housed in the outer tube 38, and the operating rod 3c is set in a substantially linear state.
[0131]
For example, after a living tissue is sutured by a suture device inserted through a trocar tube, knots are formed on the threads 2a and 2b coming out of the tissue as follows.
As shown in FIG. 22, one thread 2a passed through the living tissue is sucked from the tip of one operating rod 3c using suction means, and the winding mechanism 6 is operated as described above. Then, the thread 2a is wound up to the extent that it is securely held, and its rotation is locked.
[0132]
As shown in FIG. 23, the outer tube 38 of the operating rod 3 c is retracted to the proximal end side so that the variable bending portion 32 protrudes from the distal end of the outer tube 38. Thereby, the variable bending portion 32 is bent to form an α-shaped loop.
As shown in FIG. 24, the other operation rod 3d is moved forward to pass the inside of the loop of the variable bending portion 32 formed in the α shape. In this state, the other thread 2b is taken in by the suction means from the tip of the operating rod 3d and is securely held by the winding mechanism 6. At this time, the tip of the operating rod 3d is retracted to the position where it is removed from the loop.
[0133]
As shown in FIG. 25, the inner tube 39 of the operating rod 3c is retracted to the proximal end side, and the variable bending portion 32 is accommodated in the outer tube 38. Thereby, the thread | yarn 2a is wound around the thread | yarn 2b, and the 1st knot 21 is formed. If necessary, the winding mechanism 6 is actuated as described above to tension the yarn 2a, and the operating rod 3c is advanced toward the living tissue to form a tight knot that is in close contact with the living tissue.
After releasing the lock of the winding mechanism 6 and loosening the yarns 2a and 2b, as shown in FIG. 26, the yarn 2b is discharged from the operation rod 3d in the same manner as described above. As shown in FIG. 4, the inner tube 39 of the operating rod 3c is advanced to the distal end side so that the variable bending portion 32 protrudes from the distal end of the outer tube 38, and the variable bending portion 32 is formed in a loop shape.
[0134]
As shown in FIG. 28, the operating rod 3 d is advanced to pass inside the loop of the variable bending portion 32. In this state, the thread 2b is taken in by the suction means from the tip of the operating rod 3d and is securely held by the winding mechanism 6.
As shown in FIG. 29, the inner tube 39 of the operating rod 3c is retracted to the proximal end side, and the variable bending portion 32 is accommodated in the outer tube 38. Thereby, the thread | yarn 2a is wound around the thread | yarn 2b, and the 2nd knot 22 is formed. As described above, the winding mechanism 6 is actuated to tension the yarns 2a and 2b, and the operating rods 3c and 3d are advanced toward the living tissue to form a tight knot in close contact with the living tissue.
[0135]
According to such a knot forming device 10, in addition to the same advantages as the knot forming device 8, for the operation rod 3 c, a wire for bending the variable bending portion 32, a reel for pulling them, and the like are provided. The operation rod 3d does not need to have the variable bending portion 32. Therefore, the operation rods 3c and 3d can be further reduced in diameter, and the bending operation of the variable bending portion 32 is extremely simple. Since the portion 32 is always curved into a predetermined shape, there is an advantage of excellent reproducibility. In addition, as another application example of the knot forming device 10, the operation rod 3 c may be configured such that the variable bending portion 32 as in the second embodiment described above forms a spiral (coiled) loop. .
[0136]
Next, a fifth embodiment of the knot forming device of the present invention will be described. 30 to 33 are partial perspective views of a knot forming device according to a fifth embodiment of the present invention. Hereinafter, in describing the fifth embodiment, the same members as those in the fourth embodiment are denoted by the same reference numerals, and the description of the same configuration is omitted.
[0137]
The knot forming device 11 of the fifth embodiment of the present invention has an operating rod 3c, 3d ′, an operating device (not shown) for remotely operating the operating rod 3c, 3d ′ from outside the body, and a bundling tube 9 similar to the above. doing.
