JPH07328019A - Suturing tool - Google Patents

Abstract

PURPOSE:To provide a suturing tool capable of forming a film knot with a simple action in a body cavity, suturing the tissues sufficient to be cured, being easily operated, and using forceps of a special shape. CONSTITUTION:This suturing tool is a suture holding member 1 holding a suture 7 and forming a loop section 7L for a knot, and the suture holding member 1 is provided with an inner tube 2 and an outer tube 3. The loop section 7L is stored between the inner tube 2 and the outer tube 3 while an inside space is maintained, both end sections of the loop section 7L of the suture 7 are hooked on a suture hook groove 11 formed on the outer tube 3, and the suture holding member 1 having the outer tube 3 and the inner tube 2 is made deformable.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suturing tool for suturing and ligating a thread in an environment where a surgical operation is performed while observing the inside of a body cavity with an endoscope.

[0002]

2. Description of the Related Art In recent years, surgical operations are often performed while observing the inside of a body cavity with an endoscope. In such an environment in which a special tool must be operated within a body cavity with limited movement while watching a flat image from the endoscope on a monitor, it is not possible to sew or ligate a thread. very hard. Therefore, many tools and methods for easily tightening the thread have been developed.

At present, there are an external ligature and an internal ligature as the generally used suture ligation methods. Here, the extracorporeal ligation is
Once the thread is inserted through the living tissue in the body cavity, both ends of this thread are taken out of the body, a knot is made outside the body, and the knot is sent again to the body with a special tool for sending the knot into the body. is there.

An example of a tool for tying threads in a similar manner is
It is described in US Pat. No. 5,144,961. For this, one end of the thread with 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.

On the other hand, in the case of performing internal ligation, two forceps for laparoscopic surgery are used, and a male-female knot (double ligation) or a male-female-knot ( For example, triple ligation) is performed. Such ligation will be described further below.

Further, as a method for simplifying the work of knotting in the body, there is a method shown in US Pat. No. 5,234,445. In this method, a substantially lasso-shaped loop and a knot are formed 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 does 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 substantially lasso-shaped loop to form a knot.

In the method of ligating with two forceps in the body cavity, for example, the tool used is a forceps for laparoscopic surgery (see FIGS. 9 and 10 (A), (B)).
By operating two such forceps, as described above, a male-female knot or a male-female-male knot is performed as in the normal laparotomy.

As one example of the procedure at this time, first, one A forceps is used to take one end (a end) of the thread and wind it around the other B forceps. Subsequently, the A forceps holding the a end of the thread keeps the thread held as it is, and the other end (b end) of the thread is held by the B forceps wound with the thread.

Here, the A forceps is moved toward the tip of the B forceps, and the loop of the wound thread is brought over the B forceps and onto the b end of the thread. In this state, pulling both forceps in the opposite directions and tightening the loop of the wound thread forms a knot.

A male-female knot, a male-female-male knot, etc. are performed by reversing the winding direction and repeating the same two or three times. By the way, when a male-female knot is performed, a knot as shown in FIG. 5 (B) is obtained.

The knot thus obtained is firm and strong, and the two forceps pull both ends of the thread in the opposite direction to the side of the knot so that the thread can be securely tightened. By performing in this way, it is easy to adjust the tightening degree.

[0013]

However, in the case of the above-mentioned conventional structure, in order to tie a knot outside the body, it is necessary to once pull out both ends of the thread guided into the body, so that the forceps are taken in and out. There are many movements, and the work is troublesome.

Since both ends of the thread are taken out of the body, a very long thread is required. Therefore, when the thread is taken out of the body, the living tissue penetrated by the thread may be rubbed with the thread for a long time.
Further, a special tool for feeding the knot into the body is required, which causes a problem of high cost, and it may be difficult to tighten the knot by the method of feeding the knot from the body into the body.

Further, when performing ligation in the body using two forceps for laparoscopic surgery, the operation is performed in the special environment as described above, and therefore, it is performed as in a normal laparotomy. Operation is a very difficult problem. In particular, the work of winding a thread around the forceps is difficult and requires skill and skill.

Further, in the method of tightening the other end of the thread by the substantially lasso-shaped loop to form a knot, the knot may be relatively weak and the knot may be untied. In addition, when attaching a substantially lasso-shaped loop to the tip of the rod and inserting the loop into a body cavity, two holes for inserting two forceps for performing a normal sewing operation are formed on the body surface of the patient. In addition to the need, it is necessary to make another hole for inserting this rod on the body surface of the patient, which may increase the burden on the patient.

The present invention has been made in view of the above circumstances, and an object thereof is to reliably and firmly tie a knot in a body cavity with a simple operation and to suture a tissue sufficient for healing. At the same time, it is possible to reduce the number of times the treatment tools are taken in and out of the body cavity without increasing the number of treatment tools such as forceps at the time of suturing. In addition, several types of commonly used ligatures are not used. It is an object of the present invention to provide a suturing tool that can be used corresponding to a treatment tool.

[0018]

SUMMARY OF THE INVENTION The present invention holds a suture thread that forms a knot loop, maintains a space inside the loop for looping the suture thread around a forceps, and And a thread holding member having locking means for locking at least one location of the suture thread, and at least part of the thread holding member is deformable.

[0019]

The loop of the suture thread of the body tissue, for example, a loop for ligation is previously formed in a part of the loop is held by the thread holding means of the thread holding member, and an extension portion of the thread extending from the loop or a thread The portion is locked by the thread locking means of the thread holding member. Further, a member having a gripping function, such as forceps, is inserted into the internal space of the thread holding means. At this time, the thread holding member is deformed according to the shape of the forceps inserted into the internal space of the thread holding means. In addition, after the thread is passed through the body tissue to be sutured in the body cavity, the loop is removed from the thread holding means by another forceps and the like, and the loop is ligated.

[0020]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS.
This will be described with reference to 0. FIG. 1 shows a thread holding member 1 of a suturing tool.
FIG. The thread holding member 1 is provided with an inner cylinder 2 and an outer cylinder 3 which is detachably connected to the inner cylinder 2.

Here, the inner cylinder 2 and the outer cylinder 3 are formed of deformable elastic members. Further, as the elastic member, for example, a rubber material such as silicon rubber, fluororubber, nitrile rubber or the like, or a plastic material such as fluororesin, polyethylene or vinyl chloride is used.

Further, the inner cylinder 2 has a distal end portion provided with an inner cylinder gripping portion 4 which has an outer diameter dimension substantially the same as that of the outer cylinder 3 and is not housed in the outer cylinder 3. Further, a tapered taper which is inserted into the outer cylinder 3 on the rear end side of the inner cylinder 2 and accommodates the space inside the loop with the yarn accommodating portion 9 of the outer cylinder 3 which will be described later. A thread winding section 5 having a surface is provided, and a fixing section 6 for fixing the inner cylinder 2 by being fitted between the inner cylinder gripping section 4 and the thread winding section 5 on the inner peripheral wall surface of the outer cylinder 3. Is provided. Then, as shown in FIG. 3, the suture thread 7 is wound around the thread winding portion 5 of the inner cylinder 2 by a winding method described later to form a triple ligation loop portion 7L for knotting. . The suture thread 7 may be any thread as long as it is used for surgical operation.

As shown in FIGS. 6 (A) and 6 (B), the inner cavity 2a of the inner cylinder 2 is provided with a closing portion 2b on the inner cylinder gripping portion 4 side. Then, the inner cavity 2a ends at the closing portion 2b on the tip end side of the inner cylinder 2. Further, the inner diameter 2a of the inner tube 2 is formed at the tip of the insertion portion 22 of the forceps used in combination with the thread holding member 1, for example, the Kelly forceps 21 shown in FIG. The diameter is set to be larger than the diameter of the curved portion 23.

Further, the inside of the outer cylinder 3 is shown in FIG.
As shown in (C), a small-diameter forceps fixing portion 8 is formed on one end side, and a thread storing portion 9 having a diameter larger than that of the forceps fixing portion 8 is formed in a portion other than the forceps fixing portion 8. The thread winding section 5 of the inner cylinder 2 in which the loop section 7L of the suture thread 7 is formed is inserted into the thread winding section 5 of the inner cylinder 2 and the thread storing section 9 of the outer cylinder 3, and the loop section 7L is The space inside is kept and stored.

Here, the length of the yarn accommodating portion 9 is set to be substantially the same as the length obtained by adding the lengths of the fixing portion 6 of the inner cylinder 2 and the yarn winding portion 5. Further, the inner diameter of the thread accommodating portion 9 is set to a size such that the thread accommodating portion 9 fits lightly into the fixing portion 6 of the inner cylinder 2.

Further, the inner diameter of the forceps fixing portion 8 is a forceps used in combination with the thread holding member 1, for example, Kelly forceps 2
The size is set so that the insertion portion 22 of No. 1 fits lightly. Further, the forceps fixing portion 8 is formed with radial notch grooves 10 arranged at six positions in the circumferential direction from the inner hole toward the outer periphery of the outer cylinder 3 at equal intervals.
At the time of inserting the forceps, the portion between the cut grooves 10 is relatively easily deformed to ensure the fixation of the forceps.

Further, a thread locking groove 11 as thread locking means for locking the thread is cut and formed at two locations opposed to each other in the radial direction at the tip of the outer cylinder 3 opposite to the forceps fixing portion 8. ing. Both ends of the suture thread 7 wound around the thread winding portion 5 of the inner cylinder 2 are respectively attached to the thread locking groove 1 of the outer cylinder 3.
It is adapted to be locked in a state in which it is inserted in 1. The outer diameter of the outer cylinder 3 is set so that it can be inserted into an insertion aid such as a trocar.

Next, a method of winding the suture thread 7 wound around the thread winding portion 5 of the inner cylinder 2 will be described. First, as shown in FIG. 4 (A), the suture thread 7 is wound once around the thread winding portion 5 of the inner cylinder 2 in the distal direction, and the first loop 7L
Form ₁ (loop 1).

Then, as shown in FIG. 4B, loop 1
On the other hand, the suture thread 7 is wound around the thread winding portion 5 so as to be symmetrical with respect to the dotted line portion A to form the second loop 7L ₂ (loop 2).

Further, as shown in FIG.
With respect to the dotted line portion B (that is, loop 1
The third loop 7L ₃ (loop 3) is formed by winding the suture thread 7 around the thread winding portion 5 in the same winding manner as described above.

As a result, the loop portion 7L of the triple ligature for knot shown in FIG. 3 is formed. Then, as shown by the arrow in FIG. 5 (A), one end (A end) 7a of the suture thread 7 is passed through these _three loops 7L _{1 to} 7L ₃ and the thread 7 on the A end 7a side is obtained. Each loop 7L _{1 to} 7L of the loop portion 7L
The relationship of entanglement with ₃ is the same as the triple ligation of male-female-male knot shown in FIG. 5 (B). That is, the loop 7L ₁ , the loop 7L ₂ , and the loop 7L ₃ are respectively shown in FIG.
It corresponds to the single ligation part o, the double ligation part p, and the triple ligation part q of the triple ligation of (B), respectively.

