JPH0654855A - Needle holder for operation under endoscope, cartridge for ligature and suturing and ligating device for operation under endoscope consisting of combination thereof - Google Patents

Abstract

PURPOSE:To enable the free control of the angle of a needle within the abdominal cavity and to enable the execution of rapid ligature without the need for putting yarn for forming a knot to the outside of a trochar 65 during the course of suture. CONSTITUTION:A needle holding piece body 8 of a needle holding device 1 consists of a combination of two pieces of lower holding pieces 5, 6 and one piece of an upper holding piece 7. The needle angle is freely adjusted by sliding the lower holding piece. The cartridge for ligature is freely slidably fitted with a cartridge body 41 having a through-hole to enable the penetration of the needle holder in a sleeve tube 60 and bushing tube bodies 42, 50 having a yarn engaging means at the front end. The cartridge is previously mounted with yarn 71 with the needle and executes suture by delivering the knot to the sutured part with the bushing tubes after suture.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic surgical instrument, and more particularly to an endoscopic surgical suturing and ligating apparatus comprising a needle holder, a ligating cartridge and a combination thereof.

[0002]

2. Description of the Related Art Recently, in place of conventional open surgery, various treatment tools such as forceps and scalpels are inserted from the puncture site of the abdominal wall to perform surgical treatment under endoscopic observation. Surgery is performed by cholecystectomy. Endoscopic surgery has the advantage that the physical recovery after surgery is fast and the physical burden on the patient is light, but the surgeon cannot obtain a stereoscopic view because it is performed under endoscopic observation. Since it is performed by remote operation, there is a problem that the operation is very troublesome and requires a high degree of skill in operation. In particular, in the suturing method, handling of the needle and ligation are troublesome, and it takes a considerably long time to suture.

In the conventional suturing method in endoscopic surgery, first, the thread portion of the thread with a needle is held by a needle device, the trocar is passed through the needle device, and forceps are inserted from another trocar. , Hold the needle held by the needle holder with this forceps, change the needle with the needle holder, and operate the forceps and the needle holder to adjust the angle of the needle. Next, bring the needle holder to the sutured part, operate the forceps and needle holder to suture, hold the thread, and once pull the thread out of the trocar, make a knot, and push the knot into the abdominal cavity Send in and ligate. This operation 1
Repeat 3 times, and finally cut the thread to finish. in this way,
This conventional method requires a lot of trouble such as changing the needle and taking the thread in and out of the trocar. Moreover, since it is not a stereoscopic field of view, it is difficult to determine the direction of the needle tip and it is difficult to adjust the angle of the needle, and since the thread feeding path is long, entanglement of the thread easily occurs and there are many problems. Ligation is the biggest obstacle in laparoscopic surgery.

[0004]

The present invention was devised to solve the above-mentioned problems of the conventional endoscopic surgery, and can be easily performed in the abdominal cavity only by operating a needle holder. Consists of a needle holder, a ligating cartridge, and a combination thereof that can freely control the angle of the needle, do not let the thread go out of the trocar during suturing, and can ligate quickly with less entanglement of the thread. An object of the present invention is to provide a suturing / ligating device for endoscopic surgery.

[0005]

A needle holder for endoscopic surgery according to the present invention, which has the above-mentioned object, comprises three holding pieces, two lower holding pieces and one upper holding piece. Each of the holding pieces has a needle holding portion integrally formed at the tip of the rod portion, and the holding portions of the three holding pieces constitute a needle holding port, and the two lower holding pieces slide on each other with respect to the upper holding piece. A needle holding piece body that is movably combined, and an outer tube that can be slidably fitted in the needle holding piece body and that has a shorter length than the needle holding piece body. did it. By providing a slidable needle holding piece control body having a lower holding piece control lever on the outer tube, the two lower holding pieces can be easily slid.

Further, the ligating cartridge of the present invention which achieves the above object has a cartridge main body having a through hole having a size capable of penetrating a needle holder therein, a push tube body having a thread engaging means at a tip thereof, and an outer jacket. The cartridge body and the push tube body are fitted to the outer cover, and the push tube body is slidable with respect to the cartridge body. There is. The push cheve
A combination of a first push tube body through which a wire that forms a loop that expands and contracts at the tip of the tube penetrates, and a second push tube body that passes the thread through the tube and outputs the end of the thread to the outside , Various forms of knots can be easily ligated, which is desirable. Then, by combining the needle holder and the ligation cartridge, a suturing / ligating device for endoscopic surgery that can achieve the above object can be obtained.

