CN102138813B - Stitching instrument - Google Patents
Stitching instrument Download PDFInfo
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- CN102138813B CN102138813B CN201010106072.6A CN201010106072A CN102138813B CN 102138813 B CN102138813 B CN 102138813B CN 201010106072 A CN201010106072 A CN 201010106072A CN 102138813 B CN102138813 B CN 102138813B
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- leading section
- stiching instrument
- bar portion
- pusher
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Abstract
The invention provides a stitching instrument, which comprises an insert disposal part, a barrel-shaped operation main body, a rod part, a front end part of pushing device, and a guide mechanism, wherein a stitching part used for stitching tissues by using an endoscope is arranged at the front end of the insert disposal part; the barrel-shaped operation main body is connected with a base end of the insert disposal part; the rod part is inserted into the base end of the operation main body along the axis of the operation main body to eject a suture from the front end of the stitching part and operate a plurality of end part components connected with at least one end of the suture; the front end part of the pushing device pushes and presses the end part components corresponding to operations of the rod part; the guide mechanism performs guide to individually eject respective end part components; and finally, the end part components can be separated.
Description
Technical field
The present invention relates to be inserted into the stiching instrument using in body cavity.Relate in more detail and use stitching thread that fixture (anchor) is installed in end to being formed at the stiching instrument using when the perforation etc. of the luminal organs such as stomach, intestinal is sewed up.
Background technology
In the past, for the object that the perforation, the laceration etc. that are formed on the luminal organs such as stomach, intestinal are sewed up, known use was provided with the sutural stiching instrument (for example,, with reference to International Publication 2007-37326 communique) of fixture at two ends.In this stiching instrument, the fixture that makes stitching thread two ends is in tissue or organize wild card to schedule the tissue around perforation, by straining stitching thread, by the tissue approximation of fixture institute engaging, thereby sews up.
Sew up reliably in order to utilize the stiching instrument described in International Publication 2007-37326 communique, relative tissue place that need to be around this above-mentioned perforation etc., penetrate each time reliably a fixture that fills in stiching instrument front end from stiching instrument front end, make this fixture engaging in tissue.Therefore,, in the stiching instrument described in International Publication 2007-37326 communique, be located at the groove and the protrusions snap of inner surface of pin that is located at stiching instrument front end of the surperficial ring-type of fixture.And, be following structure: in the time having penetrated fixture, engaging between groove and projection thrown off and transmitted this sense of touch to user, thereby user can recognize this situation of fixture that penetrated.
Summary of the invention
A kind of stiching instrument of the present invention's the first technical scheme, it comprises: insert disposal portion, it has the suturing part that utilizes the stitching that endoscope organizes at front end, the operating main body of tubular, it is connected in the cardinal extremity of above-mentioned insertion disposal portion, bar portion, its mode with the axis along aforesaid operations main body is inserted into the cardinal extremity of aforesaid operations main body, carries out penetrating stitching thread and the operation of multiple end members of being connected with above-mentioned sutural at least one end from the front end of above-mentioned suturing part, pusher leading section, its operation corresponding to above-mentioned bar portion and push above-mentioned end member and move, and guide, it makes above-mentioned pusher leading section carry out the position after rectilinear movement, the rectilinear movement of above-mentioned pusher leading section is stopped, make to penetrate an above-mentioned end member from the front end of above-mentioned suturing part, by making above-mentioned bar portion upwards rotate ormal weight in week, thereby make the state of another above-mentioned end member in penetrating, repeat above-mentioned rectilinear movement and above-mentioned rotation guides, make individually to penetrate each end member of above-mentioned multiple end members, above-mentioned guide comprises: cylindrical structural member, it is configured in the base end side of above-mentioned insertion disposal portion, be linked to above-mentioned suturing part by coupling member, fastened component, it is fixed on the front end of above-mentioned bar portion, and is inserted in above-mentioned cylindrical structural member, , a guiding groove, this guiding groove has multiple pods and multiple translot in the either party's of above-mentioned cylindrical structural member and above-mentioned fastened component circumferential side, above-mentioned multiple pod be around axis the position in different angles and on axis direction extend and form, along axis, above-mentioned pusher leading section can being advanced and retreat guides above-mentioned pusher leading section movably, above-mentioned multiple translot is that the mode upwards each end of above-mentioned multiple pods is coupled together in week extends to form, and the advance and retreat movement of above-mentioned pusher leading section is limited, protuberance, its opposing party who is fixed on above-mentioned cylindrical structural member and above-mentioned fastened component is upper, engages with above-mentioned guiding groove, and lobe, it is for limiting along the movement of above-mentioned guiding groove above-mentioned protuberance.
A kind of stiching instrument of the second technical scheme of the present invention, it comprises: insert disposal portion, it has the suturing part that utilizes the stitching that endoscope organizes at front end, the operating main body of tubular, it is connected in the cardinal extremity of above-mentioned insertion disposal portion, bar portion, its mode with the axis along aforesaid operations main body is inserted into the cardinal extremity of aforesaid operations main body, carries out penetrating stitching thread and the operation of multiple end members of being connected with above-mentioned sutural at least one end from the front end of above-mentioned suturing part, pusher leading section, its operation corresponding to above-mentioned bar portion and push above-mentioned end member and move, and guide, it makes above-mentioned pusher leading section carry out the position after rectilinear movement, the rectilinear movement of above-mentioned pusher leading section is stopped, make to penetrate an above-mentioned end member from the front end of above-mentioned suturing part, by making above-mentioned bar portion upwards rotate ormal weight in week, thereby make the state of another above-mentioned end member in penetrating, repeat above-mentioned rectilinear movement and above-mentioned rotation guides, make individually to penetrate each end member of above-mentioned multiple end members, above-mentioned guide also has rotary cam structure, this rotary cam structure moves by the pushing of above-mentioned bar portion forward end direction, above-mentioned bar portion after rotating predetermined distance at every turn, front end is stopped.