Then, the inner cylinder 2, the outer cylinder 3 of the thread holding member 1,
As the suture thread 7, as shown in FIG.
After forming the loop portion 7L of the triple ligature for tying the knot around the thread winding portion 5 of the knot, the portion of the thread winding portion 5 around which the loop portion 7L of the suture thread 7 is wound is placed in the thread storage portion 9 of the outer tube 3. In the inserted state, the loop portion 7L is accommodated between the thread winding portion 5 of the inner cylinder 2 and the thread accommodating portion 9 of the outer cylinder 3 while keeping the space inside the loop portion 7L. Outer cylinder 3
It is configured such that it is sandwiched and fixed in the thread locking groove 11, and finally, as shown in FIG. 2, the fixing portion 6 of the inner cylinder 2 is fitted and fixed in the outer cylinder 3.

Next, the operation of the above configuration will be described.
The thread holding member 1 of the present embodiment is, for example, Kelly forceps 21 shown in FIG. 9, forceps 25 having a linear insertion portion 24 as shown in FIG. 10 (A), or as shown in FIG. 10 (B). It is used in combination with forceps 28 having a curved portion 27 at the tip of the insertion portion 26. Here, a case will be described in which the body tissue inside the patient's body is ligated using the Kelly forceps 21 shown in FIG. 9 (hereinafter, this Kelly forceps 21 is referred to as A forceps).

As shown in FIG. 6 (A), the insertion portion 22 of the A forceps 21 is inserted into the inner cavity of the forceps fixing portion 8 at the rear end of the outer cylinder 3 of the thread holding member 1. Here, when the A forceps 21 is deeply inserted, the tip curved portion 23 of the insertion portion 22 of the A forceps 21 is inserted into the inner cavity 2a of the thread winding portion 5 of the inner cylinder 2. At this time, since the outer cylinder 3 and the inner cylinder 2 are made deformable, as shown in FIG.
Deforms according to the curved shape of.

When the A forceps 21 is pushed further from this state, the tip of the A forceps 21 is closed by the closing portion 2 of the inner cavity 2a of the inner cylinder 2.
After contacting b, the closing portion 2b is pressed by the A forceps 21 in the insertion direction of the A forceps 21, so that the inner cylinder 2 becomes the outer cylinder 3
Is extruded from. At this time, the thread winding portion 5 of the inner cylinder 2
The loop portion 7L of the thread 7 wound around the inner tube 2 is removed from the thread winding section 5 of the inner tube 2 while the shape of the inner tube 2 is being pushed out from the outer tube 3 and is changed to the inner tube 2. It is wound around the A forceps 21 that has been inserted. The inner cylinder 2 that has come off the thread winding portion 5 of the inner cylinder 2 is removed from the forceps A.

The outer cylinder 3 is lightly tightened and fixed on the A forceps 21 by the forceps fixing portion 8. At this time,
Due to the elasticity of the material of the outer cylinder 3 and the cut groove 10, the outer cylinder 3
6 is movable on the A forceps 21 in the axial direction thereof with an appropriate amount of force, and is held in a state of being arranged at an appropriate position on the A forceps 21 as shown in FIG. 6C.

After the assembling work of the A forceps 21 and the outer cylinder 3 of the thread holding member 1 is completed in this way, next, the thread holding member 1
The forceps 21 having the outer cylinder 3 attached thereto is inserted into the body cavity through a trocar or the like to ligate the living tissue. Here, for example, when it is desired to ligate a tubular tissue such as a blood vessel, as shown in FIG.
A is grasped by the A forceps 21.

Then, as shown in FIG. 7 (B), while the thread 7 is held on the back side of the tissue to be ligated such as the blood vessel K, A
The tip of the forceps 21 is passed through. If necessary, the adhesive force etc. on the back side of the blood vessel K is peeled off with the A forceps 21 while holding the thread 7.

Next, as shown in FIG. 7C, the A end 7a of the thread 7 passed through the back side of the blood vessel K is attached to another forceps (hereinafter, B forceps).
Hold at 31. Then, the A forceps 21 temporarily moves the A of the thread 7
The end 7a is separated, and as shown in FIG. 7D, the A end 7 of the thread 7 held by the B forceps 31 is pulled out from below the blood vessel K and turned upward.
Grab a again.

After that, as shown in FIG.
1 separates the A end 7a of the thread 7 and grips the B end 7b on the other end side of the thread 7 fixed to the outer cylinder 3. In this state, B forceps 31
By pulling in the direction of the A end 7a of the thread 7
When pulling b, the B end 7b of the thread 7 is pulled out from the thread locking groove 11 of the outer cylinder 3, and the B forceps 31 is further pulled, the loop portion 7L is pulled out to the outside of the outer cylinder 3, and the loop portion 7L is The A end 7a of the thread 7 passes through the loop portion 7L after being pulled out from the tip of the A forceps 21 as shown in FIG. 5 (A).

Then, as shown in FIG. 8 (B), B of the thread 7
By pulling the B forceps 31 grasping the end 7b further to the left in the figure, the A forceps 21 grasping the A end 7a of the thread 7 is strongly pulled to the right in the figure. The knot of the loop portion 7L is strongly tightened and the blood vessel K is ligated.

After the ligation of the blood vessel K, the accumulated thread 7 is cut and collected outside the body, and the ligation work is completed. The same applies to the case where the thread holding member 1 of this embodiment is used in combination with the forceps 25 and 28 as shown in FIGS. 10 (A) and 10 (B), and the description thereof will be omitted here.

Therefore, the following effects can be obtained with the above structure. That is, since the inner cylinder 2 and the outer cylinder 3 of the thread holding member 1 are formed of deformable elastic members, the Kelly forceps 21 having the curved portion 23 formed at the distal end of the insertion portion 22 and FIG. It can be used in combination with a specially shaped treatment tool such as forceps 28 having a curved portion 27 at the tip of the insertion portion 26 as shown in FIG.

A loop portion 7L to be a knot is formed outside the body in advance by the inner cylinder 2 of the thread holding member 1, and then the inner cylinder 2 is replaced with the outer cylinder 3 of the thread holding member A.
Since the loop portion 7L can be reliably placed in the body cavity by the forceps 21, it is possible to omit the difficult work of ligating the body. Therefore, without increasing the number of forceps required for suturing the living tissue in the body, the loop portion 7 can be easily operated in the body cavity.
Since the knot of L can be firmly tightened for suture ligation, it is possible to suture sufficient tissue for healing. Further, it is possible to reduce the number of times a treatment tool such as forceps is taken in and out of the body cavity, and it is possible to further facilitate the suturing operation of the biological tissue in the body.

Furthermore, when inserting the A forceps 21 to which the outer cylinder 3 of the thread holding member 1 is assembled into a trocar or the like, remove both ends of the suture thread 7 in which the loop portion 7L is wound around the A forceps 21. Since it is held by being sandwiched in the thread locking groove 11 of the cylinder 3 and held, the thread 7 is displaced during the work of inserting the A forceps 21 into the trocar or the like, and the loop portion 7L
Can be prevented from coming off the A forceps 21.

Further, both ends of the suture thread 7 are provided on the outer cylinder 3 respectively.
Since it is locked by being sandwiched in the thread locking groove 11 of B, the B forceps 31 B of the suture thread 7 is used during the ligation work of the blood vessel K or the like.
The end 7b can be easily removed in the tip direction along the thread locking groove 11.

Since the loop portion 7L of the suture thread 7 wound around the A forceps 21 is housed in the outer cylinder 3,
There is no risk that the loop portion 7L will move from the mounting position, come off, or be caught by another component or the like.

Further, the yarn winding member 5 is attached to the yarn holding member 1.
Since the inner cylinder 2 having the above is provided, when the A forceps 21 is assembled to the outer cylinder 3 of the thread holding member 1, the loop portion 7L is arranged on the outer peripheral surface of the A forceps 21 in the same shape without being collapsed. be able to. Further, when assembling the thread holding member 1 of this suturing tool, the thread 7 may be wound around the inner cylinder 2 and inserted into the outer cylinder 3, so that the work for assembling the thread holding member 1 can be facilitated.

In the above embodiment, the thread holding member 1 is used in combination with the forceps such as the Kelly forceps 21. However, as shown in FIG. 11, the endoscope (scope with channel) 32 is used. You may use it in combination with the insertion part 33.

In FIG. 11, 34 is an objective lens of the endoscope 32, and 35 is a treatment instrument insertion channel. In this case, the insertion portion 33 of the endoscope 32 is the A forceps 2 of the first embodiment.
The thread holding member 1 is assembled to the outer cylinder 3 in the same procedure as in 1.

Then, the loop portion 7 of the thread 7 wound around the thread winding portion 5 of the inner cylinder 2 along with the operation of assembling the outer cylinder 3 of the thread holding member 1 into the insertion portion 33 of the endoscope 32.
While L is maintained in its original shape, it is detached from the thread winding portion 5 of the inner cylinder 2 and wound around the insertion portion 33 of the endoscope 32 that has been inserted instead of the inner cylinder 2.

Further, after inserting the insertion portion 33 of the endoscope 32, to which the outer cylinder 3 of the thread holding member 1 is assembled, into the body cavity, it is inserted into the body cavity through the channel 35 of the endoscope 32. The thread 7 is passed through the body tissue to be ligated such as the blood vessel K under the observation by the endoscope 32 in accordance with the operation of the forceps 36 and the B forceps 37 which is inserted into the body cavity separately from the endoscope 32, and sutured. Is done.

As described above, when the thread holding member 1 is used in combination with the insertion portion 33 of the endoscope 32, the endoscope 32 is used.
One A forceps 3 through the treatment instrument insertion channel 35 of
Since 6 can be inserted into the body cavity, it is possible to reduce one insertion hole of the treatment tool in the body wall of the patient and reduce the burden on the patient.

Further, a thread with a needle in which a needle is connected to the tip of the suture thread 7 may be used in combination with the thread holding member 1 of the first embodiment. When using this thread with a needle, a needle holder is preferable as the forceps to be inserted into the thread holding member 1.

Then, after attaching the thread holding member 1 to the needle holder in the same manner as in the first embodiment, the thread holding member 1 is inserted into the body cavity, and the needle is supported by the needle holder, and the body tissue to be sutured is attached. The thread 7 is passed through, and sutures for connecting the thread 7 are performed. By using the thread with the needle in this way, the wound site can be sutured.