[0007]

[Function] The needle-holding piece is composed of two lower-holding pieces and one upper-holding piece, and each needle-holding portion constitutes a needle-holding port. Therefore, as shown in FIG. It can be held with three points, one on the upper side. Therefore, with the needle lightly held,
When one lower holding piece is slid relative to the other lower holding piece, the needle rotates about the upper one point and the needle angle can be easily adjusted. The lower holding piece can be slid by rotating the lower holding piece control lever while observing with the endoscope. Further, the needle is rotated by relatively sliding the upper holding piece and the lower holding piece, and the rotation angle of the needle can be arbitrarily adjusted within the abdominal cavity. Since the holding part of the needle holding piece is tilted outwardly and integrally with the tip of the rod part, the needle holding port is opened by moving the needle holding piece outward with respect to the outer tube, By moving it toward the outer side, the inclined surface of the needle holding portion is pushed by the tip of the outer tube to close the needle holding port. Therefore, it is possible to arbitrarily adjust the gripping force of the needle by the needle holding piece by moving the needle holding piece into and out of the outer tube.
The needle can be firmly held so that the needle does not move during suturing.

The cartridge main body of the ligating cartridge has a distal end that is obliquely opened in a cut shape, and a needle guide groove having a convex line is formed on the upper side thereof along the axial direction. The tip is guided and engaged with the needle tip guide groove to maintain a fixed posture and is collected. The first push tube body allows one end of the thread to pass through from the inside of the tube and guides it to the outside of the trocar and holds it, so that a knot can be sent out and pressed against the ligation portion at the time of ligation, and the thread can be passed through the tube. Since the thread is exposed to the outside, it can be pulled smoothly without getting tangled, and ligation can be performed easily and satisfactorily. In addition, since the thread can be sandwiched and held by the wire penetrating the inside of the tube in the opening provided inside the tip, a plurality of knots can be formed and held from the beginning, and the thread can be knotted for each knot. There is no need to put it in or out of the trocar. Further, the second push tube body has a loop of wire formed at its tip, and when the thread is passed through the loop and the end of the wire is pulled, the loop is closed and the thread can be held. Then, the knot set at the tip of the cartridge body is sent out and pressed against the ligature. Thereby, the knot of the thread can be surely pressed against the ligature portion and tightly ligated.

According to the type of knot, a thread with a needle is attached to the ligation cartridge in advance in each form, and then a needle holder is inserted into the cartridge body to hold the needle and cover the outer tube. The preparation is completed by inserting the needle into the trocar, bringing the needle holding port to the sutured portion, and adjusting the needle angle. By operating the needle holder in that state, the needle is hooked on the sutured portion to suture. When the needle is pulled out, the thread is clamped at a position 5 to 6 cm away from the needle, and the needle holder is pulled into the cartridge body, so that the needle is guided by the tip of the cartridge body and the needle tip naturally guides the needle tip. It is drawn so as to be located inside and is collected in the cartridge body. When the needle-side yarn end is pulled into the cartridge body, the yarn tip passes through the loop of the yarn that is wound around the cartridge body and held, and a predetermined knot is naturally formed. Therefore, in that state, the first knot is pushed out from the outer peripheral portion of the cartridge main body by the tips of the first and second push tube bodies to bring it to the suture portion, and the ligature is surely ligated by pulling the thread end. You can Then, the holding of the thread held in the inner opening of the first push tube body is released, and the second knot is fed out and ligated in the same manner, whereby ligation having a plurality of knots can be performed. Since it is not necessary to tie a knot externally for each knot, ligation can be performed more quickly than in the past.

[0010]

Embodiments of the present invention will now be described in detail with reference to the drawings. FIG. 1 shows an embodiment of a suture / ligation device for endoscopic surgery of the present invention, and FIGS. 2 to 6 show an embodiment of a needle holder. In the figure, 1 is a needle holder, and a needle holding piece body 8 made of a combination of three holding pieces, a lower holding piece 5, 6 and an upper holding piece 7, is fitted to the outer tube 2. In these needle holding pieces, an elongated rod portion 10 is integrally formed following the needle holding portion 9 at the tip portion, and the needle holding portions of the three needle holding pieces form a needle holding opening 11. The base end of the needle holding portion of each needle holding piece has an angle with respect to the rod portion so as to be inclined in the outward direction.
The needle holding port is open when the rod parts of the book holding part are simply aligned, but the needle holding port is closed by sliding the needle holding part with respect to the outer tube 2 as described later. It has become. The needle holding portion of each needle holding piece has a filed surface on its holding surface to enhance friction with the needle. As shown in FIG. 6, the holding portion is configured such that two lower holding pieces 5, 6 and an upper holding piece 7 are engaged with each other to hold a needle at an upper point and a lower point. By moving either one of them in the axial direction, it is possible to control the intersecting angle between the needle axis of the needle being held and the needle holding piece, and the lower holding pieces 5, 6 together or the upper holding piece. The needle can be rotated by sliding only 7.