Brief description of the drawings
Fig. 1 is the figure that represents the stiching instrument of first embodiment of the invention.
Fig. 2 is the enlarged drawing that represents the leading section of this stiching instrument with partial cutaway.
Fig. 3 is the figure of the suturing assembly that represents that this stiching instrument uses.
Fig. 4 is the figure that represents the operating portion of this stiching instrument with partial cutaway.
Fig. 5 is the figure that represents the operating portion of this stiching instrument with partial cutaway.
Fig. 6 is the figure that represents a part for the operating portion of this stiching instrument.
Fig. 7 is the operating portion while representing to use this stiching instrument and inserts the figure of disposal portion.
Fig. 8 is the figure that represents a process of being sewed up by this stiching instrument.
Fig. 9 is the figure that represents a process of being sewed up by this stiching instrument.
Figure 10 is the figure of the action of the bar portion while representing to use this stiching instrument.
Figure 11 is the figure of the action of the operating portion while representing to use this stiching instrument.
Figure 12 is the figure of the action of the leading section while representing to use this stiching instrument.
Figure 13 is the figure that represents a process of being sewed up by this stiching instrument.
Figure 14 is the figure of the action of the bar portion while representing to use this stiching instrument.
Figure 15 is the figure of the action of the operating portion while representing to use this stiching instrument.
Figure 16 is the figure of the action of the operating portion while representing to use this stiching instrument.
Figure 17 is the figure of the action of the leading section while representing to use this stiching instrument.
Figure 18 is the figure that represents a process of being sewed up by this stiching instrument.
Figure 19 is the figure that represents a process of being sewed up by this stiching instrument.
Figure 20 is the figure that represents a process of being sewed up by this stiching instrument.
Figure 21 is the figure of the action of the operating portion while representing to use this stiching instrument.
Figure 22 is the figure that represents a process of being sewed up by this stiching instrument.
Figure 23 is the figure that represents the structure of a part for the stiching instrument of second embodiment of the invention.
Detailed description of the invention
Below, with reference to Fig. 1～Fig. 6, the stiching instrument of first embodiment of the invention is described.
Fig. 1 is the figure that represents the stiching instrument 1 of present embodiment.Stiching instrument 1 comprises: be inserted into the elongated insertion disposal portion 2 in body; Be configured in insert disposal portion 2 base end side, for operating the operating portion 3 of each mechanism.
Fig. 2 is the enlarged drawing that represents to insert disposal portion 2 with partial cutaway.Inserting disposal portion 2 comprises: as the epitheca 8 of tubulose of urceolus that inserts disposal portion 2; Pin 4, it can advance and retreat and be configured in the inner side of front opening in epitheca 8, in front, suturing assembly described later is installed; From base end side free to advance or retreat be inserted into pusher (pusher) leading section 9 pin 4; The operating line 5 that pusher leading section 9 and operating portion 3 are linked up; Front end helical sheath (coil sheath) 6A, it is fixed on the base end part of pin 4, runs through for pusher leading section 9 and operating line 5; Pipe 7, it is fixed on the base end side of front end helical sheath 6A, runs through for operating line 5; Internal coiling sheath 6, it, is inserted between pipe 7 and operating line 5 more by base end side than front end helical sheath 6A, runs through for operating line 5.Form and make suturing assembly described later be sticked in the suturing part 2a that tissue is sewed up by the leading section of pin 4, pusher leading section 9, epitheca 8.
Pin 4 is the hollow members that formed by metal or other materials, is formed with groove 4A at upper surface.Contain the fixture (end member) of suturing assembly in the inside of pin 4.
Fig. 3 is the figure that represents to be housed in the suturing assembly 103 in pin 4.Suturing assembly 103 comprises: stitching thread 104; The locating part (stopper) 105 running through for stitching thread 104; Be arranged on the first bar-shaped fixture 106 of length L 1 and the second bar-shaped fixture 107 of length L 1 at the two ends of stitching thread 104.
Locating part 105 is the end 105A of left and right of the length direction of the tabular member that forms with the resin by metal, biodegradable resin etc. etc. and 105B mode bending respect to one another, end 105A and 105B engagings and forming mutually.
Pay and be closely provided with hole 105C in the left and right directions central authorities of locating part 105, be configured to extend through the 105C of hole from the face of a side contrary with end 105A, 105B at the stitching thread 104 of mid point 104A bending, between end 105A and end 105B by mutual engaging.Action during below to the use of locating part 105 is described.
As shown in Figure 2, accommodate the first fixture 106 and second fixture 107 of suturing assembly 103 with the state of arranging in the inside of pin 4 on axis direction, and make the first fixture 106 to the second fixtures 107 more be positioned at front.The stitching thread 104 that is linked to each fixture 106,107 is exposed to the outside of pin 4 from groove 4A.
In addition, on fixture 106,107, be respectively equipped with slot 106A, 107A.Each slot 106A, 107A respectively be projected into pin 4 lumen side the not shown engaging protrusion that arranges fasten, the mistake that prevents each fixture 106,107 penetrates and the front end of pin 4 naturally coming off in the time of vertical lower etc.
Pusher leading section 9 is formed by metal or other materials, and its front end extends through pin 4 from the cardinal extremity 4B of pin 4.By operating line 5 is advanced to the front of pin 4 along axis direction, thus, pusher leading section 9 also can advance, thus pushing the first fixture 106 and the second fixture 107 and injected to the outside of pin 4.In addition, the external diameter of pusher leading section 9 is greater than the external diameter of operating line 5, and the coupling part between pusher leading section 9 and operating line 5 is formed with abutting part 10, and described abutting part 10 is the stage portion that bloat diametrically from the front periphery portion of operating line 5.