[0138]
The operation rod 3d ′ has the same configuration as the operation rod 3c. In this case, the variable bending portion 32 of the operating rod 3c and the variable bending portion 32 of the operating rod 3d ′ are configured to form loops in opposite directions.
[0139]
The operating device installed on the base end side of the operating rods 3c and 3d ′ has two sets of the winding mechanism 6, the suction means, the bending operating mechanism and the like similar to the above, respectively, The bending operation of the variable bending portion 32, the suction operation of the yarns 2a and 2b, the winding operation, the tension operation, and the like can be performed independently on the operation rods 3c and 3d.
[0140]
An example of a knot forming method using the knot forming device 11 of the present invention configured as described above will be described with reference to FIGS.
The operating rods 3c and 3d 'of the knot forming device 11 of the present invention are inserted together with the tube body 8 from one of a plurality of trocar tubes installed on the abdominal wall. At this time, both the variable bending portions 32 of the operation rods 3c and 3d ′ are accommodated in the outer tube 38, respectively, and both the operation rods 3c and 3d ′ are set in a substantially linear state.
[0141]
For example, after a biological tissue is sutured by a suture device inserted through a trocar tube, the first knot 21 is formed on the threads 2a and 2b coming out of the tissue in the same manner as in the fourth embodiment.
Next, after releasing the lock of the winding mechanism 6 and loosening the yarns 2a and 2b, the yarn 2a is discharged from the operation rod 3c in the same manner as described above, as shown in FIG. Further, the operation rod 3c is in a state in which the variable bending portion 32 is housed in the outer tube 38, the operation rod 3d ′ is in a state in which the variable bending portion 32 is projected from the tip of the outer tube 38, and the variable bending portion 32 of the operation rod 3d ′. To form an α-shaped loop opposite to the above.
[0142]
As shown in FIG. 32, the operating rod 3 c is advanced to pass inside the loop of the variable bending portion 32. In this state, the thread 2a is taken in by the suction means from the tip of the operating rod 3c and is securely held by the winding mechanism 6.
The inner tube 39 of the operating rod 3d ′ is retracted to the proximal end side, and the variable bending portion 32 is accommodated in the outer tube 38. Thereby, as shown in FIG. 33, the yarn 2b is wound around the yarn 2a, and the second knot 22 is formed. As described above, the winding mechanism 6 is actuated to tension the yarns 2a and 2b, and the operating rods 3c and 3d are advanced toward the living tissue to form a tight knot in close contact with the living tissue.
[0143]
Next, another example of the knot forming method using the knot forming device 11 of the present invention will be described with reference to FIGS. 34, 35, 32, and 33. FIG.
The operating rods 3c and 3d 'of the knot forming device 11 of the present invention are inserted together with the bundling tube 9 from one of a plurality of trocar tubes installed on the abdominal wall. At this time, both the variable bending portions 32 of the operation rods 3c and 3d ′ are accommodated in the outer tube 38, respectively, and both the operation rods 3c and 3d ′ are set in a substantially linear state.
[0144]
For example, after a living tissue is sutured by a suture device inserted through a trocar tube, knots are formed on the threads 2a and 2b coming out of the tissue as follows.
One thread 2b passed through the living tissue is sucked from the tip of one operating rod 3d ′ using suction means, and is securely held by the winding mechanism 6 as described above.
[0145]
Next, the inner tube 39 of the operating rod 3d ′ is advanced to the distal end side so that the variable bending portion 32 protrudes from the distal end of the outer tube 38, and an α-shaped loop is formed in the variable bending portion 32. Further, as shown in FIG. 34, the other operation rod 3c is advanced to pass inside the loop of the variable bending portion 32 formed in the α shape.
As shown in FIG. 35, the inner tube 39 of the operating rod 3c is advanced to the tip side so that the variable bending portion 32 protrudes from the tip of the outer tube 38, and the variable bending portion 32 surrounds the thread 2b. Form a loop. Thereafter, the thread 2a is sucked from the tip of the operating rod 3c using suction means, and securely held by the winding mechanism 6 as described above.