Reference numeral 11 denotes an outer tube control flange serving as a knob when the outer tube is slid with respect to a ligation cartridge described later, and is fixed to the outer tube 2. Reference numeral 15 denotes a needle holding piece control body slidably fitted to the outer tube, and a pair of narrow widths are formed on one side surface of a support ring 16 slidably fitted to the outer tube. Support plates 17 and 18 are fixed. A lower holding piece control lever 2 for slidingly controlling the lower holding pieces 5, 6 on the support plates 17, 18.
Numerals 0 and 21 are rotatably pivotally attached by pivots 22 and 23. Pins 24 and 25 are provided between both ends of the lower holding piece control levers 20 and 21, respectively, and the pins 24 and 25 are provided on the lower holding piece so as to project laterally.
The character rods 26 and 27 are loosely fitted. Reference numeral 30 denotes a nut for fixing the upper gripping piece, which is provided between the end portions of the support plates 17 and 18, has a female screw formed inward, and allows the rod portion of the upper gripping piece to penetrate through the center portion with a space. The tube 31 is screwed into the tube 31 in which a through hole of a certain degree is formed, and the tube 31 is rotated by rotating the nut for fixing the upper holding piece,
The inner peripheral surface of the through hole is pressed against the outer periphery of the rod portion of the upper holding piece penetrating the through hole to fix the upper holding piece and prevent its movement in the axial direction. Reference numeral 33 is a knob for finely adjusting the upper holding piece, which is fixed to the end of the upper holding piece. However, these upper holding piece fixing mechanisms do not necessarily have to be provided.

The needle holder of this embodiment is constructed as described above, and the needle holding port 11 is opened by holding the support ring 16 and moving the needle holding piece 8 forward with respect to the outer tube 2, The pinching of the needle can be released, and by moving the needle in the opposite direction, it is restricted by the tip of the outer tube 2 and the pinching port 11
Is closed and the needle holding force of the needle holding piece can be arbitrarily adjusted by moving the needle holding piece 8 in and out of the outer tube. Also, hold the needle loosely at the needle holding port 11,
In that state, by rotating the lower holding piece control levers 20 and 21 around the pivots 22 and 23, the pin 2
4, 25 engage the U-shaped rods 26, 27 to move the lower holding pieces 5, 6 via the U-shaped rod in the opposite directions along the axial direction. As a result, the angle of the needle held by the holding portion can be adjusted, and the needle can be rotated by moving the knob 33.

Next, an embodiment of a ligating cartridge is shown in FIG.
And it demonstrates in detail based on FIGS. Note that some of these drawings are exaggerated so that the configuration can be easily discriminated and are drawn in appropriate sizes. The scale of each drawing is completely irrelevant. The ligation cartridge of this embodiment is composed of a cartridge body 41, a first push tube body 42, a second push tube body 55, and an outer tube 60 in combination. Cartridge body 41
Has a circular tubular shape having a through hole 45 (FIG. 12) through which the needle holder penetrates, and the tip 46 is opened in a slanting shape, and subsequently, the upper side is convex along the axial direction. The needle tip guide groove 47 is formed so that the needle tip is guided and engaged with the needle tip guide groove 47 to maintain a constant posture and is collected. In addition, as shown in FIG.
In order to prevent the yarn from being entangled, a clip 48 for holding the yarn is appropriately provided. The clip 4
No. 8 holds the thread so that the tip side is opened and the thread is caught and freely pulled out. First push tube body 42
Is for penetrating one end of the thread from the inside of the tube and guiding it to the outside of the trocar to hold it, and at the time of ligation, sends out a knot and presses it against the ligation portion to ligate without loosening. The tube 43 of the push tube body 42
In addition to the tip opening, a plurality of side openings 44 (only one is shown in the drawing) are formed in the axial direction about 5 mm inside from the tip as required. A thread knot is inserted from the side port 44 in a state where a wire 49 having an outer diameter slightly smaller than the inner diameter of the tube penetrates the side port 44, and the wire 49 is connected to the inner wall of the tube. It is possible to hold it by sandwiching it. As a result, a plurality of knots can be formed and held from the beginning, and it is not necessary to put the yarn in and out of the trocar for each knot.