Operating line 5 preferably can suitably be delivered to the single line on pusher leading section 9 by the pushing force being applied by operating portion 3, metal wire rod is carried out to spiral operating line that the stranded multithread operation line forming, metal wire rod and/or multithread operation line reeled and form in the shape of a spiral etc. but also can use.
As further shown in Figure 2, internal coiling sheath 6 is that metal wire rod, multithread operation line are wound and are formed as the helical sheath of tubulose, can run through on axis direction for operating line 5 with advancing and retreat.The internal diameter of internal coiling sheath 6 is set to such an extent that be less than the external diameter of the abutting part 10 of operating line 5, the abutting part 10 of the step between pusher leading section 9 and operating line 5 and the front end butt of internal coiling sheath 6.,, under the state of abutting part 10 and the front end butt of internal coiling sheath 6, the position relationship maintenance between operating line 5 and internal coiling sheath 6 is constant.
Pipe 7 is the members with flexible tubulose that are made up of resin or other materials.As the material of pipe 7, preferably to the less resin of the percentage elongation of axis direction or other materials.Pipe 7 is connected with front end helical sheath 6A via the connecting piece 7A of the front end that is installed in pipe 7.Front end helical sheath 6A is formed as the helical form being made up of the elasticity raw material of metal or other materials.Front end helical sheath 6A is also connected with the cardinal extremity 4B of pin 4 integratedly via connection tube 11.
The internal diameter of the axis direction of connecting piece 7A is set to such an extent that be greater than the external diameter of the abutting part 10 of operating line 5, and abutting part 10 can be advanced and retreat freely along axis direction in connecting piece 7A.On the other hand, the internal diameter of the axis direction of connecting piece 7A is set to such an extent that be less than the external diameter of internal coiling sheath 6, and internal coiling sheath 6 is constituted as and cannot enters in connecting piece 7A.
In addition, be provided with through the through hole 11A of the inner chamber of pin 4 in the circumferential exterior surface of connection tube 11, the inner chamber that is inserted into connection tube 11 by the mid point 104A of bending from through hole 11A of the stitching thread 104 of suturing assembly 103, card hangs over and extends through on inner pusher leading section 9.In addition, the position relationship between pusher leading section 9 and through hole 11A be maintained at pusher leading section 9 can be at the diameter of the internal diameter that comprises connection tube 11 and stitching thread 104 in space interior and that form in the scope that advance and retreat.
Epitheca 8 is and the helical sheath of internal coiling sheath 6 same configuration, can runs through on axis direction for pipe 7 and with pipe 7 pins that are connected integratedly 4 with advancing and retreat.And, as shown in Figure 2, pipe 7 can moved under the state of base end side, pin 4 and suturing assembly 103 entirety that are arranged on pin 4 are housed in the inner space of pipe 7.
Fig. 4 and Fig. 5 are the figure that represents operating portion 3 with partial cutaway.The operating portion 3 that is located at the base end side that inserts disposal portion 2 comprises: the operating main body 12 that is fixed with the cardinal extremity of epitheca 8; With respect to operating main body 12 and the sliding part 13 of can be on the axis direction of operating main body 12 installing slidably; And be inserted into the front-end operations portion 14 of the inside of operating main body 12.
Operating main body 12 is formed by resin or other materials, has the roughly side wall member 15 of tubular.Be fixed with the cardinal extremity 8A of epitheca 8 in the method such as front end utilization bonding, riveted joint of operating main body 12.Near the front end of operating main body 12 can with sliding part 13 butts dispose diameter and form to such an extent that be greater than the front end cover cap 16 of the diameter of operating main body 12.
Front end cover cap 16 is forward end side shifting for anti-skidding portion 13 exceeds the front end of operating main body 12, and, maximum position when sliding part 13 is oriented to make pin 4 outstanding from epitheca 8 with the position of front end cover cap 16 butts.
Be provided with the finger hang part 12A of ring-type at the cardinal extremity of operating main body 12, this finger hang part 12A is formed as protruding to foreign side from a part of radius vector of circumferential exterior surface.
Sliding part 13 is formed with the finger hooking ring portion 13A of a pair of ring-type bloating to foreign side from the circumferential exterior surface radius vector of operating main body 12.In addition, sliding part 13 is fixed with the roughly coupling member 25 of tubular, this coupling member 25 is inserted in operating main body 12, be fixed with the peripheral part of the base end side opening of pipe 7, rectilinear movement by sliding part 13 along the axis of operating main body 12, makes to manage 7 and relatively advances and retreat with respect to epitheca 8.Be extruded with operating line 5 and internal coiling sheath 6 from the base end side opening of coupling member 25.
Front-end operations portion 14 comprises: guide 23, and it is incorporated in the inside of operating main body 12, and is connected with respectively operating line 5 and internal coiling sheath 6 that the base end side opening from inserting disposal portion 2 extends, and relative advance and retreat action is controlled; Bar portion 18, it is fixed on the base end side of guide 23, and outstanding in the axial direction from the base end side opening of operating main body 12.
Guide 23 comprises: be inserted with the base end part of coupling member 25 fixing cylindrical structural member 26 in addition; And be inserted in cylindrical structural member 26 and be fixed on the roughly fastened component 27 cylindraceous of the front end of bar portion 18.
