JPH07194603A - Stitching tool - Google Patents

Abstract

PURPOSE:To achieve required stitching of tissues and make the frequency of putting in/out of a forceps when stitching up the lowest necessary, without increasing the number of forceps to be used by making knots surely and firmly through easy operation inside the abdominal cavity. CONSTITUTION:The tool has an outer cylinder 3 which retains a thread 4 for stitching of tissues and is detachable to the forceps 12. And on this outer cylinder 3, installed are a thread housing part to retain a loop formed in a part of the thread 4, and a notch 11 located in the thread housing part to fix the extension of the thread 4 extended from the loop. In this way, the tool can be inserted into a subject's body without breaking the loop for ligation previously made outside the body.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an instrument for suturing and ligating a biological tissue using a needle thread, and particularly in a body cavity,
The present invention relates to a suturing tool for suturing and ligating a biological tissue when performing a surgical operation under an endoscope.

[0002]

2. Description of the Related Art In recent years, a surgical operation is often performed while observing the inside of a body cavity with an endoscope. Thus, the movement of the body is limited while observing a flat image from the endoscope on a monitor. In an environment where a special tool has to be operated in the body cavity, it is very difficult to sew and ligate the thread. For this reason, many tools and methods for easily tightening the thread have been developed.

As a method currently practiced, a thread is inserted through a living tissue in a body cavity, both ends of the thread are taken out of the body, a knot is made outside the body, and the knot is exclusively used for sending the knot into the body. It is common to send it to the body again with the tool.

An example of a tool for tying threads in a similar method is described in US Pat. No. 5,144,961.
For this, one end of the thread with a needle (the end on the side away from the needle) is wound around a hollow rod, and a knot is formed on this hollow rod. Then, in the body cavity, insert only the thread and needle that are not wrapped around this rod, take out the thread outside the body after sewing, pass the thread through the inner hole of the hollow rod, and remove the knot from the rod. Then, the hollow rod is pushed forward to send a knot into the body cavity.

When the knot is tightened and ligated in the body in this way, two forceps for laparoscopic surgery are used to perform a male-female or male-female-male knot as in a normal operation. To do. Such ligation will be described further below.

On the other hand, a method for simplifying knotting is disclosed in US Pat. No. 5,234,445. This forms a loop and a knot in the middle of the needled thread, and the thread on the rear end side is passed through the hollow rod. In this case, the knot will not fit in this rod. Then, insert the rod into the body cavity, put the loop and needle thread attached to the tip into the body cavity, sew the tissue while holding the needle with another forceps, then pass the forceps through the loop and then the needle. Grab the side thread and pull the needle side thread through the loop while pushing the hollow bar to feed the knot. This tightens the lasso loops to form a knot.

In the method of ligating with two forceps in the body cavity, for example, the tool to be used is a forceps as shown in FIG. 6 for laparoscopic surgery. By operating two such forceps,
As described above, a man-woman, man-woman-man knot is performed as in a normal operation. As an example of the procedure at this time, first, one forceps is used to take one end of the thread and wind it around the other forceps. One forceps holding one end of the thread holds the other end of the thread while holding the other end of the thread while holding the other end of the thread with the other forceps wound with the thread. Here, one forceps is moved toward the tip of the other forceps, and the loop of the wound thread is brought over the other forceps and brought to the other end of the thread. A knot is created by pulling both forceps in opposite directions and tightening the loop of wrapped thread. Man
A woman or a man-woman-man knot is performed by reversing the winding direction and repeating the same two or three times. By the way, when a male-female knot is used, the knot is as shown in FIG. The knot obtained in this way is firm and strong, and the two forceps pull both ends of the thread in the opposite direction straight to the side centering on the knot, so that the thread can be securely tightened. Further, by performing in this way, it is easy to adjust the tightening degree.

[0008]

However, in these methods, when a knot is to be formed outside the body, both ends of the thread once guided into the body must be brought out of the body, and the forceps are often taken in and out, which is troublesome. Further, since both ends of the thread are to be taken out of the body, a very long thread is required, and when the thread is taken out of the body, the tissue penetrated by the thread may be rubbed with the thread for a longer time and damaged. A special tool for feeding the knot into the body is also required, and it may be difficult to tighten the knot tightly by this method of feeding the knot.