[0146]
The inner tube 39 of the operating rod 3c is retracted to the proximal end side to accommodate the variable bending portion 32 in the outer tube 38, and the operating rod 3c is slightly retracted to the proximal end side. Thereby, as shown in FIG. 32, the yarn 2a is wound around the yarn 2b, and the first knot 21 is formed.
From the state shown in FIG. 32, the operating rod 3c is further retracted to the proximal end side, the distal end thereof is extracted from the loop of the variable bending portion 32, and the inner tube 39 of the operating rod 3d ′ is retracted toward the proximal end side. Thus, the variable bending portion 32 is accommodated in the outer tube 38. Thereby, as shown in FIG. 33, the yarn 2b is wound around the yarn 2a, and the second knot 22 is formed. Thereafter, in the same manner as described above, a hard knot closely attached to the living tissue is formed.
[0147]
According to such a method, the first knot 21 and the second knot 22 can be formed without discharging the yarns 2a and 2b introduced into the insertion passages of the operation rods 3c and 3d ′. Is simpler and the treatment time is further reduced.
As another application example of the knot forming device 11, at least one of the operation rods 3c and 3d ′ is used, and the variable bending portion 32 as in the second embodiment described above is formed in a spiral (coiled) loop. The thing made into the structure to form is mentioned.
[0148]
Prior to forming the knot according to each of the above embodiments, the knot forming device of the present invention holds the first thread and / or the second thread into the body cavity, and the transferred thread, for example, a needle or forceps After a suture or ligation is performed on a living tissue using a suturing device or a ligature device, a knot may be formed in the same manner as described above.
In addition to the structure of each of the embodiments described above, the yarn introducing means is not limited to the suction means as described above. For example, a plurality of paired drawing rollers are continuously arranged in the operation rod 3, Can be continuously driven to sequentially take in the yarn.
[0149]
In addition, a guide wire having a hook or the like is inserted into the insertion path 30 from the operation device 4 side so that the guide wire protrudes from the front end of the operation rod 3 and hooked with the guide wire. You may use the method of taking in.
[0150]
The curved shape of the variable bending portion 32 does not need to form a complete loop as in the α shape, and what is necessary is that a space is formed so that the tip of the operation rod 3 of the other knot forming device 1 can be inserted. It may be a simple shape. For example, a knot can be made even in a semicircular shape.
[0151]
Moreover, you may change each length of the some connected pipe body 33 which comprises the variable bending part 32. FIG.
[0152]
When bending the variable bending portion by pulling a predetermined wire, the curvature on the proximal end side tends to increase and the distal end side tends to decrease, but the length of the tube 33 is changed so that the distal end side becomes shorter If it does, it will become easy to curve the front end side, and it becomes possible to form a uniform spiral loop by pulling the wire.
[0153]
In addition to the configuration described above, the variable bending portion 32 may have another structure, for example, a node ring as a unit member. A node ring is a ring having a connecting shaft in a diameter direction perpendicular to each other, and a variable bending portion is formed by connecting a plurality of node rings through the connecting shaft.
[0154]
Further, the bending direction of the variable bending portion 32 may be only one of the upward direction, the downward direction, the left direction, and the right direction, or the vertical direction, the left and right direction, the upward direction and the right direction, and the upward direction and the left direction. May be any two directions such as a direction, a downward direction and a right direction, and a downward direction and a left direction. Further, it may be three directions as in this embodiment, or may be four directions, up, down, left, and right directions.
[0155]
In particular, in the case of each of the above embodiments, since the tubular body is connected by a spherical joint, it is not limited to the above bending direction, and can be bent in any direction other than the above four directions. Therefore, it is possible to rotate the tube alone around the center of the tube, which is a preferable structure for forming a loop in a spiral shape.
Further, the variable bending portion 32 that is bent as desired by the wire operation may be configured to automatically return to the original substantially linear state. Specifically, for example, the variable bending portion 32 is urged by, for example, an elastic body installed along the axial direction, and maintains the basic posture shown in FIG. 3, FIG. When pulling the wire, it may be configured to bend in a loop shape as described above, and return to the basic posture by the action of the elastic body when the tension of those wires is removed.
