WO2017199392A1

WO2017199392A1 - Medical stapler system

Info

Publication number: WO2017199392A1
Application number: PCT/JP2016/064861
Authority: WO
Inventors: 岡部　洋; 熊田　嘉之; 契介釣本; 香由木村; 雅之小林
Original assignee: オリンパス株式会社
Priority date: 2016-05-19
Filing date: 2016-05-19
Publication date: 2017-11-23
Also published as: JPWO2017199392A1

Abstract

The purpose of the present invention is to reduce burden on an operator by reducing the amount of power required to deform a staple. This medical stapler system (1) includes a medical stapler (2) and staples (3). The medical stapler has a first holding member (5) and a second holding member (6) that are provided to be mutually openable and closable, the first holding member having a housing portion (9) that houses the staples and ejection holes (5b) for ejecting the staples in the housing portion, and the second holding member having an anvil portion (11) which is arranged in a position facing the ejection holes and has curved surfaces for bending a needle portion (7b) of each ejected staple in a predetermined direction. The needle portion of the staple has, at a position at which a needle tip of the needle portion abuts the curved surface, a first angle between a tangent of an outer edge in a bending direction and a tangent of the curved surface and a second angle between a tangent of an inner edge in the bending direction and the tangent of the curved surface which are set to angles to start the needle portion to bend under a load at or less than a buckling load.

Description

Medical stapler system

The present invention relates to a medical stapler system.

A medical stapler is known as a treatment tool for simultaneously suturing and cutting tissue (see, for example, Patent Document 1).
This medical stapler includes a large number of staples, a mechanism for ejecting the staples, and an anvil for deforming the ejected staples in a pair of jaws that grip tissue.

The anvil is provided with an anvil pocket having a predetermined concave curved surface shape at a position facing the staple that is punched out, and the punched staple is bent in accordance with the concave curved surface shape of the anvil pocket to embrace the tissue. It is made to be bent and stitched. That is, the staple punched out from the jaw is guided to slide along the concave curved surface of the anvil pocket after being bent in a predetermined direction by being buckled and deformed from the state where it hits the concave curved surface of the anvil pocket. It is plastically deformed into a curved shape at the time of final stitching.

Japanese Patent No. 5329956

However, since the medical stapler of Patent Document 1 is accompanied by buckling deformation at the start of bending of the staple, a large amount of force is required to drive out the staple. The number of staples to be driven out in one stitching operation is large, and the burden on the operating operator is great.
The present invention has been made in view of the circumstances described above, and provides a medical stapler system that can reduce the amount of force required to deform a staple and reduce the burden on an operator. It is aimed.

One aspect of the present invention includes a medical stapler and staples driven out by the medical stapler. The medical stapler is provided so as to be openable and closable with respect to each other. A gripping member; and a second gripping member, wherein the first gripping member includes a storage portion for storing the staple, and an ejection hole for injecting the staple stored in the storage portion, and the second grip A member is disposed at a position facing the ejection hole, and an anvil portion having a curved surface that curves the staple needle portion of the ejected staple in a predetermined direction, and the needle portion of the staple is the needle portion At a position where the tip of the needle abuts against the curved surface of the anvil portion, a first angle formed by a tangential plane on the outer edge side in the bending direction and a tangential plane on the curved surface, a tangential plane on the inner edge side in the bending direction, and the A second angle formed between the tangent plane of the face, said needle portion is a medical stapler system is set to an angle which starts curved buckling load following load.

According to the present invention, there is an effect that it is possible to reduce the amount of force required to deform the staple and to reduce the burden on the operator.

It is a longitudinal section showing a medical stapler system concerning one embodiment of the present invention. It is a longitudinal cross-sectional view which shows the open state before hold | gripping a structure | tissue with the medical stapler system of FIG. It is a longitudinal cross-sectional view which shows the closed state which hold | gripped the structure | tissue by the medical stapler system of FIG. It is a longitudinal cross-sectional view which shows the reference example which shows the relationship between a staple and the groove bottom of an anvil part. It is a longitudinal cross-sectional view which shows an example of the relationship between the staple in the medical stapler system of FIG. 1, and the groove bottom of an anvil part. It is a longitudinal cross-sectional view which shows the other example of the relationship between the staple in the medical stapler system of FIG. 1, and the groove bottom of an anvil part. 7 is a graph showing the relationship between the amount of deformation and the amount of deformation force in the relationship between the staple of FIGS. 4 to 6 and the groove bottom of the anvil portion.