Furthermore, in the case of ligating in the body, in the case of using two forceps for laparoscopic surgery, the operation is performed under the special environment as described above, and therefore, a normal operation is performed. Such an operation is extremely difficult, especially the work of winding a thread around the forceps is difficult, and skill and skill are required. Also, in the case where a lasso-shaped loop is used to tie a thread at the other end to form a knot, the knot may be loosened. In addition, when attaching this to the tip of the rod and inserting it into the body cavity, in addition to requiring two forceps just by the ordinary sewing operation,
It may be necessary to make another hole on the body surface for inserting this rod.

According to the present invention, it is possible to sew a tissue sufficiently to make a tight knot and to heal by a simple operation in a body cavity, and at the time of suturing, the number of forceps is not increased and the forceps need to be taken in and out. The goal is to minimize.

[0011]

A suturing tool of the present invention that achieves the above object is provided with a thread holding member that holds a thread for body tissue suturing and is detachable from a surgical tool such as forceps. A loop holding part for holding a loop formed on a part of the yarn, and a thread fixing part arranged on the loop holding part for fixing an extension part of the yarn extending from the loop. .

[0012]

Operation: This suturing tool is used in combination with a surgical tool such as forceps. For the body tissue suture thread, a loop for ligation, for example, is formed in a part thereof in advance, the loop is held by the loop holding portion of the thread holding member, and the extension portion of the thread extending from the loop is fixed to the thread fixing portion. I'll do it. Then, a surgical tool such as forceps is passed through the space inside the loop, and the thread holding member holding the loop is arranged on the outer circumference of the surgical tool. The loop is put in place by sliding the thread-holding member into place on the surgical tool. This is inserted into a body cavity, a thread is passed through a desired body tissue, the loop is removed from the surgical tool, and the loop is ligated.

[0013]

1 to 3 are schematic views of a needle thread suturing device 1 according to a first embodiment of the present invention, which includes an inner cylinder 2 and an outer cylinder 3 as a thread holding member. The outer cylinder 3 as a thread holding member holds the thread 4 with a needle for suturing the body tissue.

The inner cylinder 2 has a tubular bobbin winding portion 5 accommodated in the outer cylinder 3, a fixing portion 6 for fixing the inner cylinder 2 by an interference fit on the inner wall of the outer cylinder 3, and an outer portion. The inner cylinder holding part 7 is not housed in the cylinder 3. The bobbin winding portion 5 is provided with a slight taper on the outer side, and the diameter increases from the bobbin winding portion 5 toward the fixed portion 6. The thread winding portion 5 is formed in a tubular shape as described above, but its inner diameter is formed larger than the diameter of forceps (hereinafter simply referred to as forceps) as a surgical tool used in combination with this. Further, the inner hole of the tubular portion does not penetrate the inner cylinder 2, but terminates in the middle of the inner cylinder 2.

The outer cylinder 3 is formed of a resin having a proper elasticity into a cylindrical shape, and the outer diameter of the outer cylinder 3 is such that it can be inserted into a trocar used in laparoscopic surgery or the like. Further, the outer cylinder 3 has a thread storage portion 8 as a loop holding portion that stores a loop of a thread to be described later, and a forceps fixing portion 9 that fixes the outer cylinder 3 to forceps. The inner diameter is sized to fit into the fixed portion 6 of the inner cylinder 2 and provide a loose interference fit. The length of the yarn accommodating portion 8 is formed to be substantially the same as the length of the fixing portion 6 of the inner cylinder 2 and the yarn winding portion 5.

The forceps fixing portion 9 has an inner hole communicating with the thread accommodating portion 8, but its inner diameter is formed smaller than that of the thread accommodating portion 8 and is provided on the outer circumference of the forceps used in combination therewith. It is dimensioned to fit tightly. The forceps fixing portion 9 is provided with grooves 10 at six positions spaced at equal intervals in the circumferential direction from the inner hole toward the outer circumference of the outer cylinder 3 so as to easily and surely engage the outer circumference of the forceps with an interference fit. There is. Further, in order to hold the end of the thread 4 on the needle 4a side and the other end, the thread storage portion 8 is provided with two notches 11 as thread fixing portions facing each other in the system direction. The needle-attached thread 4 is held at the end on the needle 4a side and the other end in the notch 11 of the outer cylinder 3, and the portion between them is wound around the thread winding portion 5 of the inner cylinder 2.