Fig. 6 is the figure that represents a part for the inside of operating portion 3.On fastened component 27, be formed with on the outer surface the guiding groove 28 extending on circumferential and axial.More specifically, guiding groove 28 is first translot 128A, the first pod 128B, the second translot 128C, the second pod 128D, the 3rd translot 128E, the 3rd pod 128F becomes one article of groove continuously, wherein, described the first translot 128A extends to position 28B from the position 28A of a part for circumferential exterior surface, this position 28B has rotated predetermined angular θ 1 (in the present embodiment from the base end side of fastened component 27 in the clockwise direction around axis, predetermined angular θ 1 is 45 degree, with reference to Figure 10) after position, described the first pod 128B spends to the proximal direction bending 90 of fastened component 27 with respect to the first translot 128A at 28B place, position, extend to the position 28C that has extended the terminal of length L 1 to the axis direction base end side of fastened component 27, described the second translot 128C extends to position 28D from position 28C, this position 28D has rotated the position predetermined angular θ 1 from the base end side of fastened component 27 in the clockwise direction around axis, described the second pod 128D spends to the proximal direction bending 90 of fastened component 27 with respect to the second translot 128C at 28D place, position, extend to the position 28E that has extended the terminal of or length L more than 1 length L 2 identical with length L 1 to the axis direction base end side of fastened component 27, described the 3rd translot 128E extends to position 28F from position 28E, this position 28F has rotated the position predetermined angular θ 1 from the base end side of fastened component 27 in the clockwise direction around axis, described the 3rd pod 128F spends to the front extreme direction bending 90 of fastened component 27 with respect to the 3rd translot 128E at 28F place, position, extend to the axis direction front of fastened component 27 extended with length L 1 and length L 2 and equate or the position 28G of the terminal of more than this length sum length L 3.
Also in a part for the inner wall part of each translot of the first translot 128A, the second translot 128C and the 3rd translot 128E, be formed with the lobe 129 bloating from the inwall of guiding groove 28 in the mode of the width of constriction guiding groove 28.
In addition, be formed with a pair of front end holding section 29 at the leading section of fastened component 27, this front end holding section 29 has jut 29A, and this jut 29A is from front end periphery, to axial forward end side and footpath, inwardly side is outstanding respectively just right two positions diametrically.And, between fastened component 27 and coupling member 25, clamping roughly advance and retreat moving part 32 cylindraceous, this advance and retreat moving part 32 is formed with the engaged part 31 engaging with bearing surface 30 and the front end holding section 29 of fastened component 27 butts.
Engaged part 31 comprises: recess 31A, and it is formed on from each bearing surface 30 and has rotated in the counterclockwise direction on the position predetermined angular θ 1 around axis, can insert each front end of front end holding section 29 simultaneously; Chimeric recess 31B, it is being further rotated on the position predetermined angular θ 1 around axis in the counterclockwise direction from recess 31A, chimeric with each jut 29A of front end holding section 29.
As shown in Figure 5, the leading section of advance and retreat moving part 32 is inserted in coupling member 25 free to advance or retreatly, and inserts the outer peripheral face of the base end side opening that is fixed with internal coiling sheath 6 at the through hole 33 along axis.In addition, the operating line 5 that extends through the inside of internal coiling sheath 6 runs through free to advance or retreatly and is bearing in through hole 33, and outstanding from base end side opening, is fixed on the fastened component 27 that is configured in base end side via reinforced pipe 34.
In addition, in cylindrical structural member 26, be formed with the through hole 36 that penetrates into inner peripheral surface from outer peripheral face.In through hole 36, just insert and be fixed with pin 37 from radially foreign side's radius vector is inside, the leading section 37A of pin 37 is inserted in guiding groove 28.And the diameter W of pin 37 is less than the width of guiding groove 28, the leading section 37A of pin 37 can stride across lobe 129 and advance and retreat along guiding groove 28.
In addition, as shown in Figure 5 and Figure 6, bar portion 18 is the roughly columned members that are inserted into the base end side of operating main body 12.Bar portion 18 has multiple convex strip portions 18A and instruction unit 18B, described multiple convex strip portions 18A base end side bloat diametrically and along axis form, described instruction unit 18B is from further outstanding forming diametrically of the part of the outside of base end side.Instruction unit 18B is the anti-skidding portion of user's hook finger, and is used for identifying the mark of the relative position between bar portion 18 and operating main body 12 as user.
Action with reference to Fig. 7～Figure 22 when using above-mentioned such stiching instrument 1 forming describes.
First, endoscope apparatus 100 is inserted in patient's etc. body, the front end of endoscope apparatus 100 is moved near the tissue of disposal object of perforation etc.As shown in Figure 7, stiching instrument 1 is inserted in the forceps channel 101 of endoscope apparatus 100, makes front end from the outstanding use of operation path 10 2 in patient's etc. body.
As shown in Figure 7, user forwards slides sliding part 13.So, as shown in Figure 8, expose pin 4 and the suturing assembly 103 that is installed on pin 4 from the front end of epitheca 8.
In addition, in the time that sliding part 13 is forwards slided, the front-end operations portion 14 fixing by coupling member 25 also forwards moves, and therefore, the relative position relation between pipe 7 and pin 4 and operating line 6 and internal coiling sheath 6 does not change.
As shown in Figure 9, the front end that makes stiching instrument 1 under the state of user after making pin 4 outstanding, near the object tissue T around perforation etc., thrusts pin 4 and pin 4 is run through in a side tissue T 1.
Pin 4 runs through after tissue T 1, and as shown in Figure 10 and Figure 11, from base end side, user makes bar portion 18 rotate in the counterclockwise direction predetermined angular θ 1 with respect to operating main body 12 around axis.So pin 37 moves to position 28B from position 28A, the inwall butt of pin 37 and the first pod 128B, circumferential rotation stops.By this operation, fastened component 27 is with respect to operating main body 12 and cylindrical structural member 26 and relatively rotate predetermined angular θ 1 to counter clockwise direction.Now, pin 37 stride across lobe 129 and by time resistance pass to user, and bar portion 18 is restricted to clockwise rotation.Then, user is pressed into bar portion 18 to operating main body 12.So pin 37 is directed in the first pod 128B, moves to position 28C.Now, with respect to cylindrical structural member 26 and relatively forward end side shifting length L 1 of fastened component 27, the front end holding section 29 of fastened component 27 and bearing surface 30 butts of advance and retreat moving part 32, movements are pressed in the moving part 32 forward end thrusters of advance and retreat.Base end side butt at advance and retreat moving part 32 with internal coiling sheath 6, therefore, internal coiling sheath 6 is also urged movable length L1, and at the front end that inserts disposal portion 2, the abutting part 10 of the base end side of the front end of internal coiling sheath 6 to pusher leading section 9 pushes and moves it.So, as shown in figure 12, the first fixture 106 and the second fixture 107 that are configured in the front of pusher leading section 9 are urged movable length L1, emit the first fixture 106 from the front end of pin 4, and the slot 107A of the second fixture 107 fastens with the engaging protrusion of the position of accommodating the first fixture 106.