Also, the second push tube body 50 is
This is for sending out a knot which is formed in advance and set on the tip of the cartridge body while holding the thread, and is pressed against the ligating portion for ligation. As shown in FIG. 12, the needle guide groove 47 of the cartridge body 41 is It is made of a thin tube that can be placed laterally. As shown in FIG. 9, the push tube body is fitted with a wire stopper 53 having two holes through which a thin wire 52 can penetrate at the tip of the tube 51 and fixed, and one hole is formed in the wire stopper hole. A wire loop 54 is formed at the tip of the wire 52 through both ends of the wire 52, both ends of the wire 52 are drawn outward from the other open end of the tube 51, and a spring 55 is provided between the drawn tip and the tube tip. , Wire 52
Is always pulled out in the right direction in FIG. 9 to urge the loop 54 to be closed. The outer tube 60 includes the cartridge body 41, the first push tube body 42,
The guide plug 6 has an inner diameter large enough to allow the second push tube body 50 to pass through all at once and slide freely, and has holes formed at the ends thereof.
1 is fitted.

The ligating cartridge composed of the above members is combined and inserted into the outer tube 60 as shown in FIGS. 11 and 12, and the outer tube is inserted into the trocar 65 as shown in FIG. Used. A combination of the ligating cartridge and the needle holder constitutes a suturing / ligating device for endoscopic surgery.
Ligation is performed as follows. First, the thread 71 with the needle 70 attached to the ligating cartridge 40 is preliminarily attached in each form according to the type of knot such as leaf knot, club hitch, radar knot, or two-half hitch. For example, in the case of a leaf knot, the thread with needle is attached in the form as shown in FIG.

When the thread is attached to the ligation cartridge 40, the needle holder 1 is inserted into the cartridge body so that the needle 70 has a holding angle as small as possible with the needle holder 1 so that the needle 70 can easily pass through the tube. Hold the needle. In this state, the mantle tube 60 is covered, and the abdominal wall is perforated and inserted into the inserted trocar 65, and after passing through the trocar, the needle holding port 11 of the needle holder 1 is brought to the sutured portion, and the lower holding piece control lever. 20 and 21 are operated to slide the lower holding pieces in the directions opposite to each other, thereby adjusting the angle to an optimum angle for raising and suturing the needle. After that, the outer tube control flange 12 is operated to move the outer tube 2 to the needle holding port side,
Hold the needle firmly at the adjusted angle. As a result, the needle is firmly held in the gripping opening, which facilitates suturing.

In this state, the needle 70 is hooked on the sutured portion 72,
The holding of the needle 70 is once released, and the needle 70 is removed by pulling the needle to the tip of the needle or the like. Next, the thread 70 is held by the holding port 11 at a position 5 to 6 cm away from the needle, and the needle holder 1 is pulled into the cartridge body. At that time, the needle 70 is attached to the cartridge body 4
The needle tip is naturally guided by the beveled tip 46 of FIG. 1 so that the needle tip is positioned in the needle tip guide groove 47, and is collected in the cartridge body. By pulling the needle-side yarn end into the cartridge body, the yarn tip passes through the inside of the loop of the yarn 71 that is wound and held around the cartridge body 41 according to the knot shape, as shown in FIG. In this state, the yarn end that passes through the first push tube body and is exposed to the outside is held, and the first knot is attached to the outer periphery of the cartridge main body by the tips of the first and second push tube bodies. It is pushed out and brought to the sutured portion 72, and the thread end is pulled to ligate.
At that time, since the knot is pressed against the suture portion to perform the ligation, it is possible to surely perform the ligation. Then, the second knot is fed out in the same manner and ligated in the same manner, whereby the ligation having a plurality of knots can be performed. Then, the thread is cut to complete the ligation.