FIG. 12 shows a first modification of the thread holding member 1 of the first embodiment. This makes one thread locking groove 11 of the outer cylinder 3 and one thread locking groove 1
The yarn 7 forming the loop portion 7L is inserted into one end and held. In this case, one end of the thread 7,
Here, insert the shorter B end 7b into the thread locking groove 11 first,
The other end, here the longer A end 7a, is inserted into this thread locking groove 11 later.

The method of using the yarn holding member 1 of this modification is the same as that of the first embodiment. Therefore, in this case, when the B end 7b of the thread 7 is pulled and the thread 7 is removed from the thread locking groove 11, the thread 7 is pushed by the B end 7b of the thread 7, and the A end 7a is also pressed.
Since it is disengaged from 1, the both ends of the thread 7 can be reliably and easily disengaged from the outer cylinder 3.

FIG. 13 shows a second modification of the first embodiment. In this, a loop portion 7M in which the winding method of the suture thread 7 is changed is formed. That is,
Here multiple left direction as shown by an arrow in FIG. 13 the A-end 7a of the suture thread 7 to the yarn-winding portion 5 of the inner cylinder 2, the loop 7M ₁ ~7M ₅ of 5 fold wound example 5 times After forming, the A end 7a is looped from the right side in FIG.
The B end 7b of the thread 7 is looped into ₃ , 7M ₂ and 7M ₁ .
A knot called a so-called loader knot is formed by passing it under the M ₁ and tightening it. In addition,
A needle 38 is connected to the A end 7a of the suture thread 7.

Further, FIG. 14A shows the third embodiment of the first embodiment.
It shows a modified example of. This is a loop portion 7N formed by further changing the winding method of the suture thread 7. That is, here, the suture thread 7 is wound around the thread winding portion 5 of the inner cylinder 2 twice from the right side in FIG.
After forming a loop 1 comprising a loop 7N _1, 7N ₂ heavy, the terminal end of the loop 7N ₂ left right loop 7N
_In this state, the yarn winding portion 5 is wound once around the starting end portion 1 and folded back in the opposite direction to form a loop 7N ₃ (loop 2).

When the A end 7a of the suture thread 7 is tightened by passing it through the loops 1 and 2 from the left as shown by the arrow in the figure, the thread 7 on the A end 7a side and the loop portion 7N. The positional relationship of the side thread 7 is similar to what is called a surgical knot as shown in FIG. 14 (B).

Further, FIG. 15 shows a fourth modification of the first embodiment. This is one in which the member corresponding to the outer cylinder 3 in the first embodiment is made by the coil spring 41.

The material of the coil spring 41 is preferably a metal material such as stainless steel or a synthetic resin material.
Further, the tip 41a of the wire of the coil spring 41 is slightly bent to facilitate holding of the suture thread 7,
The thread 7 is locked by sandwiching both ends of the thread into a gap on the side of the tip end 41a of the fixed coil spring 41.

At the rear end of the coil spring 41 forming the outer cylinder 3, there is formed a forceps fixing portion 41b whose inner diameter is smaller than the outer diameter of the forceps used. In this forceps fixing portion 41b, the inner diameter of the coil spring 41 is smaller than the outer diameter of the forceps used. Other configurations are similar to those of the first embodiment. Therefore, in this case, the coil spring 41
Since it is deformable, it can be used for bent forceps as in the first embodiment.

FIG. 16 shows a fifth modification of the first embodiment. A plurality of slits 42 extending in the axial direction are formed in the thread winding portion 5 of the inner cylinder 2 in the first embodiment in the circumferential direction.

Therefore, in this case, the thread winding portion 5 of the inner cylinder 2 is more easily deformed in the direction orthogonal to the axial direction of the thread winding portion 5 than in the first embodiment. In addition,
As the material of the inner cylinder 2, metal materials such as stainless steel and aluminum can be used in addition to those used in the first embodiment.

FIG. 17 shows a sixth modification of the first embodiment. This is one in which the axial lengths of the inner cylinder 2 and the outer cylinder 3 of the first embodiment are shortened, and the forceps fixing portion 8 of the outer cylinder 3 is formed by the rubber cap 43. A fitting portion 43a that is fixed to the end edge portion of the outer cylinder 3 in an external fitting state is formed at one end of the rubber cap 43, and forceps used in combination with the thread holding member 1 at the other end.
For example, the insertion portion 22 of the Kelly forceps 21 is formed with a small diameter portion 43b that is set to have a size that allows a light interference fit.

In this case as well, the method of use is the same as in the first embodiment. Further, in this modification, since the inner cylinder 2 and the outer cylinder 3 have a short axial length and the rubber cap 43 is used as the forceps fixing portion 8 of the outer cylinder 3, even a bent forceps can be easily used. it can. Therefore, the inner cylinder 2 and the outer cylinder 3
The material may be a rigid member that does not deform.

18A and 18B show a seventh modification of the first embodiment. This is one in which a plurality of tapered tapered projections 44 are provided on the forceps fixing portion 8 of the outer cylinder 3 in the first embodiment. Therefore, in this case, as shown in FIG. 18B, when the bent portion 46 of the forceps 45 is inserted into the forceps fixing portion 8 of the outer cylinder 3, the bent portion 46 of the forceps 45 causes Since the tapered tapered projection 44 can be pushed and elastically deformed, the bent forceps 45 can be used in this case as in the first embodiment.

FIG. 19 shows an eighth modification of the first embodiment. This is used in combination with the thread holding member 1 in advance for the thread winding portion 5 of the inner cylinder 2 and the outer cylinder 3 of the thread holding member 1 in the first embodiment.
Bending portion 27 of insertion portion 26 of forceps 28 as shown in FIG.
The curved portions 2w and 3w are provided so as to be curved in accordance with the bent state. Therefore, also in this case, the bent forceps 28 can be easily used as in the first embodiment.

20 and 21 show a ninth modification of the first embodiment. In this, as shown in FIG. 21, a large tapered chamfered portion 51 is provided on the rear portion of the main body 3B of the outer cylinder 3 of the thread holding member 1.

FIG. 20 shows a state in which the forceps 52 assembled with the outer cylinder 3 of the thread holding member 1 is inserted into the trocar 53. Here, the forceps insertion port body 54 of the trocar 53 is provided with a movable valve 56 for keeping the forceps insertion port 55 airtight.

The movable valve 56 is rotatably supported by a rotary shaft 57. The forceps insertion port 55 is normally urged by a urging means such as a spring (not shown) in a direction to close the forceps insertion port 55, and when the forceps 52 is not inserted into the trocar 53, the forceps insertion port 55 is closed by the movable valve 56. The forceps insertion port 55 is kept airtight.

When the forceps 52 is inserted into the trocar 53, the movable valve 56 is pushed downward by the tip of the insertion portion of the forceps 52 against the urging force to open.

Therefore, in the above structure, when the forceps 52 inserted into the body through the trocar 53 is pulled out to the outside of the trocar 53, the main body 3B of the outer cylinder 3 of the thread holding member 1 is moved by the movable valve of the trocar 53. It is possible to prevent the hook 56 from being caught by the chamfered portion 51 at the rear portion of the outer cylinder body 3B of the thread holding member 1.

Further, FIG. 22 shows a tenth modification of the first embodiment. This is the outer cylinder 3 of the thread holding member 1.
The entire main body 3B 'is formed in a substantially conical shape. Also in this case, the same effect as that of the ninth modification can be obtained.

Further, FIG. 23 shows an eleventh modification of the first embodiment. This is the outer cylinder 3 of the thread holding member 1.
Further, for example, a hook portion 59 for hanging a recovery string 58 is provided.

In this case, when the forceps 52 inserted into the body through the trocar 53 shown in FIG. 20 is pulled out of the trocar 53, the outer cylinder 3 of the thread holding member 1 is moved to the trocar 5.
Even if the forceps 52 is caught by the movable valve 56 of No. 3,
The outer cylinder 3 can be easily recovered by pulling the recovery string 58.

Further, FIG. 24A shows the first example of the first embodiment.
2 shows a modification of No. 2. This is a configuration in which the thread holding member 1 is used in combination with a trocar 61 which is an endoscopic surgical tool.

Here, the length of the thread holding member 1 in the axial direction of the outer cylinder 3 is set to be slightly shorter than the length of the outer tube 62 of the insertion portion of the trocar 61. Further, the forceps fixing portion 8 of the outer cylinder 3 does not have the radial cut groove 10 as in the first embodiment. The inner diameter of the forceps fixing portion 8 of the outer cylinder 3 is set to be slightly smaller than the diameter of the insertion portion of the surgical tool inserted into the inner cavity of the forceps fixing portion 8, that is, the outer tube 62 of the trocar 61 in this modification. There is.

Therefore, when the outer tube 62 of the trocar 61 is inserted to the root of the inner cavity of the forceps fixing portion 8 of the outer cylinder 3, the trocar 61 into which the inner peripheral surface side of the forceps fixing portion 8 of the outer cylinder 3 is inserted. The outer tube 62 is deformed according to the shape of the outer tube 62 and is fitted in an interference fit state so as to be in close contact with and kept airtight.

When the thread holding member 1 having the above-described structure is used, the outer tube 3 of the thread holding member 1 is previously attached to the outer tube 62 of the trocar 61 by the same procedure as in the first embodiment. A state in which the loop portion 7L of the thread 7 wound around the thread winding portion 5 of the inner cylinder 2 maintains the same shape as the outer tube 3 of the thread holding member 1 is assembled to the outer tube 62 of the trocar 61. The trocar 61 that has been inserted in place of the inner tube 2 by being removed from the thread winding portion 5 of the inner tube 2 by
Is wrapped around the outer tube 62 of the.

Further, an inner needle (not shown) of the trocar 61 is assembled in the outer tube 62 of the trocar 61 to which the outer cylinder 3 of the thread holding member 1 is assembled. Then, in a state where the inner needle is inserted into the outer tube 62 of the trocar 61, the trocar 61 is pierced by the body wall S of the patient and comes out into the body cavity.

After the trocar 61 is inserted into the body cavity, the inner needle is pulled out from the outer tube 62, and the A forceps 21 is inserted into the outer tube 62 instead. Thereafter, as in the first embodiment, the thread 7 is ligated with the operation of the A forceps 21 and the B forceps 31 inserted into the body cavity separately from the A forceps 21.

When used in this way, the outer cylinder 3 of the thread holding member 1 is assembled to the trocar 61, so that the forceps 21 can be inserted into the trocar 61 alone. Therefore, the operating force of the forceps 21 may be small. Furthermore, since the trocar 61 and the outer cylinder 3 of the thread holding member 1 are in close contact with each other, airtightness is maintained when pneumoperitoneum is necessary.