[0156]
Moreover, in the said Example, although the holding means and the tension means were comprised by the same winding mechanism 6, this invention is not limited to this. However, if configured as in the present embodiment, the yarn can be held and tensioned by the same mechanism, so that the apparatus can be simplified and can be easily tensioned while holding the yarn. it can.
[0157]
【The invention's effect】
As described above, the present invention is a knot forming device for forming a knot of a thread, and the knot forming device is inserted into a communication tube that allows communication between the inside of a body cavity and the outside of the body. An insertion passage formed in the distal end portion of the operating rod, thread introduction means for introducing a yarn into the insertion passage from the opening, and a proximal end portion of the operating rod; And a variable bending portion that can change between a substantially linear state and a bent state in at least one direction by the operation of the operating device. Since it is configured, it is possible to easily and reliably perform thread knots for anastomosis, suturing and ligation in the body cavity.
[0158]
Further, when the variable bending portion is bent so as to form a single loop or a double or more loop, the knot of the yarn can be surely formed by a simple operation. In particular, when the variable bending portion bends so as to form a double or more loop, it is possible to perform stitching, ligation, etc. with a stronger knot, and the number of operations is reduced, and the processing can be speeded up. This reduces the burden on the patient.
[0159]
In addition, the operating device has at least one wire whose tip is fixed at a position decentered from the axial center in the variable bending portion, and a bending operation mechanism that operates the variable bending portion by pulling the wire to the proximal end side. When the wire is spirally wound around the variable bending portion from the position where the tip is fixed toward the bending operation mechanism, the loop of the variable bending portion is reliably formed. can do.
[0160]
The knot forming device is a pair of operation rods inserted into a communication tube that allows communication between the body cavity and the outside of the body, and an operation device that is connected to the base end portion of these operation rods and operates each operation rod from outside the body. A bundling member for bundling the base end portions of both operation rods, and at least one tip portion of both operation rods is bent in a substantially straight state and at least in one direction by the operation of the operation device. If it is a variable bending part that can change to a state, particularly a looped state, it is easy to handle and the number of communication tubes used for knot formation is reduced. To reduce the burden.
[0161]
In the case where the operating rod has a variable bending portion that is provided in a natural state and is bent to a target shape in a natural state, and a regulating member that restricts the shape of the variable bending portion to a substantially linear shape It does not require a wire for bending the variable bending portion or a reel for pulling the variable bending portion, the structure is simple, the diameter of the operation rod can be further reduced, and the bending operation of the variable bending portion is extremely This is simple, and the variable bending portion 32 always bends to a predetermined shape, so that the reproducibility is excellent.
[0162]
In addition, when a suction means is used as the thread introduction means, it is possible to quickly introduce the thread into the insertion path without damaging the living tissue, reducing the time and effort of the operation. Can be planned.
[0163]
Further, by providing the yarn holding means, the yarn can be tied easily and reliably without performing an operation of holding the yarn so that it does not fall off by hand.
[0164]
Further, by providing a thread tension means, it is possible to easily form a strong knot without performing an operation of pulling the thread with a hand or the like, and to ensure that the knot is in close contact with the living tissue. it can.
[0165]
Furthermore, when a thread cutting means is provided, it is not necessary to use a separate instrument for cutting the thread, and it is not necessary to search for a thread cutting portion with such a cutting instrument. Can be performed quickly.
[Brief description of the drawings]
FIG. 1 is an overall side view of a first embodiment of a knot forming device according to the present invention, and shows a state in which a loop is formed at the tip.
FIG. 2 is a cross-sectional side view of the variable bending portion showing the internal structure of the variable bending portion.
FIG. 3 is a cross-sectional plan view of an operating rod showing a wire insertion state.
FIG. 4 is a perspective view showing the configuration of the cutting means, and is an internal perspective view showing the attachment position and structure of the scissors.