A medical stapler system 1 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in FIG. 1, the medical stapler system 1 according to the present embodiment includes a medical stapler 2 and staples 3 attached to the medical stapler 2.

The medical stapler 2 includes a first gripping member (first jaw) 5, a second gripping member (second jaw) 6, and a second gripping member 6 that are swingable around the swinging shaft 4. A swing mechanism 7 that swings around the swing shaft 4 with respect to the first gripping member 5 and an injection cutting mechanism 8 that ejects the staple 3 and cuts the tissue A are provided.

The first gripping member 5 and the second gripping member 6 are shown in FIG. 2 by swinging the second gripping member 6 about the swinging shaft 4 with respect to the first gripping member 5 by the swing mechanism 7. Thus, they are moved relative to each other between an open state that is open to each other and a closed state that is closed to each other and grips the tissue A therebetween as shown in FIG.

The first gripping member 5 accommodates the plurality of staples 3 in, for example, two rows (only one row is shown in the figure) on the gripping surface (first contact surface 5a) that grips the tissue A in the first gripping member 5. A holder 10 capable of accommodating a staple cassette (accommodating section) 9 is provided. The first gripping member 5 has a first contact surface 5a that is brought into close contact with one surface of the tissue A sandwiched between the first gripping member 6 and the second gripping member 6 in a state where the staple cassette 9 is accommodated in the holder 10. An ejection hole 5b that opens to the contact surface 5a and ejects the staple 3 is provided.

For example, as shown in FIG. 5, the staple 3 includes a linear base portion 3a and a single needle portion 3b extending from one end of the base portion 3a in a direction perpendicular to the longitudinal direction of the base portion 3a. It has an asymmetric shape. The needle portion 3b is formed in a shape that smoothly curves in a direction closer to the other end of the base portion 3a as the distance from the base portion 3a increases in a plane including the base portion 3a.

More specifically, as shown in FIG. 5, the needle portion 3 b includes an outer edge 3 d and an inner edge 3 e that are curved in the same direction, and the outer edge 3 d and the inner edge 3 e are arranged on the outer sides each having a continuous curvature. It is constituted by a convex curved surface, for example, a single arc surface.
The needle tip 3c of the needle portion 3b is formed in a sharp shape that is easy to pierce the tissue A at a position where the outer edge 3d and the inner edge 3e intersect.

In the plurality of staples 3, in the staple cassette 9, the base portions 3 a of all the staples 3 are arranged in a straight line for each row, and the base portions 3 a and the needle portions 3 b of all the staples 3 are on the same plane. They are arranged at intervals so as to be arranged above. The staple 3 in each injection hole 5b is arranged with the needle portion 3b facing the side close to the opening of the injection hole 5b.

1 to 3 schematically show an example in which three staples 3 are arranged in each row. Accordingly, the ejection holes 5b for ejecting the staples 3 are also arranged in a line for each row in a state where the staple cassette 9 is accommodated in the holder 10.

When the second gripping member 6 is disposed in the closed state, the second contact surface 6a is brought into close contact with the other surface of the tissue A sandwiched between the first gripping member 5 and the second contact surface 6a. And an anvil portion 11 having a plurality of grooves for bending each staple 3 ejected from the ejection hole 5b in a predetermined direction.
The anvil part 11 includes a groove part 11 a that is disposed at a position facing each injection hole 5 b provided in the first gripping member 5 when the anvil part 11 is disposed in the closed state. In the example shown in FIGS. 1 to 3, three grooves 11 a are provided at positions facing the three injection holes 5 b for each row.

Each groove portion 11a has a groove width dimension in which a single staple 3 can be inserted, and as shown in FIG. 5 or FIG. 6, a groove bottom that abuts the needle tip 3c of the staple 3 ejected from the ejection hole 5b. 11b. In the example illustrated in FIG. 5, the groove bottom 11 b includes a flat surface and an arc surface that smoothly connects to the flat surface. In the example shown in FIG. 6, the groove bottom 11 b is configured by a concave curved surface that is smoothly curved so as to be deepest at a midway position in the longitudinal direction of the groove 11 a.

The groove bottom 11b shown in FIG. 6 is composed of two curved surfaces having different curvatures in the longitudinal direction of the groove 11a. The two curved surfaces are smoothly connected so as to share the tangent plane at the connection position of the two curved surfaces. Further, when comparing each of the two curved surfaces, the curvature at the position where the needle tip 3c of the staple 3 abuts first is in contact with the other curvature (the outer edge 3d of the needle portion 3b is in contact with the curvature of the needle portion 3b). The curvature is set to be smaller than the curvature at the position at which it is to occur.