The basic winding method is as shown in FIG. 4, and the winding method is such that both ends of the thread 4 are aligned and passed through the ring R formed at that time. This winding method is similar to that shown in U.S. Pat. No. 3,580,256, and the longer end in FIG. 4 is passed through the loop L, and both ends are pulled to form a double ligature as shown in FIG. Becomes In this embodiment, both ends of the thread 4 are passed through the second wheel R.

Further, in the present embodiment, the thread winding portion 5 is passed through the loop L formed by passing both ends of the thread 4 through the ring R. At this time, the thread 4 is wound around the fixed portion 6 side of the thread winding portion 5 such that the end of the thread 4 on the needle 4a side and the other end side of the thread 4 around the opening side of the thread winding portion 5. The winding method is not limited to this method, and any winding method may be used as long as it forms a knot. When the inner cylinder 2, the outer cylinder 3, and the needle thread 4 are actually assembled, the thread 4 is wound around the inner cylinder 2 as shown in FIG.
The wound portion is inserted into the thread accommodating portion 8 of the outer cylinder 3, and the needle side end and the other end of the thread 4 are sandwiched and fixed in the notch 11 of the outer cylinder 3, and the inner cylinder 2 is fixed as shown in FIG. The part 6 is fixed in the outer cylinder 3 by an interference fit.

Next, with reference to FIGS. 6 to 13, a case of suturing a body tissue using the suturing tool 1 will be described. FIG. 6 shows a needle thread suturing tool 1 configured in this way.
A forceps 12 is shown as an example of a surgical tool that is attached and sutured. To attach the forceps 12 to the forceps 12, first, the tip of the forceps 12 is inserted into the inner cavity of the forceps fixing portion 9 of the outer cylinder 3 while holding the outer cylinder 3. The forceps 12 used at this time is preferably a needle holder for arthroscopic surgery (for example, as shown in FIG. 6). Since the forceps fixing portion 9 is formed to have a diameter smaller than that of the forceps 12, the outer cylinder 3 is fixed to the forceps 12 by an interference fit, but the outer cylinder 3 is made of resin and has elasticity and is fixed to the forceps. Part 9
Since the groove 10 is provided on the forceps 1, the forceps 1
It is possible to move forward and backward in the direction of the long axis of 2.

As shown in FIG. 7, when the forceps 12 inserted in the forceps fixing portion 9 is further advanced, the tip of the forceps 12 is
Enter the inner hole of the bobbin winding portion 5 of the inner cylinder 2. When the outer cylinder is pushed further while being held, the inner cylinder 2 is pushed by the forceps 12 inserted into the inner hole of the inner cylinder 2 as shown in FIG. It is removed from the cylinder 3 and pushed out. At this time, since the thread winding portion 5 of the inner cylinder 2 may be provided with a taper, the wound thread 4 remains in its original shape and is separated from the thread winding portion 5, and then the thread winding portion 5 is replaced. And is arranged so as to be wound around the inserted forceps 12. Here, the inner cylinder 2 is removed from the forceps 12. The outer cylinder 3 moves on the forceps 12 to an appropriate position. In this state,
Insert the forceps 12 into the body cavity through a trocar or the like.
Then, the needle 4a may be held by holding the needle 4a or by inserting another forceps 13, but the portion of the living tissue D to be sewn is sewn.

Thereafter, as shown in FIG. 9, the thread 4 coming out of the tissue on the side of the needle 4a is held by the forceps 12 to which the suturing tool 1 is attached, and the thread 4a from the outer cylinder 3 of the suturing tool 1 is removed. Edge 4
Forceps 1 in which z (one not on the needle side) is separately inserted into the body cavity
Take this with 3, remove the loop L from the outer cylinder 3, and forceps 12
Pull toward the tip of. As a result, as shown in FIG. 10, the loop L accommodated in the outer cylinder 3 is pulled and sent toward the tip of the forceps 12. At this time, the thread 4 on the side of the needle 4a is grasped at the tip of the forceps 12, and therefore, if the knot is further fed, as shown in FIG. 11, the inside of the loop of the knot (loop L) is moved to the side of the needle 4a. Thread 4 passes through. Here, the forceps 12 having the needle 4a side end of the thread 4 (with a suturing tool attached) and the forceps 13 holding the other end 4z are pulled, the tissue D is tightened as necessary, and the result is shown in FIG. Tighten the knot N so that The knot N formed at this time is a double-looping male-female knot as shown in FIG.