As shown in figure 13, under the state of emitting after the first fixture 106, user extracts pin 4 from tissue T 1.Now, the first fixture 106 is engaged in tissue T 1.Then, pin 4 is penetrated into across perforation and wait and the tissue T 2 relative with tissue T 1 and pin 4 is run through.
As shown in figure 14, pin 4 is run through after tissue T 2, user is further rotated counterclockwise bar portion 18.So as shown in figure 15, pin 37 directed grooves 28 guide, from 28CXiang position, position, 28D moves.Now, from base end part, the front end holding section 29 of the leading section of fastened component 27 also around axis week upwards rotary compasses determine angle θ 1, front end holding section 29 from advance and retreat moving part 32 bearing surface 30 move to the recess 31A of engaged part 31.Then, user is further by bar portion 18 push operation main bodys 12.So as shown in figure 16, fastened component 27 forward end side shifting length L 2, until the inner wall part of the 3rd translot 128B of pin 37 and guiding groove 28 contacts, are inserted in recess 31A front end holding section 29.Now, can not push advance and retreat moving part 32 and move because the advance and retreat of fastened component 27 move, therefore, insert the front end of disposal portion 2, internal coiling sheath 6 change with the relative position relation of managing between 7.On the other hand, be connected with operating line 5 at the leading section of fastened component 27 via reinforced pipe 34, therefore, at the front end that inserts disposal portion 2, push as shown in Figure 17 pusher leading section 9 and move.The front end of pusher leading section 9 pushes the base end side of the second fixture 107.As a result, release the second fixture 107 from pin 4.Penetrating after the second fixture 107, as shown in figure 18, user extracts pin 4 from tissue T 2, makes the second fixture 107 engagings in tissue T 2.
Under this state, user is pulled to sliding part 13 base end side of operating main body 12 as shown in Figure 19, and pipe 7 and pin 4 are accommodated in epitheca 8.Now, front-end operations portion 14 also together retreats with sliding part 13, and therefore, operating line 5 and pusher leading section 9 do not change with respect to the relative position of pin 4.
So, as shown in figure 20, also accommodate in epitheca 8 the front end butt of locating part 105 and epitheca 8 around the stitching thread 104 of the suturing assembly 103 that is hung on pusher leading section 9.In the time that user further makes sliding part 13 retreat, locating part 105 and internal coiling sheath 6 keep the state of butt, and only stitching thread 104 is accommodated in internal coiling sheath 6, and the distance between locating part 105 and each fixture 106,107 shortens.
Each fixture 106,107 difference engagings are in tissue T 1 and T2, so along with locating part 105 and each fixture 106,107 approach, tissue T 1, T2 and each fixture 106,107 are together pulled to stiching instrument one example and are adjacent to.Like this, carry out the stitching of object tissue T.
Now, when stitching thread 104 is accommodated epitheca 8 when interior, engaging between end 105A and the end 105B of locating part 105 is unclamped, stitching thread 104 can relatively move with respect to locating part 105, but contrary, even if stitching thread 104 will be to each fixture 106,107 side shiftings, because acting on the power of stitching thread 104, end 105A and end 105B engage more firmly, therefore cannot move to this above-mentioned direction.That is, locating part 105 only, to each fixture 106,107 side shiftings, does not move to the opposition side of fixture 106,107 sides, so, can not make the stitching of object tissue T unclamp or remove.
After stitching finishes, as shown in figure 21, from base end side, user makes bar portion 18 again rotate in the counterclockwise direction predetermined angular θ 1 around axis.So pin 37 is from the position 28B of the guiding groove 28 position 28F that relatively moves, at the inner wall part butt of 28F place, position and the 3rd pod 128F, fastened component 27 and cylindrical structural member 26 become the position relationship being relatively further rotated after predetermined angular θ 1.Now, the front end holding section 29 of the front end of fastened component 27 also rotates predetermined angular θ 1, and the jut 29A of front end holding section 29 is with chimeric adjacent to the stitching recess 31B of recess 31A.Under this state, user pulls bar portion 18 to the proximal direction of operating main body 12.So the pin 37 position 28F movable length L3 (with reference to Fig. 6) from guiding groove 28, until at the inner wall part butt of 28G place, position and the 3rd pod 128F.And, the power that pulls bar portion 18 to base end side is also passed to chimeric recess 31B via jut 29A, and, being also passed to the operating line 5 and the pusher leading section 9 that are fixed on fastened component 27, operating line 5 and pusher leading section 9 and internal coiling sheath 6 are pulled to base end side simultaneously.
As shown in figure 22, in the time that the front end of pusher leading section 9 more rearward moves than connection tube 11, stitching thread 104 comes off from pusher leading section 9, and suturing assembly 103 separates from stiching instrument 1.Like this, a series of disposal finishes.
In existing stiching instrument, emit the mechanism of a fixture exemplified with avoid each fixture to be emitted simultaneously at every turn, but the situation that when power that has pushing pusher leading section 9 is stronger, multiple fixtures are emitted simultaneously, and be provided with special mechanism in order to emit the second fixture, user need to change operating portion for this reason, thus exist operation more complicated, can bring out the problem that misoperation etc. should solve.