Further, in the medical stapler system 1 according to the present embodiment, the curved surface on the outer edge 3d side of the needle portion 3b at the needle tip 3c position when the needle tip 3c of the staple 3 abuts against the groove bottom 11b of the anvil portion 11. The angle (first angle) formed between the tangent plane and the tangent plane of the curved surface constituting the groove bottom 11b is less than 53.5 °, and the curved surface on the inner edge 3e side of the needle portion 3b at the same position is connected. The angle (second angle) formed between the flat surface and the tangent plane of the curved surface constituting the groove bottom 11b is set to be larger than the first angle and less than 90 °.

FIG. 4 is a reference example in which the first angle is 53.5 ° and the second angle is 90 °.
The first angle is preferably 43.5 ° or less as shown in FIG. 5, and more preferably 28.5 ° or less as shown in FIG. 6.
Further, the second angle is preferably 80 ° or less as shown in FIG. 5, and more preferably 65 ° or less as shown in FIG.

The swing mechanism 7 includes a linear first elongated hole 7a provided in the first holding member 5 and a linear first elongated hole provided in the second holding member 6 and inclined so as to intersect the first elongated hole 7a. Two elongated holes 7b, a slider member 7c disposed through these

elongated holes

7a and 7b at the intersection of the first elongated hole 7a and the second elongated hole 7b, and the slider member 7c as the first elongated hole. An opening / closing driving force transmission member 7d that pushes and pulls in a direction along 7a.

When the slider member 7c is pressed against the distal end side of the first gripping member 5 by the opening / closing driving force transmission member 7d, the slider member 7c is moved along the first long hole 7a and the second long hole 7b. The crossing position of the long hole 7a and the second long hole 7b changes. As a result, the second gripping member 6 is swung about the swinging shaft 4 toward the open state with respect to the first gripping member 5.

Conversely, when the slider member 7c is pulled toward the proximal end side of the first gripping member 5 by the opening / closing driving force transmission member 7d, the slider member 7c is moved along the first long hole 7a and the second long hole 7b. The second gripping member 6 is swung around the swing shaft 4 toward the closed state with respect to the first gripping member 5.

The injection cutting mechanism 8 includes a slider 8a that is linearly movable along the arrangement direction of the staples 3 in the staple cassette 9 in the holder 10 of the first gripping member 5, and a shaft that applies a pressing force to the slider 8a. 8b. The slider 8a is disposed in the gap between the slope 8c that applies a radiant power in the direction in which the staple 3 is ejected from the ejection hole 5b to the base portion 3a of the staple 3, and the first contact surface 5a and the second contact surface 6a. The cutter 8d that cuts the tissue A gripped between the first contact surface 5a and the second contact surface 6a is fixed by the movement of the slider 8a.

When the slider 8a is pushed to the distal end side by applying a pressing force to the shaft 8b, the base portion 3a of the staple 3 on the most proximal side rides on the slope 8c, receives the radiation output from the slope 8c, and is ejected from the ejection hole 5b. It has come to be. Since the staple 3 is arranged with the needle tip 3c facing the opening side of the ejection hole 5b, the staple 3 ejected from the ejection hole 5b is located outward of the ejection hole 5b from the needle tip 3c side of the needle portion 3b. The tissue A that has been ejected and is gripped between the first gripping member 5 and the second gripping member 6 is penetrated in the thickness direction by the needle portion 3b.

When the slider 8a is further pressed toward the distal end side, the needle tip 3c of the needle portion 3b of the staple 3 penetrating the tissue A abuts against the groove bottom 11b of the groove portion 11a of the anvil portion 11 of the second gripping member 6. Since the needle tip 3c of the staple 3 is curved so as to fall toward the other end of the base portion 3a, an external force is received from the groove bottom 11b of the anvil portion 11 in the direction of increasing the curvature.

Then, as the staple 3 is further ejected, the needle tip 3c of the needle portion 3b slides and moves along the groove bottom 11b of the anvil portion 11, is bent so as to be folded back, and is allowed to puncture the tissue A again. It has become. Thereby, the needle 3b of the staple 3 is bent so as to embrace the tissue A, and the tissue A can be appropriately sutured.