Further, FIG. 24 (B) shows the first part of FIG. 24 (A).
The outer cylinder 3 of the thread holding member 1 of the second modification is used in combination with the forceps 71. Also in this case
In the same manner as the outer tube 62 of the 4 (A) trocar 61,
Outer cylinder 3 of the thread holding member 1 up to the base of the insertion portion 72 of the forceps 71
Is assembled. At this time, the insertion portion 72 of the forceps 71 and the forceps fixing portion 8 of the outer cylinder 3 of the thread holding member 1 are in close contact with each other to maintain airtightness.

Further, the insertion portion 72 of the forceps 71, to which the outer cylinder 3 of the thread holding member 1 is assembled, is the outer tube 7 of the trocar 73.
4 is inserted into the body cavity. At this time, the seal member (not shown) of the trocar 73 and the outer cylinder 3 of the thread holding member 1
The outer peripheral surface is closely attached to maintain airtightness. After this, the first
Similar to the embodiment described above, the thread 7 is ligated in accordance with the operation of the forceps 71 (A forceps) and the B forceps 31 inserted into the body cavity separately from the A forceps 71.

Therefore, in this case, the outer cylinder 3 of the thread holding member 1 is in close contact with the outer peripheral surface of the insertion portion 72 of the forceps 71 to maintain airtightness, and between the trocar 73 and the outer cylinder 3 of the thread holding member 1. Also, since the airtightness is closely adhered to each other, the airtightness in the body cavity of the patient can be maintained when the airway is necessary.

Further, in FIG. 25, the outer tube portion 82 of the trocar 81 is formed by a double tube (inner tube 82a, outer tube 82b), and the inner tube 2 and the outer tube 3 of the thread holding member 1 of the first embodiment.
As the inner cylinder 82a and the outer cylinder 82 of the trocar 81
b is used.

In this case, the loop portion 7L of the thread 7 is wound around the outer peripheral surface of the inner cylinder 82a, and the thread 7 extending from the loop portion 7L into the slit-shaped thread locking groove 83 provided in the outer cylinder 82b.
The extension of is fixed. Further, the forceps insertion port body 84 of the trocar 81 has a movable valve 5 that keeps airtightness.
6 (see FIG. 20) are provided.

When the trocar 81 having the above structure is used, the trocar 81 is pierced into the body wall S of the patient with the trocar 81 combined with an inner needle (not shown). Then, the trocar 8 is penetrated through the body wall S of the patient.
After the tip of 1 is inserted into the body cavity, the inner needle is pulled out. Next, the A forceps 21 is inserted into the inner cavity of the inner cylinder 82a of the trocar 81. After this, the A forceps 21 is used as in the first embodiment.
Along with the operation of the B forceps 31 that is inserted into the body cavity separately from the A forceps 21, the thread is passed through the body tissue and the thread 7 is ligated.

26 to 30 show the second embodiment of the present invention. FIG. 26 shows a substantially tape-shaped film unit connection body 92 in which a large number of film units 91 which are thread holding members of a suturing tool are continuously connected in a line. Each film unit 91 has a forceps insertion opening 94 formed at the center thereof for inserting the forceps 93.

Further, each film unit 91 is shown in FIG.
As shown in FIG. 5, a base film 95 and a holding film 96 that is separably joined to the base film 95.
And a suture thread 97. Here, the base film 95 and the holding film 96 are sufficiently thin, have flexibility, and are deformable, and various synthetic resin materials, paper, and the like can be used. Each film unit 91 is connected to another adjacent film unit 91 via a flexible base film 95.

Further, in the holding film 96, a split groove 96 is cut from one end of the film main body 96a, from the lower end in FIG. 27 to a position corresponding to the forceps insertion opening 94 at the substantially central portion.
b is formed. The holding film 96 as a whole has a substantially inverted U-shape. Further, the tag 9 is provided on the upper end of the film body 96a of the holding film 96.
6c is projected. The tag 96c is provided in a state of being separated from the base film 95.

Further, the suture thread 97 is provided with a loop portion 97L similar to the loop portion 7L shown in FIG. A needle 98 is connected to the tip of the extension on the A end 97a side, which is one end of the loop portion 97L. The loop portion 97L of the suture thread 97 is formed so that the center of the loop portion 97L and the forceps insertion opening 94 are aligned with each other.
And the holding film 96 are housed in a state of being sandwiched between them, whereby the loop portion 97L keeps the space inside the loop and is housed in the film unit 91, and at the same time, the suture thread 97 is the thread holding member. Film unit 9
Locked at 1.

Next, the operation of the above configuration will be described.
First, when the film unit 91 is used, the film unit connection body 92 of the film unit 91 is inserted into the body cavity via a trocar or the like.

Subsequently, the first forceps (hereinafter, A forceps) 93 for mainly operating the needle 98 is inserted into the body cavity, which is inserted through the same hole and the same trocar. It should be noted that another hole may be used.

Then, as shown in FIG. 28, the A forceps 93 is passed through the forceps insertion opening 94 of the leading-edge film unit 91 of the film unit connection body 92, and then the A forceps 93 is used.
Take the needle 98 with, and pass the needle 98 through the area to be sutured, and thread 9
7 is passed between living tissues H ₁ and H ₂ . Furthermore, A forceps 93
Then, the extended portion of the thread 97 on the A end 97a side, which is the needle 98 side, is grasped.

Further, as shown in FIG. 29, the second forceps (hereinafter, B forceps) 99 is inserted, the tag 96c of the holding film 96 is grasped by the B forceps 99, and the holding film 96 is peeled off from the base film 95. The holding film 9
6 is finally collected outside the body.

Next, as shown in FIG. 30, with B forceps 99,
B end portion 9 which is the other end portion of loop portion 97L of suture thread 97
The loop portion 97L is moved from the peripheral portion of the A forceps 93 to the suture portion while sandwiching the extension portion on the 7b side. As it is, A forceps 93
And the B forceps 99 to pull the suture thread 97,
To the desired strength. This completes the suturing operation for the first stitch.

Then, when it is desired to sew, the next film unit 91 of the film unit connecting body 92 is used.
Perform the same operation as above. After that, by similarly using the film units 91 of the film unit connection body 92 one after another, it is possible to continuously perform stitching.

Therefore, the following effects can be obtained with the above configuration. That is, each film unit 91 of the film unit connected body 92 includes a base film 95 and a holding film 96 formed of a thin film, and a suture thread 9 sandwiched between these films 95 and 96.
7, the forceps insertion port 94 can be easily inserted even with the bent forceps 93.

Since each film unit 91 of the film unit connecting body 92 has high flexibility, the film unit connecting body 92 is inserted from the same trocar as the forceps 93 with the film unit connecting body 92 inserted in the gap between the forceps 93 and the trocar. it can. Therefore, it is not necessary to make an insertion hole in the body wall of the patient for inserting the suturing tool into the body wall, so that the number of holes to be made in the body wall of the patient can be reduced and the burden on the patient can be reduced. it can.

Further, since a large number of film units 91 are housed in the film unit connecting body 92, one-needle stitching can be repeated without the troublesome operation of inserting and removing the forceps 93 from the body cavity. for that reason,
A knot for suturing a relatively wide area can be easily and surely manufactured, and the suture and ligation work can be efficiently performed.

The holding film 96 of the film unit 91 may be made of a safe bioabsorbable material.
In this case, since the holding film 96 may be left inside the body, the troublesome work of collecting the holding film 96 outside the body at the end of the suture and ligation work can be omitted, and the work efficiency of the suture and ligation work can be further improved. Can be increased.

Alternatively, one end of the recovery cord may be connected to the holding film 96, and the other end of the recovery cord may be held outside the body. In this case, since the holding film 96 can be collected outside the body by peeling the holding film 96 and then pulling the collecting string, the holding film 96 can be easily collected.

Further, FIGS. 31A to 31D show a third embodiment of the present invention. Here, similar to the second embodiment, a substantially tape-shaped film unit connected body 10 in which a large number of film units 101 are continuously connected in a line.
Two are provided. And each film unit 10
1, a forceps insertion opening 1 through which the forceps 103 is inserted in the center thereof.
04 are formed.

Further, each film unit 101 is shown in FIG.
As shown in FIG. 1 (C), the base film 105, the holding film 106, and the suture thread 107 are included. Here, the holding film 106 does not have the tag 96c of the second embodiment, and the range enclosed by the diagonal lines in FIG. 31C at the upper end of the holding film 106 is the base film 10.
It is integrally joined to the 5 side.

Further, the holding film 106 has a forceps insertion opening 104 at a substantially central portion from the lower end of the film body 106a.
A split groove 106b cut to a position corresponding to is formed, and the entire shape of the holding film 106 is substantially inverted U.
It is shaped like a letter.

Further, the suture thread 107 is provided with a loop portion 107L similar to the loop portion 7L shown in FIG. A end 107 which is one end of the loop 107L
A needle 108 is connected to the tip of the extension on the a side. Then, the suture thread 107 is formed so that the center of the loop portion 107L and the forceps insertion opening 104 are aligned with each other.
05 and the holding film 106 are sandwiched and housed.

Further, the needle 108 is provided on the holding film 106 as shown in FIG.
The forceps insertion port 104 is arranged at a position where it is divided into two, and both ends 108a and 108b thereof are adhered onto the film unit 101 to such an extent that the needle 108 can be removed immediately by pulling lightly.

Next, the operation of the above configuration will be described.
First, when the film unit 101 is used, the film unit connecting body 102 and the forceps 103 of the film unit 101 are trocar 109 as shown in FIG.
After being inserted through the inside into the body cavity, the forceps 103 are slightly half-opened and inserted into the forceps insertion opening 104 of the film unit 101 from the base film 105 side.

At this time, when the needle 108 is inserted into the half-opened portion of the forceps 103 to be inserted and the forceps 103 is pushed out as it is, the needle 108 is peeled off from the film unit 101 as shown in FIG. 31 (B). And this needle 1
Along with 08, the extension portion side of the suture thread 107 on the A end 107a side is pulled out.

Here, after the needle 108 is firmly held by the forceps 103 and pierced into the tissue, the forceps 103 is attached to the thread 107.
To the A end 107a of the needle 108 side. In this state, the B end 107b, which is the other end of the thread 107, is held and pulled by the B forceps other than the forceps 103 to pull the loop portion 107L to the holding film 106 and the base film 105.
It is pulled out from between and and moved from the peripheral portion of the forceps 103 to the suture portion. As it is, the suture thread 107 is pulled by the A forceps 103 and the B forceps, and the suture thread 107 is tightened with a desired strength to form a knot. This completes the suturing operation for the first stitch.

Then, when it is desired to sew, the same operation as above is performed using the film unit 101 next to the film unit connected body 102. After that, by similarly using the film units 101 of the film unit connected body 102 one after another, it is possible to continuously perform stitching.