According to the stiching instrument 1 of present embodiment, promoting in the axial direction sliding part 13 for the operation of emitting the first fixture 106 from pin 4 by keeping operating main body 12 carries out, after having emitted the first fixture 106, emit the second fixture 107 and promote in the axial direction sliding part 13 and carry out by keeping operating main body 12 similarly.And, emitting the action of the first fixture 106 and emitting between the action of the second fixture 107, clip and make bar portion 18 in the operation rotating up in week, thereby can emit reliably a fixture at every turn, and, do not require that user changes action from the posture that keeps operating main body 12 and bar portion 18.Therefore, make bar portion 18 complete to sew up in the action rotating up in week and the so simple action of action that bar portion 18 is moved linearly in the axial direction by hocketing and dispose, so can reduce maloperation.
In addition, the Length Ratio of the leading section of pusher leading section 9 is long to the length of through hole 11A from the front end of pin 4, thus, stitching thread 104 can not touch the step part that is formed with abutting part 10, while having pulled operating line 5 to base end side, can avoid stitching thread 104 to be drawn in to base end side the stitching thread 104 being caused by above-mentioned step part and depart from such unfavorable condition from pusher leading section 9.
Then, with reference to Figure 23, the second embodiment of the present invention is described.The stiching instrument 41 of present embodiment is to replace the guide 23 of the first embodiment with the difference of above-mentioned stiching instrument 1 and guide is rotary cam structure 42.
In addition, the element identical with the first above-mentioned embodiment marked to identical Reference numeral, and the repetitive description thereof will be omitted.
Figure 23 is the enlarged drawing that represents a part of structure of stiching instrument 41.Stiching instrument 41 replaces the guide 23 of the first embodiment and comprises that rotary cam structure 42, this rotary cam structure 42 are connected with each base end part of internal coiling sheath 6 and internal coiling sheath 6 at leading section, and is fixed with bar portion 18 at base end part.
Rotary cam structure 42 comprises: helical spring 43, and it is fixed on sliding part 13 by coupling member 25, is penetrated with internal coiling sheath 6 in inside; Roughly supporting member 44 cylindraceous, it is fixed on the cardinal extremity of helical spring 43, runs through for internal coiling sheath 6; Advance and retreat moving part 52, it with respect to supporting member 44 and relatively links with supporting member 44 freely rotating up in week, the base end side open end butt of advance and retreat moving part 52 and internal coiling sheath 6, and for running through from the outstanding operating line 5 of the base end side opening of internal coiling sheath 6; Cylindrical structural member 46, it is disposed at coaxially base end side on the axis direction of advance and retreat moving part 52, and engaging is in operating main body 12; Fastened component 47, its with the mode of end butt of the base end side of advance and retreat moving part 52 free to advance or retreat be inserted into cylindrical structural member 46.Be fixed with bar portion 18 at the base end side of fastened component 47.
Cylindrical structural member 46 is formed with multiple tilting cam 46A of portion, and the 46A of this tilting cam portion is with outstanding along the circumferential mode towards axial forward end side in front outer portion, and the helically that the face shape of jag is centered by axis tilts.In addition, in a part for circumferential exterior surface, have cylindrical structural member 46 and operating main body 12 are blocked to the not shown engaging mechanism of de-engaging freely.And, on the side wall portion of the base end side of the 46A of tilting cam portion, be formed with for the not shown chimeric recess of advance and retreat moving part 52 tablings.
Fastened component 47 is inserted into the inside of cylindrical structural member 46 free to advance or retreatly, is upwards formed with multiple outstanding shapes, the big or small identical 47A of tilting cam portion across predetermined distance at the leading section of fastened component 47 in week.The face shape of the jag of the 47A of tilting cam portion is the helically identical with the 46A of tilting cam portion and tilts.
Advance and retreat moving part 52 is formed with the tilting cam portion 50 of extending to axial base end side in the mode of the front at cylindrical structural member 46 and fastened component 47 and the 46A of tilting cam portion and the 47A of tilting cam portion butt.In addition, observe advance and retreat moving part 52 from base end side, be formed with at the circumferential both ends of tilting cam portion 50 engaged part 51 that the 46A of tilting cam portion engages.And, be formed with in week at the side wall portion of the base end side of tilting cam portion 50 project upwards, the jut 50A chimeric with the chimeric recess of cylindrical structural member 46.
Action with reference to Figure 23 when using above-mentioned such stiching instrument 41 forming describes.
User and the first embodiment similarly make pin 4 run through tissue T 1.Then, by bar portion 18 push operation main bodys 12.So, be fixed on the fastened component 47 of bar portion 18 with respect to operating main body 12 distolateral relatively moving forward, the 47A of tilting cam portion of the front end of fastened component 47 and be inserted into tilting cam portion 50 butts between the 46A of tilting cam portion, be directed into the relative wall portion of the 46A of tilting cam portion, simultaneously mobile to the pushing of axis direction front.In addition, therefore tilting cam portion 50 is by helical spring 43 and to the base end side application of force,, from base end side, being tilted in the tilting cam portion 50 of cam part 47A pushing, upwards produce to clockwise pushing force in week, be pushed to the wall portion of the 46A of tilting cam portion.
Now, front end and the internal coiling sheath 6 of advance and retreat moving part 52 link, and therefore, internal coiling sheath 6 is with respect to managing 7 and distolateral relatively moving forward similarly emitted the first fixture 106 with the first embodiment.