FIG. 5 is a partial side view of the operating device body, showing the structure of the operating portion of the cutting means.
FIG. 6 is a cross-sectional side view of a winding mechanism.
FIG. 7 is a bottom view of a rotary knob in the winding mechanism.
FIG. 8 is a plan view of a leaf spring in the winding mechanism.
FIGS. 9A to 9D are enlarged perspective views of the distal end portion of the operating rod showing a procedure for forming a knot using the knot forming device of the first embodiment. FIGS.
FIGS. 10A to 10D are enlarged perspective views of the distal end portion of the operating rod showing a second procedure in the case of forming a tight knot using the knot forming device of the first embodiment. FIGS.
FIG. 11 is an overall side view of a second embodiment of the knot forming device of the present invention, and shows a state in which a spiral loop is formed at the tip.
FIG. 12 is a partial cross-sectional side view of the operating rod showing the structure of the straight portion of the operating rod.
FIG. 13 is a cross-sectional side view of the variable bending portion showing the internal structure of the variable bending portion.
FIG. 14 is an internal perspective plan view of an operating rod showing a wire insertion state.
FIG. 15 is an internal perspective partial perspective view of a variable bending portion showing a wire insertion state;
FIGS. 16A to 16D are enlarged perspective views of a distal end portion of an operating rod showing a procedure for forming a knot using the knot forming device of the second embodiment. FIGS.
FIGS. 17A to 17C are enlarged perspective views of the distal end portion of the operating rod showing a procedure for forming a knot using the knot forming device of the second embodiment. FIGS.
18A to 18D are enlarged perspective views of the distal end portion of the operating rod showing a second procedure in the case of forming a tight knot using the knot forming device of the second embodiment.
FIG. 19 is a partial perspective view of a third embodiment of the knot forming device of the present invention, showing a configuration when both operating rods are in a straight line state.
FIG. 20 is a partial perspective view showing a state in which a knot is formed using the knot forming device of the third embodiment.
FIG. 21 is a partial perspective view showing a state in which a knot is formed using the knot forming device of the third embodiment.
FIG. 22 is a partial perspective view of a fourth embodiment of the knot forming device of the present invention, showing a configuration when both operating rods are in a straight line state.
FIG. 23 is a partial perspective view showing a state in which the first knot is formed using the knot forming device of the fourth embodiment.
FIG. 24 is a partial perspective view showing a state in which the first knot is formed using the knot forming device of the fourth embodiment.
FIG. 25 is a partial perspective view showing a state in which the first knot is formed using the knot forming device of the fourth embodiment.
FIG. 26 is a partial perspective view showing a state in which the second knot is formed using the knot forming device of the fourth embodiment.
FIG. 27 is a partial perspective view showing a state in which a second knot is formed using the knot forming device of the fourth embodiment.
FIG. 28 is a partial perspective view showing a state in which a second knot is formed using the knot forming device of the fourth embodiment.
FIG. 29 is a partial perspective view showing a state in which a second knot is formed using the knot forming device of the fourth embodiment.
FIG. 30 is a partial perspective view of a fifth embodiment of the knot forming device of the present invention.
FIG. 31 is a partial perspective view showing a state in which a second knot is formed using the knot forming device of the fifth embodiment.
FIG. 32 is a partial perspective view showing a state in which the second knot is formed using the knot forming device of the fifth embodiment.
FIG. 33 is a partial perspective view showing a state in which a second knot is formed using the knot forming device of the fifth embodiment.
FIG. 34 is a partial perspective view showing a state in which a knot is formed using the knot forming device of the fifth embodiment.
FIG. 35 is a partial perspective view showing a state in which a knot is formed using the knot forming device of the fifth embodiment.