Therefore, the following effects can be obtained with the above-mentioned structure. That is, in this embodiment, it is not necessary to peel off the holding film 106 from the base film 105 as in the second embodiment, so that the sewing operation can be performed more easily than in the second embodiment. .

Furthermore, since the holding film 106 is not separated from the film unit 101, it is not necessary to finally collect the holding film 106. Further, since all the parts other than both ends of the suture thread 107 are accommodated in a state of being sandwiched between the base film 105 and the holding film 106, the thread 107 is not likely to interfere with the operation of the forceps 103. .

Further, since the needle 108 is fixed on the holding film 106, there is no possibility that the needle 108 is held in a state of being projected to the outside, and the film unit 101 is inserted to the target site in the body cavity. It is possible to prevent the needle 108 from being caught in the surrounding living tissue or the like during the operation of the operation.

FIG. 32 shows a first modification of the suturing tool. The suturing tool is provided with a suturing tool main body 112 through which the forceps 111 are inserted, and a reducer 113 detachable from the suturing tool main body 112.

Here, the suturing tool main body 112 has substantially the same structure as the thread holding member 1 of the first embodiment. Then, a reducer coupling portion 114 having a smaller diameter than the outer cylinder 3 is projectingly provided at an end portion of the outer cylinder 3 of the suturing tool body 112 on the side of the forceps fixing portion 8. This reducer coupling section 114
A ring-shaped engagement groove 115 is formed on the outer peripheral surface of the.

Further, the reducer 113 is provided with a cylindrical body 116 having substantially the same diameter as the outer cylinder 3 of the suturing tool body 112. At the front end of the cylindrical body 116, the suturing tool body 112 is provided.
An engaging portion 117 is provided that is engageably and disengageably engaged with the reducer coupling portion 114. Furthermore, the trocar 12 shown in FIG.
A coupling portion 118 that is detachably coupled to the first side is provided. When the forceps 111 is inserted into the reducer 113 at the inner peripheral portion of the coupling portion 118 of the cylindrical body 116,
The reducer 113 and the forceps 11 are brought into sliding contact with the forceps 111.
1 is provided with a seal member 118a that seals the gap between the seal member 118 and

Further, the trocar 121 is an instrument used in a procedure for injecting gas into the body cavity to secure a space and enabling an approach inside and outside the body. The trocar 121 has an outer tube 122 and the outer tube 12
There is provided an inner needle (not shown) that is removably inserted into the inside.

Further, a forceps insertion port body 123 is provided at the base end of the outer tube 122. This forceps insertion opening 12
3 is a forceps insertion port 12 for preventing gas leakage from the body cavity.
A movable valve 124 for maintaining the airtightness of 3a is provided.

The movable valve 124 is rotatably supported by a rotary shaft 125. Then, the forceps insertion opening 123a is normally urged by an urging means such as a spring (not shown) in a direction to close the forceps insertion port 123a, and the forceps insertion is performed when the forceps 111 is not inserted into the trocar 121 as shown in FIG. The port 123a is closed by the movable valve 124 so that the forceps insertion port 123a is kept airtight.

Further, as shown in FIG. 33 (B), the forceps 11
1 is inserted into the trocar 121, forceps 11
The movable valve 124 is pushed downward against the urging force by the tip of the insertion portion 1 to open the forceps insertion port 123a. An instrument connecting portion 126 that is detachably connected to the connecting portion 118 of the reducer 113 is provided on the upper end portion of the forceps insertion opening 123.

Next, a method of using the suturing tool will be described. First, as shown in FIG. 32, the suturing tool main body 112
The forceps 111 is passed through the inside of the reducer 113 while the reducer 113 is connected to the suture tool body 11.
It is inserted in 2.

The forceps 111 is inserted into the suturing tool body 112, and the outer tube 3 of the suturing tool body 112 is wound around the thread winding portion 5 of the inner tube 2 of the suturing tool body 112 as the forceps 111 is assembled. The loop portion 7L of the thread 7 being detached is removed from the thread winding portion 5 of the inner cylinder 2 and is wound around the forceps 111 that has been inserted in place of the inner cylinder 2 while maintaining its original shape.

Furthermore, the forceps 111 to which the outer cylinder 3 is attached
Is inserted into the trocar 121 as shown in FIG. In this case, the movable valve 124 is pushed downward against the biasing force by the tip of the insertion portion of the forceps 111, and the forceps insertion opening 123a is opened.

Then, by further inserting the forceps 111 further, the connecting portion 118 of the reducer 116 is engaged with the instrument connecting portion 126 of the trocar 121 as shown in FIG. 34 (B), and the reducer 116 is trocared. 12
It is fixed to side 1. At this time, the movable valve 124 is held in the open state by the reducer 116.

Also, the reducer 116 uses the trocar 12.
After being fixed to the first side, the forceps 111 is further inserted into the trocar 121 to separate the outer cylinder 3 of the suturing tool body 112 from the reducer 116.

As a result, the outer cylinder 3 of the suturing tool body 112.
Is inserted into the body cavity through the outer tube 122 of the trocar 121, and at the same time, the movable valve 124 of the trocar 121 is held in the open state by the reducer 116. At this time, the sealing member 118 a of the reducer 116 is fixed to the forceps 11.
It is slidably brought into contact with the body 1 to maintain the airtightness inside the body cavity.

When the forceps 111 is pulled out from the trocar 121, the outer cylinder 3 of the suturing tool body 112 and the reducer 11 are first moved along with the pulling-out operation of the forceps 111.
After the connection between the first and second members 6 is completed, the suturing tool main body 112 is pulled out from the trocar 121. Then, by pulling out the entire forceps 111 from the trocar 121, the movable valve 124 of the trocar 121 is closed and the airtightness inside the body cavity is maintained.

Therefore, in the case of the above structure, even if the diameter of the trocar 121 to be used and the diameter of the insertion tool such as the forceps 111 are different, it is possible to easily cope with it by using the suturing tool main body 112 of the above structure. The application range of the suturing tool can be expanded.

FIG. 35 shows a first modification of the suturing tool shown in FIG. This is the suturing tool body 112.
A cylindrical reducer coupling portion 131 is provided at the end portion of the outer cylinder 3 on the side of the forceps fixing portion 8, and the reducer 11 is provided.
A cylindrical outer fitting portion 132 that is removably fitted to the reducer coupling portion 131 of the suturing tool body 112 by frictional engagement is provided at the front end portion of the third cylindrical body 116.

Therefore, in this case, the suturing tool body 1
The structure of the connecting portion between the reducer 113 and the reducer 113 can be simplified, and the manufacturing cost of the suturing tool as a whole can be reduced.

FIG. 36 shows a second modification of the suturing tool shown in FIG. This forms a male screw part 133 on the outer peripheral surface of the reducer coupling part 131 in the suturing tool body 112 of the suturing tool of FIG. 35, and at the inner peripheral surface of the outer fitting part 132 at the front end of the reducer 113. The female screw portion 134 screwed to the male screw portion 133 of the reducer coupling portion 131 is provided.
In this case, the reliability of the connecting structure of the connecting portion between the suturing tool body 112 and the reducer 113 can be improved.

37 (A) and 37 (B) show a second modification of the suturing tool. This is provided with a suturing tool body 141 having a forceps function. That is, as shown in FIG. 37 (A), the suturing tool main body 141 of this modification is provided with the insertion portion 142 and the operation portion 143 connected to the proximal end portion of the insertion portion 142.

Here, the insertion portion 14 of the suturing tool main body 141
An outer cylinder 144 and a forceps functioning part 145 arranged in the outer cylinder 144 are provided in the unit 2. Further, the forceps function part 145 has a tubular fixed shaft body 146, and the fixed shaft body 1
An operation shaft 147 arranged so as to be able to move forward and backward is provided at an axial center portion of 46.

Further, a fixed side gripping member 149 of the forceps gripping section 148 is provided at the tip of the fixed shaft body 146, and a movable gripping member 150 which can be opened and closed with respect to the fixed side gripping member 149 is illustrated. It is rotatably connected via a connecting pin.

Further, the operating portion 143 is provided with an operating lever 151 for opening and closing the movable holding member 150 of the holding portion 148 via the operating shaft 147. With the operation of the operation lever 151, the movable gripping member 150 is opened and closed with respect to the fixed-side gripping member 149 to obtain a forceps function similar to that of forceps.

Further, as shown in FIG. 37 (B), a small diameter portion 152 is provided on the outer peripheral surface of the fixed shaft body 146 on the front end side on the rear side of the fixed side grip member 149. This small diameter part 15
2 is formed with a taper surface whose diameter gradually increases toward the tip end direction, and is smoothly connected to the fixed-side gripping member 149 on the tip end side of the fixed shaft body 146.

Further, on the outer peripheral surface of the small diameter portion 152 of the fixed shaft body 146, a needle thread 154 having a needle 153 connected to one end thereof.
The loop portion 154L is wound around. The loop portion 154L of the needle thread 154 is the loop portion 7L shown in FIG.
It is wound around the small diameter portion 152 of the fixed shaft body 146 in the same manner as.

The outer cylinder 144 of the suturing tool body 141 is attached to the fixed shaft body 146 so as to be movable back and forth in the axial direction. Further, a biasing spring 155 is attached to the rear end portion of the outer cylinder 144 to bias the outer cylinder 144 in the direction of pressing the fixed shaft body 146 forward. And
The outer cylinder 144 is normally driven by the spring force of the biasing spring 155.
The small diameter portion 152 of the fixed shaft body 146 is held in a state of being openably and closably covered by the tip portion of the.

At the rear end of the outer cylinder 144, the outer cylinder 1
A trigger 156 for sliding 44 along the axial direction with respect to the fixed shaft body 146 is provided. Further, a thread fixing groove 157 is cut and formed at the tip of the outer cylinder 144. Then, in the thread fixing groove 157, the fixed shaft body 14
Both ends of the needled thread 154 wound around the small diameter portion 152 of No. 6 are inserted and locked.

Next, the operation of the above structure will be described.
First, the insertion portion 142 of the suturing tool body 141 is inserted into the body cavity via a trocar or the like. Then, the suturing tool body 1
The movable lever 150 of the handle 148 is opened / closed with respect to the fixed side gripping member 149 by the operation lever 151 of the operation unit 143 of No. 41 to grip the needle 153, and the needle 153 is passed through the wound site to thread the thread 154 into the tissue. Pass through.

Further, the grip portion 14 of the suturing tool body 141 is
The A end 154a on the needle 153 side of the thread 154 that has passed through the tissue is grasped by 8. Then, another B forceps grips the B end 154b on the other end side of the thread 154.