When tilting cam portion 50 is urged until while exceeding the front end of the 46A of tilting cam portion, the side wall portion of the 46A of tilting cam portion is disengaged the supporting of tilting cam portion 50, therefore, tilting cam portion 50 is along the inclination of the 47A of tilting cam portion, rotate around axis, rotating to tilting cam 46B (this element is positioned at the rear side of suturing part, therefore cannot illustrate in Figure 23) locates rear engaged.Now, the sense of touch that is accompanied by the rotation of advance and retreat moving part 52 is delivered to user, thereby user recognizes this situation of state that the first fixture 106 can be emitted that becomes.Then, user and the first embodiment similarly make pin 4 run through tissue T 2.
User is pressed into operating main body 12 by bar portion 18 again pin 4 has been run through under the state of tissue T 2.So fastened component 47 is inserted into from base end side the engaged part 51 of advance and retreat moving part 52.Now, advance and retreat moving part 52 is mobile to axis direction advance and retreat, but mobile along engaged member 47 pushings of operating line 5 of axis configuration in the front of fastened component 47, its result, with respect to advance and retreat moving part 52 and forward distolateral relatively moving of operating line 5.So, with the first embodiment similarly, pusher leading section 9 is pushed movement by operating line 5, emits the second fixture 107.Then, by user to operating main body 12 ramming stem portions 18, thereby make the further forward end side shifting of fastened component 47.So the tilting cam portion 50 of the 47A of the tilting cam portion pushing advance and retreat moving part 52 of fastened component 47 moves.In the time removing engaging between tilting cam portion 50 and the 47A of tilting cam portion, the moving part 52 of advancing and retreat is rotated action around axis.Now, chimeric recess 46D (this element is positioned at the rear side of suturing part, therefore cannot illustrate in Figure 23) and jut 50A tabling, cylindrical structural member 46 and advance and retreat moving part 52 are connected, thereby synchronously advance and retreat.
Then, user and the first embodiment, similarly with respect to operating main body 12 and to the base end side sliding part 13 that furthers, draw in pin 4 to the inside of epitheca 8, carry out the stitching of object tissue T thus.And user, to the base end side pull-out bar portion 18 of operating main body 12, pulls out cylindrical structural member 46 thus together with advance and retreat moving part 52, pull internal coiling sheath 6 and operating line 5 with respect to pin 4 to base end side.Thus, same with the first embodiment, in the time more rearward moving than connection tube 11 to the front end of base end side pulling pusher leading section 9, operating line 5 with respect to pin 4, stitching thread 104 departs from from operating line 5, and suturing assembly 103 separates from stiching instrument 1.Like this, a series of disposal finishes.
According to the stiching instrument 41 of present embodiment, the pushing that is divided into the moving part 52 of advancing and retreat by the pushing of the front to pin 4 of pusher leading section 9 is moved to the multistage is moved with the pushing of the base end part of operating line 5 and is formed movably, thereby avoid emitting the misoperation of multiple fixtures in once-through operation, and, by adopting rotary cam structure 42, user is only by catch bar portion 18, just can be after having emitted the first fixture 106, easily make the second fixture 107 come the position that can emit, therefore, can overcome the complexity of the operation while emitting multiple fixture successively.
Above, the preferred embodiment of the invention has been described, but the present invention is not limited to these embodiment.Without departing from the spirit and scope of the invention, can carry out interpolation, omission, displacement and other the change of structure.
For example, in above-mentioned each embodiment, illustrated after pin runs through tissue, penetrate fixture and engaging in the example of tissue, but can replace, make the front end of pin stop at organization internal, make it to injecting fixture in tissue with around organize phase engaging.
In addition, in above-mentioned each embodiment, show and use the first fixture 106 and second fixture 107 these two examples that fixture is sewed up, but be not limited to this, also can adopt suitable interpolation guiding groove 28 or the such structure of rotary cam structure 42, to emit successively three with upper fixing element.
In addition, in above-mentioned each embodiment, adopt the suturing assembly 103 of the structure the first fixture 106 and the second fixture 107 being linked up by stitching thread 104, even if but link different stitching thread at each fixture, these stitching thread all engage with locating part 105, also can realize the effect identical with above-mentioned embodiment.
In addition, the present invention is not limited by above-mentioned explanation, and the claims that only attached limit.
Claims (7)
1. a stiching instrument, it comprises:
Insert disposal portion, it has the suturing part that utilizes the stitching that endoscope organizes at front end;
The operating main body of tubular, it is connected in the cardinal extremity of above-mentioned insertion disposal portion;
Bar portion, its mode with the axis along aforesaid operations main body is inserted into the cardinal extremity of aforesaid operations main body, carries out penetrating stitching thread and the operation of multiple end members of being connected with above-mentioned sutural at least one end from the front end of above-mentioned suturing part;
Pusher leading section, its operation corresponding to above-mentioned bar portion and push above-mentioned end member and move;
Guide, this guide comprises cylindrical structural member and fastened component, this cylindrical structural member is configured in the base end side of above-mentioned insertion disposal portion, be linked to above-mentioned suturing part by coupling member, this fastened component is fixed on the front end of above-mentioned bar portion, and be inserted in above-mentioned cylindrical structural member, this guide makes above-mentioned pusher leading section carry out the position after rectilinear movement, the rectilinear movement of above-mentioned pusher leading section is stopped, make to penetrate an above-mentioned end member from the front end of above-mentioned suturing part, by making above-mentioned bar portion upwards rotate ormal weight in week, thereby make the state of another above-mentioned end member in penetrating, repeat above-mentioned rectilinear movement and above-mentioned rotation guides, make individually to penetrate each end member of above-mentioned multiple end members,
Front end holding section, its front end peripheral part from above-mentioned fastened component is inwardly given prominence to side to axial forward end side and footpath; And
Advance and retreat moving part, it has the abutting part of the front end institute butt of above-mentioned front end holding section, and the engaged part that when having above-mentioned bar portion and relatively rotating on circumferentially with respect to above-mentioned cylindrical structural member, above-mentioned front end holding section engages, it is configured in the inside of above-mentioned cylindrical structural member free to advance or retreatly.