Although the embodiment of the suture / ligation device for endoscopic surgery comprising the needle holder, the ligating cartridge and the combination thereof according to the present invention has been described above, the present invention is not limited to the above embodiment. , Various design changes are possible. For example, the needle holding piece control body is not necessarily limited to the embodiment described above, and may have any form as long as it can slide the two lower holding pieces. Also,
The push tube body is preferably two sets as in the above embodiment, but one set is also possible. Further, in the above embodiment, both the needle holder and the ligation cartridge are formed of a rigid body and do not bend, but if they are made of a flexible material and can be bent arbitrarily, under the conventional endoscope, It is also possible to ligate the back side of an organ that was difficult. The needle holder and the ligation cartridge of the present invention are not necessarily limited to the combination of the both, and may be used in combination with the needle holder and the conventional ligation instrument, or in combination with the ligation cartridge of the present invention and the usual grasping forceps. Of course it is possible.

[0019]

The present invention has the following special effects. According to the needle holder of the present invention, the angle of the needle can be freely controlled within the abdominal cavity. Therefore, it is only necessary to pass the inside of the trocar while holding the needle with the needle holder and adjust to the optimum angle at the sutured site, so there is no need to hold the needle with the needle holder with forceps in the abdominal cavity as in the past. . Moreover, since the needle can be strongly clamped, it is possible to reliably perform suturing. Further, according to the ligation cartridge of the present invention, it is possible to preliminarily attach a thread with a needle in accordance with various types of knots, and it is not necessary to take out the thread after suturing to form a knot and Since ligation can be performed continuously, it can be performed much more quickly than in the past. In addition, since the thread is not taken in and out so much, the thread is not entangled so that the ligation can be performed quickly. By operating the two push tube bodies, the knot can be reliably delivered to the suture site and pressed. The ligation can be performed easily and satisfactorily. Since the needle tip of the cartridge body is naturally guided and engaged in the needle tip guide groove and is collected while maintaining a constant posture, the needle tip does not damage the thread.

[Brief description of drawings]

FIG. 1 is a perspective view of an endoscopic surgical suture according to an embodiment of the present invention.
It is a perspective view in the use state of a ligation device.

FIG. 2 is a side sectional view of a needle holder.

3 is a cross-sectional view taken along the line AA of FIG.

FIG. 4 is a sectional view taken along line BB of FIG.

5 is a sectional view taken along line CC of FIG.

FIG. 6 is a front view of a needle holding port.

FIG. 7 shows a cartridge main body of a ligation cartridge, (a) is a side view, (b) is a plan view, and (c) is a bottom view.

FIG. 8 is a side view of the outer tube of the ligation cartridge.

FIG. 9 is a side view of a second push tube body of the ligation cartridge.

FIG. 10 is a side view of a first push tube body of the ligation cartridge.

FIG. 11 is a side view of the ligation cartridge.

FIG. 12 is a front view thereof.

FIG. 13 is an explanatory diagram of a state where the thread is attached to the ligation cartridge.

FIG. 14 is an explanatory view showing a state at the time of ligation by the ligation cartridge.

[Explanation of symbols]

1 Needle holder 2 Outer tube 5,6 Lower holding piece 7 Upper holding piece 8 Needle holding piece body 15 Needle holding piece control body 20,21 Lower holding piece control lever 40 Ligation cartridge 41 Cartridge body 42 First push tube body 43 tube 44 side opening 45 through hole 47 needle tip guide groove 48 clip 49 wire 50 second push tube body 51 tube 60 mantle tube 65 trocar 70 needle 71 thread

Claims (5)

[Claims] 1. A lower holding piece and an upper holding piece, wherein each holding piece is integrally formed with a needle holding portion at a tip of a rod portion, and the holding portion of the three holding pieces holds the needle. A needle holding piece body that constitutes a holding mouth and is formed by slidably combining the two lower holding pieces with respect to the upper holding piece, and the needle holding piece body is slidably fittable A needle holder for endoscopic surgery, which is characterized by being combined with an outer tube having a short length. 2. The needle holder for endoscopic surgery according to claim 1, wherein a needle holding piece control body having a lower holding piece body control lever is slidably provided on the outer tube. 3. A cartridge main body having a through hole of a size capable of penetrating a needle holder therein, a push tube body having thread engaging means at a tip thereof, and an outer sheath tube, wherein the cartridge main body is provided in the outer sheath. The push tube body is fitted with the push tube body, and the push tube body is slidable with respect to the cartridge body. 4. A first push tube body through which a wire forming a loop at the tip of the push tube penetrates, and a second push tube body through which a thread is inserted into the tube and the end of the thread is exposed to the outside. The cartridge for ligation according to claim 3, wherein 5. The endoscopic surgery needle holder according to claim 1, wherein the needle holder for endoscopic surgery according to claim 1 is fitted into a through hole of a cartridge main body of the ligation cartridge according to claim 3. Suture / ligation device.