[Explanation of symbols]
1, 8, 10, 11 Knot forming device
2 Yarn
3 Operation
30 passage
301 opening
30 passage
31 Substantially straight section
311 Large diameter part
32 Variable bending part
33 Tube
331 insertion hole
332 end
34 Connecting members
35 Coating material
36 鋏
361 blade
362 blades
363 fulcrum
37 Operation unit
38 Outer pipe
39 Inner pipe
391 Coil
4 operating devices
40 body
41 gripping part
411 pin
42 Movable gripping part
420 Contact surface
421 slit
422 teeth
423 teeth
43 Winding gear
44 passage
45 Suction nozzle
51-57 wire
6 Winding mechanism
61 Winding shaft
611 hole
612 holes
62 Rotating knob
621 hole
622 groove
623 recess
63 Spring
64 connecting members
641 Rod-shaped part
642 Picking part
65 Locking member
651 engaging part
652 Arm part
653 Shaft support
654 Energizing means
66 leaf spring
661 fixed end
662 hole
663 Convex
7 Bending operation mechanism
71 Take-up reel
72 Tensile reel
9 Bundling tube

Claims (11)

A knot forming device for forming a knot of a thread,
An operating rod inserted into a communication tube that allows communication between the body cavity and the outside of the body,
An insertion passage formed in the operating rod and having an opening at the tip of the operating rod;
Thread introduction means for introducing a thread into the insertion path from the opening;
An operating device connected to the base end of the operating rod and operating the operating rod from outside the body;
The knot-forming instrument is characterized in that the distal end portion of the operating rod forms a variable bending portion that can be changed into a substantially linear state and a bent state in at least one direction by operation of the operating device. A knot forming device for forming a knot of a thread,
A pair of operating rods inserted into a communication tube that allows communication between the body cavity and the outside of the body;
An insertion passage formed in each of the operating rods and having an opening at the tip of the operating rod;
Thread introduction means for introducing a thread into each insertion path from each opening;
An operating device connected to the base end of each operating rod and operating each operating rod from outside the body;
A bundling member for bundling the base ends of the two operating rods;
The tip of at least one of the operating rods constitutes a variable bending portion that can be changed between a substantially straight state and a state bent in at least one direction by operation of the operating device. A knot forming device. The operating device includes at least one wire having a distal end fixed at a position decentered from an axis in the variable bending portion, and a bending operation mechanism that operates the variable bending portion by pulling the wire toward a proximal end side. The knot according to claim 1, wherein the knot is provided so as to be spirally wound around the variable bending portion from the position where the tip is fixed toward the bending operation mechanism. Forming tool. A knot forming device for forming a knot of a thread,
An operating rod inserted into a communication tube that allows communication between the body cavity and the outside of the body,
An insertion passage formed in the operating rod and having an opening at the tip of the operating rod;
Thread introduction means for introducing a thread into the insertion path from the opening;
An operating device connected to the base end of the operating rod and operating the operating rod from outside the body;
The operating rod includes a variable bending portion that is provided at a distal end of the operation rod and that is curved in a natural state to a target shape, and a restriction member that restricts the shape of the variable bending portion to a substantially linear shape. Instruments. The knot forming instrument according to any one of claims 1 to 4, wherein the variable bending portion is bent so as to form at least a single loop. The knot is formed by a first yarn introduced from the opening and passing through the insertion passage, and a second yarn passing through the loop formed in the variable bending portion. The knot forming device according to any one of the above. The variable bending portion includes a plurality of unit members having thread insertion holes and a connecting member that swingably connects adjacent unit members, and the adjacent unit members are bent and connected by the connecting member. Accordingly, the knot forming device according to any one of claims 1 to 6, wherein the variable bending portion is configured to be bent as a whole. The knot forming device according to any one of claims 1 to 7, wherein the yarn introducing means is a suction means connected to a proximal end side of the insertion passage so as to communicate with the insertion passage. The knot forming device according to any one of claims 1 to 8, further comprising holding means for holding the yarn introduced into the insertion passage. The knot forming device according to any one of claims 1 to 9, further comprising tension means for maintaining a tension state of the yarn introduced into the insertion passage. The knot-forming instrument according to any one of claims 1 to 10, further comprising a cutting means that is provided in the operating rod and cuts a thread located in the insertion path.

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