In this way, the suture / ligation work is completed,
The excess thread 4 is cut and collected outside the body together with the needle 4a, and the outer cylinder 3 attached to the forceps 12 is also removed. When sewing the second stitch, another suture tool 1 is taken and the above procedure is repeated.

In the suturing tool 1 having such a construction, the notch 1 provided at the tip of the outer cylinder 3 in the tip direction of the forceps 12.
Since the thread is held by 1, the thread does not shift when it is operated on the trocar, and it can be easily removed in the distal direction by another forceps 13. Since the inner tube 2 is provided, the loop L can be placed on the outer circumference of the forceps 12 without being broken, and because the inner tube 2 is provided, the thread 4 is wound around the inner tube 2 to assemble the suturing tool 1. If you insert it in 3, you can make it very easily. Since the loop L is covered with the outer cylinder 3,
There is no concern that the loop L will move, come off from the forceps 12, or be caught by something. Since the loop L is housed in the outer cylinder 3, it is easy to store. The knot N is a double looping male-female knot double ligature, so that a tight knot is formed. Since the two ends of the thread 4 are directly pulled in the opposite directions by using the two forceps 12 and 13, the knot N is tightened, so that the knot N can be tightly tied.

14 and 15 show a modified example of the first embodiment 1 described above, which differs from the first embodiment in the structure of the fixing means for fixing the outer cylinder 3 to the forceps 12. In this modification, a forceps fixing member 14 having a diameter smaller than that of the outer cylinder 3 is provided on the forceps fixing portion 9 at the rear end of the outer cylinder 3. The inner diameter of this portion is the same as or slightly larger than that of the forceps 12, and communicates with the inner hole of the thread accommodating portion 8 with this diameter as it is. Further, from the forceps fixing member 14 to the rear of the outer cylinder 3, it is divided into six in the axial direction. A fastening cylinder 15 having an inner diameter slightly smaller than that of the forceps fixing member 14 is prepared so as to be assembled with the forceps fixing member 14.

In the case of such a mechanism, when the suturing tool 1 is attached to the forceps 12, first, the forceps 12 is inserted into the tightening cylinder 15, and then the outer cylinder 3 as in the first embodiment.
The forceps 12 is inserted from the rear end. At this time, the outer cylinder 3 slides smoothly on the forceps 12, and the tightening cylinder 15 previously inserted at a desired position is fitted into the forceps fixing member 14 to fix the outer cylinder 3 to the forceps 12. FIG. 15 shows this state.
This makes the forceps 12 slide smoothly,
Since the suturing tool 1 can be easily attached and is securely fixed by the tightening cylinder 15, the outer cylinder 3 may be for some reason
There is no accidental displacement of its position.

16 to 18 show a suturing tool 20 according to a second embodiment. As shown in FIG. 16, the suturing tool 20 according to the second embodiment includes a hollow cylindrical thread winding member 23 as a thread holding member, and a thread accommodating section as a loop holding section provided on the outer peripheral portion thereof. 24, needle 4 at the tip
Hold the thread 4 with a. The bobbin wound member 23 has a tubular shape with a sufficiently thin thickness, and its inner hole is approximately the same as or slightly smaller than the outer diameter of the forceps used correspondingly.
Thread holding grooves 21 are formed in two rows above the tip of the tubular portion of the thread winding member 23 at an appropriate distance, and similarly, thread holding grooves 21 are also formed in the lower portion. In this embodiment, these thread holding grooves 21 and 21 form a thread fixing portion.

Although the yarn is wound around the yarn winding member 23 in the same manner as in the first embodiment, any winding manner may be used as long as the knot N can be formed. The end of the wound thread 4 on the needle 4a side is held by being passed through the thread holding groove 21 cut into two rows at the lower end of the tip of the thread holding member 23, and the opposite end 4z thereof is held at the upper side. It is passed through and held in the thread holding groove 21. Further, the thread holding member 23 is made of resin having an appropriate elasticity.