In this state, subsequently, the trigger 1 of the outer cylinder 144
56 is pulled to expose the small diameter portion 152 of the fixed shaft body 146. Now, pull the thread 154 with another B forceps, and
The loop part 154L of No. 4 is slid to the tip side of the fixed shaft body 146.

The loop portion 154L of the thread 154 slides on the tapered surface of the small diameter portion 152, and the fixed shaft body 1
It comes off from the tip of 46. At this time, the suturing tool body 141
Since the grip portion 148 of the thread 154 grasps the A end 154a of the thread 154 on the needle 153 side, the loop portion 154 of the thread 154 is held.
Inside the L, the A end 154a of the thread 154 on the needle 153 side
Passes through. In this state, the suturing tool main body 141 and another B forceps are further pulled to tighten the knot, thereby completing the suturing of the first needle.

Therefore, the following effects are obtained with the above-mentioned structure. That is, since the suturing tool body 141 is provided with a forceps function, it can be sufficiently used as a forceps. Therefore, the suturing tool body 141 can be used as it is without the trouble of attaching it to other forceps or the like, and the operability of the suturing tool can be enhanced.

Further, the small-diameter portion 1 of the fixed shaft body 146 is always provided.
Since the loop portion 154L of the needle thread 154 wound around the outer peripheral surface of 52 is covered with the outer cylinder 144, when the suture tool body 141 is inserted into the trocar or the like, the loop portion 154L of the needle thread 154 The knot will not slip or come off.

Further, it is not necessary to pass other forceps through the suturing tool body 141, and a mechanism for sliding the outer cylinder 144 of the suturing tool body 141 is provided. It can be thin. Therefore, it can also be used for a small diameter trocar.

38A and 38B show a third modification of the suturing tool. This is shown in FIG.
As shown in FIG. 5, a thread fixing tube 162 used in combination with the forceps 161 and the like is provided.

The thread fixing tube 162 is made of a cylindrical body having a sufficiently thin thickness, and the inner cavity is set to be slightly smaller than the outer diameter of the forceps 161 used in combination, so that the thread fixing tube 162 is lightly tightly fitted on the outer peripheral surface of the forceps 161. It has such elasticity.

A thread fixing portion 163 is provided at one end of the thread fixing cylinder 162 so as to project therefrom. The thread fixing portion 163 can be deformed with an appropriate amount of force. Further, a thread fixing groove 164 is cut and formed in the thread fixing portion 163.

Next, the operation of the above configuration will be described.
When using the thread fixing tube 162, it is used in combination with the forceps 161 and the like. Here, the forceps 161 is the thread fixing tube 1.
It is inserted from the rear end of 62 and placed at an appropriate position on this forceps 161. At this time, the thread fixing tube 162 is fixed to the forceps 16
Fixed on top of the 1 in a light interference fit.

In this state, the loop portion 166L of the needle thread 166 having the needle 165 connected to one end thereof is wound around the forceps 161 and both ends of the thread 166 are held in the thread fixing groove 164 of the thread fixing portion 163. Loop part 1 of the thread 166 at this time
66L is the same as the loop portion 7L shown in FIG.
Is wrapped around. The loop portion 16 of the thread 166
The winding method of 6L is not particularly limited, and any winding method that can form a knot may be used.

Then, as shown in FIG. 38B, the loop portion 166L of the thread 166 is arranged below the thread fixing portion 163. Therefore, the loop portion 166L of the thread 166 is the forceps 16
It is fixed in a state of being sandwiched between 1 and the thread fixing portion 163.

Furthermore, the forceps 16 thus prepared
1 is inserted into the body cavity through a trocar or the like. Thereafter, the thread 166 is ligated in accordance with the same operation as in the first embodiment.

Therefore, in the above-mentioned construction, the thread fixing tube 162 is formed by a cylindrical tube having a sufficiently thin thickness. Therefore, the forceps 161 to which the thread fixing tube 162 is attached has a thin trocar. You can put it in

FIG. 39 shows a thread winding device 171 for the thread holding member 1 of the suturing tool according to the first embodiment. The bobbin winding device 171 includes three film-shaped tray portions 172.
a, 172b, 172c are provided respectively.

Here, the first saucer portion 172a is connected to the second saucer portion 172b via the first connecting portion 173a so as to be folded and superposed, and similarly, the third saucer portion 17b.
2c is connected to the second saucer portion 172b via the second connecting portion 173b so as to be folded back and superimposable. The centers of the three pans 172a, 172b, 172c are arranged at the respective vertex positions of the triangle.

Further, as shown in FIG. 45, the inner cylinder mounting portion 176 on which the inner cylinder 2 of the thread holding member 1 of the suturing tool of the first embodiment is detachably mounted is mounted on the second tray 172b.
Is projected. A first cylinder 174 is fixed on the first tray 172a, and a second cylinder 175 is fixed on the third tray 172c. Here, in each cylinder 174 of the first cylinder 174 and the second cylinder 175.
The inner cylinder 2 of the thread holding member 1 can be inserted into a and 175a.

Next, an example of how to use the bobbin winder 171 will be described. First, as shown in FIG. 40, the suture thread 7 is provided with the second tubular body 175 on the third tray portion 172c, the first tubular body 174 on the first tray portion 172a, and the second tray portion. successively wound in order of the inner cylinder 2 on the 172 b, to form three loops _{7L 3, 7L 2, 7L 1} .

Subsequently, as shown in FIG. 41, the first cylindrical body 174 is folded in a state in which the first saucer portion 172a is folded over the second saucer portion 172b through the first connecting portion 173a and overlapped with each other. The second loop 7L ₂ is fitted into the inner cylinder 2 and is moved from the first cylinder 174 to the inner cylinder 2.

After the movement of the second loop 7L ₂ , the first tray portion 172a is returned to its original position as shown in FIG. Next, as shown in FIG. 43, the second tubular body 175 is inserted into the second tubular body 175 in a state where the third tray portion 172c is folded back onto the second tray portion 172b through the second connecting portion 173b and overlapped.
Then, the third loop 7L ₃ is moved from the second cylinder 175 to the inner cylinder 2.

After the movement of the third loop 7L ₃ , the third tray portion 172c is returned to its original position as shown in FIG. At this time, a loop portion 7L is formed on the inner cylinder 2 by winding the thread 7 in the same manner as in FIG.

Finally, as shown in FIG. 45, the inner cylinder 2 is removed together with the suture thread 7 from the inner cylinder mounting portion 176 of the second tray portion 172b, and then the inner cylinder 2 is attached to the inner cylinder 2 as shown in FIG. Attach the outer cylinder 3 to. As a result, the yarn holding member 1 shown in the first embodiment is combined.

Therefore, in the above-mentioned structure, since the dedicated thread 7 is not preliminarily attached to the inner cylinder 2 of the thread holding member 1, any existing thread 7 can be used. for that reason,
Saves 7 threads. Further, since the loop portion 7L of the thread 7 as shown in FIG. 3 can be easily and surely produced in the inner cylinder 2, the loop portion 7L serving as a knot can be easily arranged on the forceps or the like.

FIG. 47 shows a modified example of the bobbin winding device 171. This is provided with an insertion hole 181 for inserting the fixed shaft body 146 of the suturing tool body 141 of FIGS. 37 (A) and 37 (B) in the second tray portion 172b of the bobbin winding device 171 of FIG. 39.

Next, the operation of the above configuration will be described.
First, the trigger 156 of the outer cylinder 144 of the suturing tool body 141
To pull out the small diameter portion 152 of the fixed shaft body 146. In this state, the fixed shaft body 146 is inserted into the insertion hole 181 of the second tray portion 172b from below, and the small diameter portion 152 is pulled out to the upper side of the second tray portion 172b.

Then, in the same procedure as the above-described thread winding operation of the thread winding device 171, the suture thread 154 is inserted into the third tray portion 1.
Second cylinder 175, first pan 172a above 72c
The first cylindrical body 174 on the upper part and the small diameter portion 152 of the fixed shaft body 146 on the second pan 172b are sequentially wound in this order.
Form one loop.

Thereafter, the first saucer portion 172a and the third saucer portion 172c are processed in the same procedure as the above-described thread winding operation.
Is moved to move the three loops to the small diameter portion 152 of the fixed shaft body 146 as shown in FIG.

Subsequently, both ends of the loop portion 154L of the suture thread 154 on the small diameter portion 152 of the fixed shaft body 146 are fixed in the thread fixing groove 157 of the outer cylinder 144. In this state, next, the outer cylinder 144 is returned to the original position, and the loop portion 154L is
Is stored in the outer cylinder 144.

After that, the small-diameter portion 152 of the fixed shaft body 146 is pulled out together with the suture thread 154 from the insertion hole 181 of the second saucer portion 172b, so that the loop portion 154L of the suture thread 154 to the suturing tool body 141 is secured. The winding work is completed.

Therefore, in the case of the above configuration, FIG.
Fixed shaft body 146 of the suturing tool body 141 of (A) and (B)
The work of winding the loop portion 154L of the suture thread 154 around the small diameter portion 152 can be easily performed, and the workability thereof can be improved.

Further, the loop portion 166L of the thread 166 may be wound around the forceps 161 to which the thread fixing cylinder 162 of FIG. 38 (A) is attached by using the thread winding device 171 of FIG.

49 to 62 show the fourth embodiment of the present invention.

As shown in FIGS. 49 and 50, the thread holding member 201 of the suturing tool according to this embodiment is similar to the first embodiment shown in FIG. 1 in that the inner cylinder 202, the outer cylinder 203 and the suture thread. 207 and.

In this embodiment, unlike the above-mentioned first embodiment, a needle 208 is previously attached to one end of the suture thread 207. The suture thread 207 is wound in the opposite direction to that of the first embodiment and extends from the loop portion 207L.
Both ends of 07 are fixed to the same thread locking groove 211 as in the modification shown in FIG. Further, two windows or openings 204 are formed on the side of the outer cylinder 203, and the inner diameter of the forceps insertion port 208 is formed to be larger than the outer diameter of the forceps to which the outer cylinder 203 is attached.

In the vicinity of the forceps insertion port 208, a latch portion 210 for latching engagement with an adapter described later is provided. The latch portion 210 is a forceps insertion port 20.
8 has protrusions 210a having a trapezoidal cross section, and these protrusions 210a are separated from each other by grooves 209 formed at substantially equal intervals in the circumferential direction so that they can be easily elastically deformed. Further, the surface of the outer cylinder 203 is colored black or roughened. The other points are almost the same as those of the first embodiment.

FIG. 51 shows an adapter 220 for fixing the outer cylinder 203 of the suturing tool to the forceps.

This adapter 220, as shown,
A sheath portion 221 and a forceps fixing portion 222 are provided. The sheath portion 221 has an inner diameter larger than the outer diameter of the forceps, and the outer diameter of the sheath portion 221 can be inserted into the trocar, and
It is formed to be substantially the same as or slightly larger than the outer cylinder 203 of the suturing tool.