The cutter 8d is disposed with the cutting edge facing the distal end side of the first gripping member 5, and the staple A is ejected by moving the slider 8a toward the distal end side, and the tissue A after being stitched by the staple 3 is removed. Cutting is performed in the vicinity of the stitching position by the staple 3.

The operation of the medical stapler system 1 according to this embodiment configured as described above will be described below.
In order to sew and cut the tissue A using the medical stapler system 1 according to the present embodiment, the slider member 7c is moved to the distal end side of the first gripping member 5 via the opening / closing driving force transmission member 7d of the swing mechanism 7. Apply driving force to move. Then, the slider member 7 c moves to the tip side along the first long hole 7 a provided in the first gripping member 5. Since the slider member 7c also penetrates the second elongated hole 7b provided in the second gripping member 6, the second elongated hole 7b is moved so as to change the penetrating position in the second elongated hole 7b. As a result, as shown in FIG. 2, the second gripping member 6 provided with the second elongated hole 7 b swings about the swing shaft 4 with respect to the first gripping member 5, and the first gripping member 5 And the 2nd holding member 6 will be in the open state opened mutually.

In this state, as shown in FIG. 2, the tissue A to be sutured is disposed between the first contact surface 5a and the second contact surface 6a of the first gripping member 5 and the second gripping member 6, and is swung. A driving force for moving the slider member 7 c to the proximal end side of the first gripping member 5 is applied via the opening / closing driving force transmission member 7 d of the mechanism 7. As a result, the second gripping member 6 swings about the swinging shaft 4 with respect to the first gripping member 5 and is in a closed state in which the second gripping member 6 is closed to each other as shown in FIG. The tissue A is gripped between the first contact surface 5 a of the second gripper 5 and the second contact surface 6 a of the second gripping member 6.

Next, a pressing force is applied to the shaft 8 b of the injection cutting mechanism 8. As a result, the slider 8a is pushed out to the distal end side, and as shown in FIG. 4, the base portion 3a rides on the slope 8c from the most proximal staple 3 and is ejected from the ejection hole 5b. The staple 3 arranged with the needle tip 3c of the needle portion 3b facing the opening side of the ejection hole 5b is gripped between the first gripping member 5 and the second gripping member 6 when ejected from the ejection hole 5b. The formed tissue A is penetrated in the thickness direction by the needle portion 3b.

Since the groove portion 11a is provided in the second contact surface 6a that is in contact with the other surface of the tissue A at a position facing the injection hole 5b across the tissue A, the needle portion 3b penetrating the tissue A is As shown in FIG. 5, the needle tip 3c is abutted against the groove bottom 11b by being inserted into the groove 11a.
In this case, according to the medical stapler system 1 according to the present embodiment, the outer edge 3d of the needle portion 3b is connected to the groove bottom 11b at the initial contact position between the needle tip 3c of the staple 3 and the groove bottom 11b of the groove portion 11a. Since the relative angle is less than 53.5 ° and the inner edge 3e of the needle portion 3b contacts the groove bottom 11b at a relative angle of less than 90 °, the needle portion 3b can be bent with a relatively small amount of force. .

For example, in the case of the reference example of FIG. 4, as indicated by the symbol A in FIG. 7, the deformation amount of the needle portion 3 b does not increase unless a large amount of deformation force is initially applied. That is, as in the case of the reference example of FIG. 4, the outer edge 3d of the needle portion 3b makes a relative angle of 53.5 ° with the groove bottom 11b, and the inner edge 3e of the needle portion 3b has a relative angle of 90 ° with the groove bottom. When the contact is made, the bending of the needle portion 3b is not started unless a large amount of deformation force (buckling load) for buckling the needle portion 3b is applied.

On the other hand, at the initial contact position between the needle tip 3c of the staple 3 and the groove bottom 11b of the groove 11a as described above, the outer edge 3d of the needle 3b has a relative angle of less than 53.5 ° with the groove bottom 11b. In addition, when the inner edge 3e of the needle portion 3b satisfies the condition of a relative angle of less than 90 ° with the groove bottom 11b, the amount of deformation force for starting the bending can be reduced.
In particular, the outer edge 3d of the needle portion 3b such as the staple 3 described in FIG. 5 forms a relative angle of 43.5 ° or less with the groove bottom 11b, and the inner edge 3e of the needle portion 3b has an angle of 80 ° or less with the groove bottom 11b. When the contact is made at a relative angle, the curve is as shown by symbol B in FIG. 7, and the outer edge 3d of the needle portion 3b is 28.5 ° with the groove bottom 11b as in the staple 3 described in FIG. When the following relative angles are formed and the inner edge 3e of the needle portion 3b is in contact with the groove bottom 11b at a relative angle of 65 ° or less, a curve as indicated by reference C in FIG. 7 is obtained. In this way, the needle portion 3b can be continuously curved without being given a force amount equal to or greater than the buckling load of the needle portion 3b, that is, within a range of the force amount equal to or less than the buckling load. it can.