In the case of suturing using the suturing tool 20 having such a structure, first, as shown in FIG.
The forceps 12 is passed through the inner hole of the. The diameter of this inner hole is 1
It is the same as the diameter of 2 or slightly smaller,
Further, since the thread winding member 23 has an appropriate elasticity, it is fixed to the outer periphery of the forceps 12 to the extent that it can be moved with an appropriate amount of force. This is inserted into the body cavity via a trocar or the like.
At this time, since the yarn 4 wound around the yarn winding member 23 is held by the yarn holding groove 21 at both ends, the yarn 4 maintains its shape even in the body cavity. Then, another forceps 13 is used to perform suturing in the same manner as in the first embodiment.

In such a structure, the thread winding member 23
The wall thickness is thin, and therefore it is possible to insert it from a small diameter trocar. Further, since the loop L is attached to the forceps 12 together with the inner cylinder (thread winding member 23), the loop L can be arranged on the outer periphery of the forceps 12 without being collapsed.

FIG. 18 shows a modification of the second embodiment, which is different from the second embodiment in the method of holding the thread 4, and in this modification, the thread is strongly attached to the tip of the thread winding member 23. Adhesion is made with an adhesive 25 to such an extent that it is peeled off when pulled, and the thread fixing portion is formed by this adhesive.

In this way, it is easy because it can be removed by simply pulling the thread. Incidentally, instead of such an adhesive,
Both the thread 4 and the thread winding member 23, which are resin materials, are electrically charged,
The thread 4 can be held by the thread winding member 23 by static electricity. In this way, even if the ligature is once removed, it can be held again, and can be stopped again when the ligation is once stopped due to a failure or the like.

19 and 20 show a suturing tool 30 according to a third embodiment, which is especially for use with a trocar device.

The suturing tool 30 comprises a trocar outer tube 4
0 (FIG. 20), a thread winding portion 33 is provided at the tip of a trocar insertion tube 32, and a notch 31 as a thread fixing portion is formed at the tip of the thread winding portion 33 to fix the needle thread 4. . The trocar insertion tube 32 as the thread holding member is formed of one cylindrical elastic member, and an inner hole 35 having a constant diameter communicates with the inside thereof. The forceps 12 is provided in the inner hole 35.
The inner diameter of the inner hole 35 is substantially the same as or slightly larger than the outer diameter of the forceps 12, so that the forceps 12 can slide freely, and at the same time, the airtight state can be maintained. I am supposed to keep it. Reference numeral 34 is a locking portion for locking the trocar insertion tube 32 to the proximal portion 41 of the trocar outer tube 40.

Thread winding portion 3 at the tip of the trocar insertion tube 32
Although the thread 4 is wound around the thread 3, the thread winding portion 33
The winding method of the thread 4 is the same as that of the second embodiment,
The description is omitted.

The trocar insertion portion 36, which is disposed between the thread winding portion 33 and the locking portion 34 and is disposed inside the trocar outer tube 40, has a diameter larger than that of the thread winding portion 33, and thus the trocar outer tube 40. The loop L is prevented from shifting backward when it is inserted into the inside. The outer diameter of the trocar insertion portion 36 is substantially the same as or slightly smaller than the inner hole of the trocar outer tube 40 to be used. The length of the trocar insertion portion 36 is the trocar outer tube 40.
Although the length is longer to some extent, the entire length of the trocar insertion tube 32 is shorter than the length of the forceps 12 used. The trocar locking portion 34 is sufficiently larger than the inner diameter of the trocar outer sheath tube 40, and this portion is locked by the hand portion 41, and the trocar outer sheath tube 40 is
Does not enter inside.

In the suturing tool 30 having such a structure, first, the trocar insertion tube 32 is inserted into the trocar outer tube 40 inserted into the body wall P from the tip. At this time,
If the straight portion of the needle 4a and the thread 4 connected to the needle 4a is placed in the trocar insertion tube 32, it can be easily inserted into the trocar outer tube 40. Next, the forceps 12 to be used is attached to the trocar insertion tube 32.
It is inserted into the body cavity O through the inner hole 35 of the. At this time, the needle 4a and the thread 4 put in the inner hole 35 are pushed out by the forceps 12 and fed into the body cavity O. Another forceps is inserted, and the same operation as in the first and second embodiments is performed to perform suturing. This state is shown in FIG.