The outer cylinder 2 is attached to the tip of the sheath portion 221.
An outer cylinder fixing portion 223 that meshes with the latch portion 210 of No. 03 and fixes the outer cylinder 203 via the latch portion 210 is arranged. As shown in FIG. 51, the outer cylinder fixing portion 223 of the present embodiment has a small-diameter stepped structure in which a protrusion 224 and a groove 225 are arranged from the tip side, and the outer cylinder 203 has a latch portion 210. The arranged protrusion 210 a fits in this groove 225 after overcoming the protrusion 224.

Further, the forceps fixing portion 222 arranged at the rear end portion of the sheath portion 221 is provided with a large diameter inner hole portion 226 having a slightly enlarged diameter and a screw portion 227 formed on the outer peripheral portion thereof. Has been done. A ring 22 made of an elastic material such as silicon or rubber is provided in the large-diameter inner hole portion 226.
8 are accommodated. This ring 228 has a large diameter inner hole 226.
Is formed longer along the axial direction and has an inner diameter slightly larger than the outer diameter of the forceps. Further, a cap-shaped screwing member 229 formed with a female screw to be screwed with this screw is screwed to the screw portion 227. A collar 230 protruding inward and a forceps insertion port 231 are formed at the outer end of the screw member 229.

When suturing and ligating using the suturing tool of this embodiment, the following procedure is performed.

First, as shown at 51, the adapter 22
The ring 228 is attached to the large diameter inner hole portion 226 of 0, and the screwing member 229 is screwed to the screw portion 227 of the forceps fixing portion 222. At this time, the screw-in member 229 has the collar 230.
Is preferably located at a position where does not press the end of the ring 228.

Then, as shown in FIG. 52, a forceps 233 having a needle holder 232 at the tip is inserted from the forceps insertion port 231 of the adapter 220, and the needle holder 232 is projected from the adapter 220. Since the inner diameter of the ring 228 is formed to be slightly larger than the outer diameter of the forceps 233, the forceps 233 can be easily inserted. Then, the screwing member 229 is screwed in and the ring 2 is inserted through the collar 230.
Energize 29. As a result, the diameter of the ring 229 is reduced, the outer peripheral surface of the forceps 233 is tightened, and the adapter 22
0 is fixed on the forceps 220, and the forceps 220 and the adapter 220 are sealed.

As shown in FIG. 50, the suturing tool has an inner cylinder 20.
53 and the outer cylinder 203 are fitted to each other, and the needle holder 232 arranged at the tip of the forceps 220 is inserted from the forceps insertion opening 208 of this suturing tool as shown in FIG. And
As shown in FIG. 54, the opening 20 formed in the outer cylinder 203.
Loop 207L arranged on the inner cylinder 202 through 4
While holding down (Fig. 49), as shown in Fig. 55, the inner cylinder 2
02 is extruded from the outer cylinder 203. This allows loop 20
7L is disposed on the inner cylinder 202 and on the outer circumference of the needle holder 232. Further, when the outer cylinder 203 is pushed into the adapter 220 side together with the loop 207L, the protrusion 210 of the latch portion 210
a goes over the protrusion 224 of the adapter 220, and the groove 225
It is fitted inside, and the outer cylinder 203 is fixed to the forceps 233 according to the adapter 220.

Thus, the loop 207 of the suture thread 207 is
After L is attached to the forceps 233, the needle holder 232 at the distal end is inserted into the body cavity via a trocar (not shown), and a suturing operation is performed. In this embodiment, other forceps 234 are used together with the forceps 233 equipped with the suture thread 207.

56 to 62 show the procedure of the suturing operation using the suturing tool of this embodiment.

First, as shown in FIG. 56, after the needle 208 is inserted through the portion K to be sewn, the suture thread 207 is grasped near the needle 208. Then, as shown in FIG. 57, the end portion of the suture thread 207 opposite to the end portion to which the needle 208 is attached is grasped by the forceps 234 separately inserted into the body cavity, and the forceps 234 is held. Toward the tip side of the container 232,
Move in the direction indicated by arrow 240. As a result, the suture thread 207 is disengaged from the thread locking groove 211. This forceps 234
By further moving to the tip side of the needle holder 232.
The loop 270L of the suture thread 207 is pulled out from the outer cylinder 203, and slides on the needle holder 232 as the forceps 234 moves. This state is shown in FIG.

As shown in FIG. 59, forceps 234 is moved to the arrow 2 position.
By further moving along the direction of 40, the loop 207L of the suture thread 207 is pulled out from the needle holder 232. Continuing, Figure 5
As shown in FIG. 9, the needle 2 held by the needle holder 232.
The end of the suture thread 207 on the 08 side is inserted into this loop 207L together with the needle 208.

Next, as shown by an arrow 241 in FIG. 60 (A), the needle holder 232 is moved in a direction separating from the sutured portion K, the suture thread 207 is pulled, and the sutured portion K of the sutured portion K is pulled. Tighten the tissue with appropriate force. As a result, as shown in FIGS. 60B and 60C, the loop closest to the sutured portion K is tightened, and the tissue of the non-sutured portion K is tightened. Thereafter, as shown in FIG. 61 (A), the other forceps 2
When 34 is moved in the direction of arrow 242, until then, as shown in FIG. 61 (B), the loop having the suture thread 207 on the needle holder 232 side as the center was formed. By pulling the loop shown in (2) in the direction of the arrow 242, the loop is deformed so as to form a loop around the suture thread 207 on the forceps 234 side, and the diameter of the loop is reduced. This state is shown in FIGS. 61C and 61D. This makes the knot of the suture thread 207 stiffer.

Finally, as shown in FIG. 62, the needle holder 23
2 and the forceps 242 are strongly pulled in directions opposite to each other as indicated by arrows 241 and 242, respectively, and the nodule is strongly tightened.

According to the suturing tool of this embodiment, the outer cylinder 203
And the adapter 220 are securely and firmly fixed by a latch engagement in which the protrusion 210a and the groove 225 are fitted,
The outer diameter of the outer cylinder 203 is almost the same as the outer diameter of the adapter 220 or is formed to be slightly smaller than this, so that the outer cylinder 203 is pulled out from the trocar after the completion of suturing.
There is no risk that the outer cylinder 203 will fall out, and a procedure such as suturing can be performed efficiently.

Also, the outer cylinder 20 for holding the suture thread 207.
Since the opening 204 is formed in the sewing machine 3,
When 01 is attached to the forceps 233, the operator holds the loop 207L in the outer cylinder 203 with a finger, prevents the loop 207L together with the inner cylinder 202 from coming out of the outer cylinder 203, and can be efficiently attached. . Further, while the loop 207L is slid on the needle device 232 by the other forceps 234 during the suturing in the body cavity, the loop 207L
Even when the needle holder 232 is tightened due to tightening, the external force can be applied to the loop portion 207L through the opening 204, and the needle holder 232 can be pulled out from the needle holder 232.

Further, by coloring the surface portion of the outer cylinder 203 black or roughening the surface, the outer cylinder 203 can be clearly identified even during the treatment under a mirror view and the Reflection can be prevented.

Further, it can be used in combination with the adapter 220, so that the trocar and the needle holder 232 can be reliably sealed during an operation or the like requiring pneumoperitoneum, and there is a risk of leakage of pneumoperitoneum. Absent.

The present invention is not limited to the above-mentioned embodiments, and it goes without saying that various modifications can be made without departing from the spirit of the present invention.

Next, other characteristic technical matters of the present invention will be additionally described as follows.

(Additional Item 1) A means for holding a loop formed from a body tissue suture thread, and a thread holding means for holding at least a part of the thread are provided, at least a part of which is deformable. A suturing tool comprising a thread holding member.

(Additional Item 2) The suturing device according to Additional Item 1, wherein the thread is a thread with a needle.

(Additional Item 3) In the additional item 1, a suturing tool comprising a thread partially forming a loop and the thread holding member.

(Additional Item 4) In the additional items 1, 2, and 3, the suturing instrument is characterized in that the thread holding member is detachable from a surgical instrument such as forceps.

(Additional Item 5) In the additional items 1, 2 and 3, at least two thread holding members are separable from each other.

(Additional Item 6) Additional Items 1, 2, 3, 4, 5
The suturing tool according to claim 1, further comprising a means for attaching the loop made of the thread to a surgical tool such as forceps.

(Additional Item 7) In the additional item 6, the suturing tool characterized in that the thread holding member is detachable from a surgical tool such as forceps.

(Additional Item 8) Additional Items 1, 2, 3, 4, 5
In the suture tool, the thread holding member has a gripping function.

(Additional Item 9) In the additional item 1, the suture tool, wherein the thread holding member is made of a deformable elastic member.

(Additional Item 10) In the additional item 1, the suture tool, wherein the thread holding member is made of a deformable plastic member.

(Additional Item 11) In Additional Item 7, the thread holding member comprises an outer cylinder and an inner cylinder housed in a removable outer cylinder, and the outer cylinder has a thread fixing portion for retaining the thread. A suturing tool, characterized in that a means for attaching and detaching to a surgical tool such as forceps is provided, and a loop formed of a thread is held between an inner cylinder and an outer cylinder.

(Additional Item 12) In the additional item 6, the suture holding member is a deformable film-like member and has a loop holding portion and a forceps passage.

(Additional Item 13) In the additional item 12, there is a plurality of threads, whereas the thread holding member has a plurality of loop holding portions and a plurality of forceps passages.

(Supplementary Note 14) In Supplementary Note 7, one member of the thread holding member has an airtight means for a surgical tool such as forceps, and the suturing tool.

(Additional Item 15) In the additional item 11, a suturing instrument wherein at least one end surface of the thread holding member has a conical shape or a large chamfer.

(Additional Item 16) The suturing device according to Additional Items 1 and 11, wherein the thread holding means or the outer cylinder is deformable.

(Additional Item 17) In the additional items 1 and 11, the suturing instrument characterized in that the loop holding means or the inner cylinder is deformable.

(Additional Item 18) Additional Items 1, 6, 7, 1
1. The suturing tool according to any one of 1 and 12, wherein the forceps insertion port is deformable.

(Additional Item 19) Additional Items 1, 6, 7, 11
In the suture tool, the forceps fixing portion is deformable.

(Additional Item 20) A suturing device according to Additional Item 1, wherein the thread fixing portion is deformable.

(Additional Item 21) Additional Items 1, 6, 7, 1
1. A suturing tool according to any one of 1 and 12, which is deformable in accordance with insertion of forceps.

(Additional Item 22) The suturing device according to Additional Item 1, wherein the loop holding member is deformable.