2. stiching instrument according to claim 1, wherein,
Above-mentioned guide also comprises:
, a guiding groove, the either party of this guiding groove in above-mentioned cylindrical structural member and above-mentioned fastened component circumferential side has multiple pods and multiple translot, above-mentioned multiple pod be around axis the position in different angles and on axis direction extend and form, along axis, above-mentioned pusher leading section is guided, make the movement of can advancing and retreat of above-mentioned pusher leading section, above-mentioned multiple translot extends and forms in the mode upwards each end of above-mentioned multiple pods being coupled together in week, and the advance and retreat movement of above-mentioned pusher leading section is limited; And
Protuberance, its opposing party who is fixed on above-mentioned cylindrical structural member and above-mentioned fastened component is upper, for engaging with above-mentioned guiding groove.
3. stiching instrument according to claim 1, wherein,
Above-mentioned insertion disposal portion comprises:
Operating line, its one end is connected in the cardinal extremity of above-mentioned pusher leading section, and the other end is connected in above-mentioned bar portion, and the diameter of this operating line is thinner than the external diameter of above-mentioned pusher leading section;
Pin cylindraceous, it has in circumferential exterior surface and is formed with the base end part of through hole and sharp keen leading section, and, insert for the front end of above-mentioned pusher leading section; And
Flexible pipe, it is connected with above-mentioned guide with the base end part of above-mentioned pin respectively, runs through for above-mentioned operating line,
Above-mentioned stitching thread via above-mentioned through hole around hanging over above-mentioned pusher leading section, the above-mentioned stitching thread of above-mentioned pusher leading section be identical around hanging the external diameter in region.
4. stiching instrument according to claim 3, wherein,
There is the front end helical sheath being formed by elastomeric material at the leading section of above-mentioned pipe.
5. stiching instrument according to claim 4, wherein,
Between above-mentioned pipe and aforesaid operations line, also comprise along the internal coiling sheath of the axis configuration of aforesaid operations line, the base end side of above-mentioned internal coiling sheath is fixed on above-mentioned advance and retreat moving part, and, the front of above-mentioned internal coiling sheath and the face butt vertical with axis producing at above-mentioned pusher leading section with than the connecting portion between the thin aforesaid operations line of above-mentioned pusher leading section, push above-mentioned pusher leading section and move.
6. stiching instrument according to claim 1, wherein,
Above-mentioned guide also has rotary cam structure, and this rotary cam structure moves by the pushing of above-mentioned bar portion forward end, and above-mentioned bar portion is stopped after a circumferential side rotates predetermined distance at every turn.
7. stiching instrument according to claim 2, wherein,
In above-mentioned guiding groove, be provided with the lobe that above-mentioned protuberance is limited along the movement of above-mentioned guiding groove.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201010106072.6A CN102138813B (en) | 2010-01-29 | 2010-01-29 | Stitching instrument |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201010106072.6A CN102138813B (en) | 2010-01-29 | 2010-01-29 | Stitching instrument |
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| Publication Number | Publication Date |
|---|---|
| CN102138813A CN102138813A (en) | 2011-08-03 |
| CN102138813B true CN102138813B (en) | 2014-11-19 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN201010106072.6A Active CN102138813B (en) | 2010-01-29 | 2010-01-29 | Stitching instrument |
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Families Citing this family (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US8986327B2 (en) * | 2012-10-18 | 2015-03-24 | Smith & Nephew, Inc. | Flexible anchor delivery system |
| KR101548646B1 (en) * | 2014-01-21 | 2015-09-01 | 가톨릭관동대학교산학협력단 | Trans-Platform Apparatus and Their Uses |
| US20170135715A1 (en) * | 2015-11-12 | 2017-05-18 | Covidien Lp | Balloon dissection kit with multiple balloons |
| US11369367B2 (en) * | 2017-01-31 | 2022-06-28 | Zeon Corporation | Suturing device |
| CN111388040B (en) * | 2020-03-25 | 2021-04-09 | 李晋 | Half-moon plate sewing crochet hook for orthopedic operation |
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|---|---|---|---|---|
| US6066146A (en) * | 1998-06-24 | 2000-05-23 | Carroll; Brendan J. | Laparascopic incision closure device |
| WO2006044837A2 (en) * | 2004-10-18 | 2006-04-27 | Temple University Of The Commonwealth System Of Higher Education | Apparatus and method of endoscopic suturing |
| WO2007018264A1 (en) * | 2005-08-11 | 2007-02-15 | Olympus Medical Systems Corp. | Medical treatment device |
| CN101396293A (en) * | 2007-09-28 | 2009-04-01 | 奥林巴斯医疗株式会社 | Suturing device |
| EP2108317A2 (en) * | 2008-04-11 | 2009-10-14 | Olympus Medical Systems Corporation | Suture device |
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Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6066146A (en) * | 1998-06-24 | 2000-05-23 | Carroll; Brendan J. | Laparascopic incision closure device |
| WO2006044837A2 (en) * | 2004-10-18 | 2006-04-27 | Temple University Of The Commonwealth System Of Higher Education | Apparatus and method of endoscopic suturing |
| WO2007018264A1 (en) * | 2005-08-11 | 2007-02-15 | Olympus Medical Systems Corp. | Medical treatment device |
| CN101396293A (en) * | 2007-09-28 | 2009-04-01 | 奥林巴斯医疗株式会社 | Suturing device |
| EP2108317A2 (en) * | 2008-04-11 | 2009-10-14 | Olympus Medical Systems Corporation | Suture device |
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| CN102138813A (en) | 2011-08-03 |
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Effective date of registration: 20151119 Address after: Tokyo, Japan, Japan Patentee after: Olympus Corporation Address before: Tokyo, Japan, Japan Patentee before: Olympus Medical Systems Corp. |