In the suturing tool 30 constructed as described above, since the suturing tool 30 is not directly attached to the tip of the forceps 12, the tip of the forceps 12 is light and therefore the operation is easy.

Therefore, according to the suturing tools of the first, second, and third embodiments, the loop L serving as the knot N can be formed outside the body in advance and can be guided into the body cavity. There is no need to make a loop using a surgical tool that is difficult to ligate in the body, and the operation to tie a knot in the body cavity is easy, and because the two forceps are ligated in the body cavity, the tightness is easy to understand, It is easy to adjust and can also tighten the knot. When the loop L is inserted into the body cavity, the thread is fixed to the thread holding member, so that the loop L does not come off from the forceps 12 even when the loop L is inserted into the body cavity through a trocar or the like. , Quick operation is possible.

Further, ligation does not require much, and once inserted into the body cavity, it is not necessary to take in and out the forceps 12 until the one-needle suture is completed, and the tip of the forceps 12 is sutured. It does not interfere with the tool, does not impair the function of the forceps 12, and can be used with any forceps 12 as long as it has a corresponding diameter, so the degree of freedom of operation is high.

Further, since the space through which the forceps 12 is inserted is held inside the loop L, the loop L can be easily attached to the forceps 12 by the loop L.
Can be placed around. In addition, since the loop L serving as the knot N is wound around the forceps 12 in advance and the knot N can be formed only by simple operations such as grasping, pulling, and pushing, there is no sufficient space for suturing in the body cavity, or the operation is performed. Even under difficult conditions, suturing is possible.

[0041]

As is apparent from the above, according to the present invention, since a loop to be a knot is formed outside the body in advance and the loop can be surely guided into the body cavity, a surgical instrument which is difficult to perform with a normal internal ligature is used. There is no need to make a loop by using it, and by a simple operation in the body cavity, the knot can be firmly and firmly knotted, and the tissue can be sutured enough to heal, while the number of forceps is not increased at the time of suturing. It is possible to minimize the loading and unloading of.

[Brief description of drawings]

FIG. 1 is a side sectional view of a suturing tool according to a first embodiment of the present invention.

2 is a partially exploded view of the suturing tool of FIG. 1. FIG.

3 is a perspective view of the suturing tool of FIG. 1. FIG.

FIG. 4 is an explanatory diagram of loops formed on the yarn used in the example of FIG.

5 is an illustration of a knot formed from the loop of FIG.

FIG. 6 is a schematic view of forceps to which the suturing tool of FIG. 1 is attached.

FIG. 7 is an explanatory view showing a state in which the suturing tool of FIG. 1 is attached to the distal end portion of the forceps.

8 is an explanatory view showing a state in which the inner cylinder is removed from the state of FIG. 7 and a thread is attached on the forceps.

FIG. 9 is an explanatory view showing a state in which the suturing tool is attached to the forceps and sutured.

FIG. 10 is an explanatory diagram when a loop is extracted from the forceps and ligated.

FIG. 11 is an explanatory diagram showing a state in which a knot is formed using a loop extracted from the forceps.

FIG. 12 is an explanatory diagram showing a state in which a thread is pulled and ligated.

FIG. 13 is an explanatory diagram of a knot for ligating body tissues.

FIG. 14 is a perspective view of a suturing tool according to a modification of the first embodiment.

15 is a schematic cross-sectional view of the suturing tool of FIG.

FIG. 16 is a perspective view of a suturing tool according to a second embodiment.

FIG. 17 is a perspective view of the suture tool of FIG. 16 attached to forceps.

FIG. 18 is a perspective view showing a part of the suturing tool according to a modification of the second embodiment.

FIG. 19 is a perspective view of a suturing tool according to a third embodiment.

FIG. 20 is an explanatory view showing a state of suturing using the suturing tool according to the third embodiment.