That is, an external force applied by the slope 8c acts on the needle tip 3c that has abutted against the groove bottom 11b in a direction orthogonal to the second contact surface 6a at the contact position, but the outer edge 3d of the needle portion 3b is applied to the needle tip 3c. Since the second contact surface 6a is in contact with the groove bottom 11b at a shallow angle, and the inner edge 3e of the needle portion 3b is at an angle of less than 90 °, the reaction force received from the second contact surface 6a A moment in the direction of bending the portion 3b is generated, and the needle tip 3c slides on the groove bottom 11b. As a result, the load received by the needle portion 3b is equal to or less than the buckling load, and the needle portion 3b is bent from the beginning of contact without buckling, so that an increase in deformation force due to buckling can be prevented.

The needle portion 3b is guided to bend by the shape of the groove bottom 11b, is bent so as to be folded back to the tissue A side, and is punctured into the tissue A again. Thereby, the tissue A can be firmly sutured by the staple 3.

Next, in conjunction with the operation of ejecting the staple 3, the cutter 8 d provided on the slider 8 a cuts the tissue A adjacent to the portion stitched by the staple 3. Accordingly, the operation of pushing the shaft 8b toward the distal end side sequentially repeats the stitching and cutting of the tissue A, and the tissue A that has been properly sutured by the staple 3 can be separated.

As described above, according to the medical stapler system 1 according to the present embodiment, the staple 3 starts to bend without buckling. Therefore, the amount of force required when the tissue A is sutured can be reduced. Even in the suturing operation in which the staples 3 are sequentially bent, there is an advantage that the burden on the doctor can be greatly reduced.

In the present embodiment, the case where three staples 3 are arranged in two rows is illustrated for ease of illustration and description, but the number of staples 3 and the number of rows per row are arbitrary. Good.
The medical stapler 2 that swings the two

gripping members

5 and 6 is illustrated, but the medical stapler that deforms a large number of staples 3 at a time like a circular or linear type medical stapler. You may apply to the stapler system 1. FIG. By doing in this way, the force at the time of deform | transforming many staples 3 at a time can be reduced significantly, and the reduction effect of a doctor's burden can be improved.

DESCRIPTION OF SYMBOLS 1 Medical stapler system 2 Medical stapler 3 Staple

3b Needle part

3c Needle tip

3d Outer edge 3e Inner edge 5 1st holding member 5b Injection hole 6 2nd holding member 9 Staple cassette (accommodating part)
11 Anvil Department A Organization

Claims

Comprising a medical stapler and staples driven out by the medical stapler;
The medical stapler is provided so as to be openable and closable with each other, and includes a first gripping member and a second gripping member that can grip tissue in the closed state,
The first gripping member includes a storage unit that stores the staples, and an injection hole that injects the staples stored in the storage unit,
The second gripping member is disposed at a position facing the ejection hole, and includes an anvil portion having a curved surface that curves the needle portion of the ejected staple in a predetermined direction,
The staple portion of the staple has a first angle formed by a tangential plane on an outer edge side in a bending direction and a tangential plane of the curved surface at a position where a needle tip of the staple portion abuts on the curved surface of the anvil portion, and the curved portion. A medical stapler system in which a second angle formed by a tangential plane on the inner edge side of the direction and a tangential plane of the curved surface is set to an angle at which the needle portion starts to bend with a load equal to or less than a buckling load.
The medical stapler system according to claim 1, wherein the outer edge of the needle portion is formed of an outwardly convex curved surface having a continuous curvature.
The first angle is less than 53.5 °;
The medical stapler system according to claim 1 or 2, wherein the second angle is less than 90 °.
The first angle is 43.5 ° or less;
The medical stapler system according to claim 3, wherein the second angle is 80 ° or less.
The first angle is 28.5 degrees or less;
The medical stapler system according to claim 3, wherein the second angle is 65 ° or less.