(Additional Item 23) In the additional item 1, the suture holding member has a latch means capable of latching engagement with an adapter mounted on a surgical instrument such as forceps.

(Additional Item 24) The additional item according to Additional Item 11, wherein the outer cylinder has at least one opening on its side portion.

(Additional Item 25) In the additional item 23, the adapter is a suturing instrument having a ring for sealing the surgical instrument such as forceps.

[0225]

According to the present invention, a suture thread for forming a loop is held, a space for looping the suture thread on the inside of the loop around the forceps is kept, and a thread holding for accommodating the loop is held. Means and a thread holding member having a locking means for locking at least one position of the suture thread, and at least a part of the thread holding member is deformable, so that it can be easily operated in the body cavity. A knot can be securely sewn, and enough tissue can be sutured to heal, and the number of treatment tools such as forceps is not increased at the time of suturing, and the number of times the treatment tool is taken in and out of the body cavity is reduced. In addition, various forceps can be used for suture ligation.

[Brief description of drawings]

FIG. 1 is a perspective view showing a thread holding member according to a first embodiment of the present invention.

FIG. 2 is a perspective view showing a state in which the inner cylinder of the thread holding member is fitted and fixed in the outer cylinder.

FIG. 3 is an explanatory diagram for explaining how to wind the suture thread wound around the inner cylinder.

FIG. 4 (A) is a side view showing a first loop formed by winding a suture once around the distal end of the inner cylinder, and FIG. 4 (B) is centered on a dotted line A with respect to the first loop. A side view showing a state in which a second loop is formed by winding a suture thread around the inner cylinder so as to be symmetrical, (C) shows that the second loop is symmetrical about the dotted line portion B The side view which shows the state in which the 3rd loop was formed by winding the suture thread around the inner cylinder.

FIG. 5A is a schematic configuration diagram showing a state in which the A end of the suture thread is passed through the first to third loops, and FIG. 5B is a male-female-male knot triple ligature of the suture thread. The schematic block diagram which shows a state.

FIG. 6A is a vertical cross-sectional view showing a state before inserting the forceps A into the outer cylinder, and FIG. 6B is a vertical cross-sectional view showing a state in which the forceps A are inserted into the inner cavity of the forceps fixing portion at the rear end of the outer cylinder. FIG. 3C is a vertical cross-sectional view showing a state in which the inner cylinder is pushed out from the outer cylinder, and the thread wound around the inner cylinder is wound around the forceps A which is inserted into the inner cylinder in its original form.

FIG. 7A is a perspective view showing a state in which the A end of the suture thread is grasped by A forceps, and FIG. 7B shows the suture thread while holding the suture thread on the back side of a tissue to be ligated such as a blood vessel. FIG. 6C is a perspective view showing a state in which forceps are passed through, and FIG. 6C is a perspective view showing a state in which the thread passed through the back side of the blood vessel is held by the B forceps, and the A forceps once the thread is released is pulled out from under the blood vessel. , (D) is a perspective view showing a state in which the A end of the thread held by the B forceps is pulled out from under the blood vessel and is grasped again by the A forceps turned upward.

FIG. 8A is a perspective view showing a state in which the B end of the suture thread fixed to the outer cylinder is grasped by the B forceps in which the A end of the suture thread is separated, and FIG. 8B is the A forceps and the B forceps. FIG. 6 is a perspective view showing a state in which the knot of the suture thread is tightly tightened and the blood vessel is ligated.

FIG. 9 is a perspective view showing Kelly forceps.

10A is a perspective view showing a forceps having a linear insertion portion, and FIG. 10B is a perspective view showing a forceps having a curved portion at the tip of the insertion portion.

FIG. 11 is a perspective view showing a state in which the suturing tool is used in combination with an endoscope.

FIG. 12 is a perspective view showing the yarn holding member of a first modified example of the first embodiment with a part thereof broken away.

FIG. 13 is a perspective view showing a wound state of a suture thread according to a second modification of the first embodiment.

FIG. 14 is a perspective view showing a third modified example of the first embodiment, in which (A) shows a wound state of the suture thread,
FIG. 3B is a schematic configuration diagram showing a method of winding a suture thread called a surgical knot.

FIG. 15 is a perspective view of an outer cylinder showing a fourth modification of the first embodiment.

FIG. 16 is a side view of an inner cylinder showing a fifth modification of the first embodiment.

FIG. 17 is a side view of a thread holding member showing a sixth modification of the first embodiment.

FIG. 18 shows a seventh modified example of the first embodiment, wherein (A) is a perspective view showing the main configuration of the thread holding member,
FIG. 6B is a perspective view of a main part showing a usage state of the thread holding member.

FIG. 19 is a vertical cross-sectional view of a thread holding member showing an eighth modification of the first embodiment.

FIG. 20 is a vertical cross-sectional view showing a usage state of a yarn holding member of a ninth modified example of the first embodiment.

FIG. 21 is a vertical cross-sectional view showing the main structure of a yarn holding member of a ninth modification.

FIG. 22 is a vertical cross-sectional view of a thread holding member showing a tenth modification of the first embodiment.

FIG. 23 is a vertical cross-sectional view of a thread holding member showing an eleventh modification of the first embodiment.

FIG. 24 shows a twelfth modified example of the first embodiment, wherein (A) is a perspective view showing a state where a thread holding member is used in combination with a trocar, (B) is a thread holding figure of (A). The perspective view which shows the state which inserted the forceps used in combination with a member in a trocar.

FIG. 25 is a perspective view showing a modified example of the trocar.

FIG. 26 is a perspective view showing a film unit connected body of the suturing tool according to the second embodiment of the present invention.

FIG. 27 is an exploded perspective view of the film unit.

FIG. 28 is a perspective view showing a state in which a needle is passed through a portion to be sutured and a thread is passed through a tissue.

FIG. 29 is a perspective view showing a state in which the tag is sandwiched by B forceps and the holding film is peeled off.

FIG. 30 is a perspective view showing a state in which an extension portion on the B end side is sandwiched by B forceps and the loop portion is moved from the peripheral portion of the A forceps to the suture portion.

FIG. 31 shows a third embodiment of the present invention,
(A) is a perspective view showing the film unit, (B) is a perspective view showing a state in which the forceps are pushed out from the inside of the forceps insertion opening of the film unit, the needle is peeled off, and the thread is pulled out, (C).
FIG. 3 is an exploded perspective view of the film unit, and FIG. 6D is a perspective view showing a state in which the film unit and the forceps are inserted into the body cavity of the patient through the trocar.

FIG. 32 is a longitudinal sectional view showing a first modification of the suturing tool.

FIG. 33A is a vertical cross-sectional view showing a state where the movable valve of the trocar is closed, and FIG. 33B is a vertical cross-sectional view showing a state where the movable valve is opened by inserting forceps inside the trocar.

FIG. 34A is a vertical cross-sectional view showing a state in which a suturing tool is attached to forceps and inserted into a trocar, and FIG. 34B is a vertical sectional view showing a state in which the suturing tool body and the reducer are separated.

FIG. 35 is a longitudinal sectional view showing a first modification of the suturing tool of FIG. 32.

36 is a longitudinal sectional view showing a second modification of the suturing tool of FIG. 32. FIG.

FIG. 37 shows a second modification of the suturing tool,
(A) is a perspective view showing a schematic configuration of the entire suturing tool, (B)
[Fig. 3] is a perspective view showing a main configuration of a suturing tool.

FIG. 38 shows a third modified example of the suturing tool,
(A) is a perspective view showing a schematic configuration of the entire suturing tool, (B)
FIG. 6 is a perspective view showing a usage state of the suturing tool.

FIG. 39 is a perspective view showing a thread winding device of a suturing tool.

FIG. 40 is a perspective view showing a state in which a suture thread is wound around the thread winding device.

FIG. 41 is a perspective view showing a state in which the first cylinder is fitted in the inner cylinder and the second loop is moved to the inner cylinder.

FIG. 42 is a perspective view showing a state in which the first cylinder is returned to the original position.

FIG. 43 is a perspective view showing a state in which the second cylinder is fitted in the inner cylinder and the third loop is moved to the inner cylinder.

FIG. 44 is a perspective view showing a state in which the second cylinder is returned to the original position.

FIG. 45 is a perspective view showing a state in which the inner cylinder is removed from the bobbin winding device together with the suture thread.

FIG. 46 is a perspective view showing a state before the inner cylinder and the outer cylinder around which the suture thread is wound are assembled.

47 is a perspective view showing a modified example of the bobbin winding device shown in FIG. 39. FIG.

FIG. 48 is a perspective view showing a state where the three loops are moved to the forceps.

FIG. 49 is an exploded perspective view showing a yarn holding member according to a fourth embodiment of the present invention.

50 is a perspective view showing a state in which the inner cylinder of the thread holding member of FIG. 49 is fitted and fixed in the outer cylinder.

51 is a partial cross-sectional view of an adapter for attaching the outer cylinder of FIG. 49 to forceps.

52 is a side view showing the state where the adapter of FIG. 51 is attached to the forceps.

53 is a perspective view showing a state in which the thread holding member of FIG. 49 is attached to the forceps.

FIG. 54 is a perspective view showing a state where the inner cylinder of FIG. 49 is pushed out from the outer cylinder.

FIG. 55 is a sectional view thereof.

FIG. 56 is a perspective view showing a state in which the affected area is sutured using the suturing tool shown in FIG. 49.

FIG. 57 is a perspective view showing a state in which the end portion of the suture thread is removed from the outer cylinder of the thread holding member.

FIG. 58 is a perspective view showing a state in which the suture thread is removed from the outer cylinder of the thread holding member and then the forceps is slid to pull out the loop.

FIG. 59 is a perspective view showing a state in which the needle is passed through the loop of the suture thread extracted from the forceps.

FIG. 60 is an explanatory view sequentially showing a state in which the needle side end that has passed through the loop is pulled and the body tissue is tightened with a suture thread.

FIG. 61 is an explanatory view sequentially showing a state in which the opposite end of FIG. 60 is pulled to narrow the loop of the suture thread.

FIG. 62 is an explanatory diagram showing a state in which a loop of suture thread is pulled from both sides to form a knot.

[Explanation of symbols]

2 ... inner cylinder (thread holding means), 3 ... outer cylinder (locking means), 7 ...
Suture thread, 7L ... Loop portion, 11 ... Thread locking groove.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Minoru Tsuruta 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Naoki Uchiyama 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Kaji Kunihide 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A thread holding means for holding a suture thread forming a loop for knotting, maintaining a space for mounting the suture thread inside the loop on a forceps, and accommodating the loop. A suturing tool having a thread holding member provided with a locking means for locking at least one position of the suture thread, wherein at least a part of the thread holding member is deformable.