[Explanation of symbols]

1, 20, 30 ... Suturing tool, 2 ... Inner cylinder, 3 ... Outer sheath, 4 ...
Thread, 4a ... Needle, 5 ... Thread winding portion, 6 ... Fixing portion, 7 ... Gripping portion, 8, 24 ... Thread storage portion, 9 ... Forceps fixing portion, 10 ... Groove,
11, 21, 31 ... Notch, 12, 13 ... Forceps, 14
... forceps fixing member, 15 ... tightening cylinder, 23 ... thread tightening member,
25 ... Adhesive agent, 32 ... Trocar insertion tube, 33 ... Thread winding section, 34 ... Trocar locking section, 35 ... Inner hole, 40 ... Trocar outer tube, 41 ... Hand section, L ... Loop.

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[Procedure amendment]

[Submission date] August 11, 1994

[Procedure Amendment 1]

[Document name to be amended] Statement

[Correction target item name] 0016

[Correction method] Change

[Correction content]

The forceps fixing portion 9 has an inner hole communicating with the thread accommodating portion 8, but its inner diameter is formed smaller than that of the thread accommodating portion 8 and is provided on the outer circumference of the forceps used in combination therewith. It is dimensioned to fit tightly. The forceps fixing portion 9 is provided with grooves 10 at six positions spaced at equal intervals in the circumferential direction from the inner hole toward the outer circumference of the outer cylinder 3 so as to easily and surely engage the outer circumference of the forceps with an interference fit. There is. Further, in order to hold the end portion of the thread 4 on the needle 4a side and the other end, the thread storage portion 8 is provided with two notches 11 as thread fixing portions that are radially opposed to each other. The needle-attached thread 4 is held at the end on the needle 4a side and the other end in the notch 11 of the outer cylinder 3, and the portion between them is wound around the thread winding portion 5 of the inner cylinder 2.

[Procedure Amendment 2]

[Document name to be amended] Statement

[Name of item to be corrected] 0029

[Correction method] Change

[Correction content]

In such a structure, the thread winding member 23
Thickness of thin, therefore allows the insertion from Toraka Le small diameter. Further, since the loop L is attached to the forceps 12 together with the inner cylinder (thread winding member 23), the loop L can be arranged on the outer periphery of the forceps 12 without being collapsed.

[Procedure 3]

[Document name to be amended] Statement

[Correction target item name] 0033

[Correction method] Change

[Correction content]

The suturing tool 30 comprises a trocar outer tube 4
0 (FIG. 20), a thread winding portion 33 is provided at the tip of a trocar insertion tube 32, and a notch 31 as a thread fixing portion is formed at the tip of the thread winding portion 33 to fix the needle thread 4. . The trocar insertion tube 32 as the thread holding member is
It is formed of a cylindrical elastic member, and an inner hole 35 having a constant diameter communicates with the inside thereof. Although the forceps 12 is inserted into the inner hole 35, the diameter of the inner hole 35 is substantially the same as or slightly larger than the outer diameter of the forceps 12, and the forceps 12 can slide freely. At the same time, it is designed to keep airtight. Reference numeral 34 is a locking portion for locking the trocar insertion tube 32 to the proximal portion 41 of the trocar outer tube 40.

[Procedure amendment 4]

[Document name to be amended] Statement

[Name of item to be corrected] 0037

[Correction method] Change

[Correction content]

In the suturing tool 30 constructed as described above, since the suturing tool 30 is not directly attached to the tip of the forceps 12, the tip of the forceps 12 is light and therefore the operation is easy. Further, since the airtightness is maintained between the trocar, the suturing tool, and the forceps, it does not hinder the pneumoperitoneum operation.

[Procedure Amendment 5]

[Document name to be corrected] Drawing

[Name of item to be corrected] Figure 2

[Correction method] Change

[Correction content]

[Fig. 2]

[Procedure correction 6]

[Document name to be corrected] Drawing

[Name of item to be corrected] Figure 7

[Correction method] Change

[Correction content]

[Figure 7]

Claims (1)

[Claims] 1. A loop holding member for holding a body tissue suture thread and a thread holding member detachable from a surgical tool such as forceps, and holding a loop formed in a part of the thread on the thread holding member. A suturing tool, comprising: a portion; and a thread fixing portion that is arranged in the loop holding portion and fixes an extension portion of a thread extending from the loop.