SUTURE INSTRUMENT
A suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, including a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is approximately pointed in the direction of the proximal end of the base; a tip position changing mechanism that is provided for changing the tip position of the anchor holding instrument and causes the anchor holding instrument to move in a direction that intersects with the axial line of the lengthwise direction of the base; and a position operation device that operates the tip position changing mechanism at the hand side and operates the tip position of the anchor holding instrument.
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This application is a continuation application based on a PCT Patent Application No. PCT/JP2006/319335, filed on Sep. 28, 2006, whose priority is claimed on U.S. patent application Ser. No. 11/238,016 filed on Sep. 28, 2005. The contents of both the PCT Application and the U.S. Application are incorporated herein by reference.
TECHNICAL FIELDThe present invention relates to a suture instrument that inserts a suture tool through the mouth or anus and sutures a perforation. For example, it relates to a suture instrument that sutures a perforation that is formed in the wall of a hollow organ.
BACKGROUND ARTIn the case of performing treatment in a body of a patient, the treatment can be performed by incising the body of the patient by surgical operation, or by oral endoscopic treatment or transanal endoscopic treatment. A method for suturing a perforation formed in an abdominal area by surgical operation is disclosed in FIGS. 6a to 6c of U.S. Pat. No. 6,066,146. According to this suturing method, a needle is thrust into the tissue around the perforation, and an anchor equipped with a suture thread is then extruded from the needle. After the needle is drawn out from the tissue, two suture threads across the perforation are knotted together to close the perforation.
The treatment using an endoscope is carried out by passing a forceps, high-frequency treatment instrument, incision instrument, suture tool or the like through a channel of the endoscope. When the medical treatment is carried out by using an endoscope inserted into a hollow organ through a natural opening of a living body such as the mouth, anus, or the like, for example, a hole is formed by removing the tissue from the abdominal cavity or incising the tissue in the abdominal cavity, and the medical treatment is then carried out by approaching the abdominal cavity through this hole from the inside of the hollow organ. After performing the medical treatment, the formed hole is sutured by a suture tool.
Here, a method for suturing in a hollow organ is disclosed in FIGS. 6 to 9 of Japanese Unexamined Patent Application, First Publication No. 2004-601, for example. According to this suturing method, the tissue is drawn into an overtube, and a needle is then thrust through this tissue from the proximal side to the distal end side thereof. From the inside of the needle, an anchor equipped with a suture thread is pushed out to the distal end side of the tissue. After that, when the needle is pulled out, the suture thread penetrates through the tissue, and so the tissue is tightened up by this suture thread. There is also a method disclosed in FIG. 1, FIG. 4, FIGS. 5A to 5C of U.S. Pat. No. 5,297,536. According to this method, a flexible endoscope is inserted into the vicinity of a perforation via the mouth or the anus. The tissue around the perforation is aspirated by a tube of the flexible endoscope. When an O-ring provided at the outside of the tube is pushed out from the distal end of the tube, the aspirated tissue is clamped by the O-ring.
Patent Document 1: U.S. Pat. No. 6,066,146
DISCLOSURE OF THE INVENTION Problem to be Solved by the Invention Disclosure of the InventionA first aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, the suture instrument being provided with a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is approximately pointed in the direction of the proximal end of the base; a tip position changing mechanism that is provided for changing the tip position of the anchor holding instrument and causes the anchor holding instrument to move in a direction that intersects with the axial line in the lengthwise direction of the base; and a position operation device that operates the tip position changing mechanism at the hand side and operates the tip position of the anchor holding instrument.
A second aspect of the present invention is the suture instrument in accordance with the first aspect, wherein the tip position changing mechanism changes the position by causing the anchor holding instrument to move to a position that is offset from the axial line in the lengthwise direction of the base.
A third aspect of the present invention is the suture instrument in accordance with the first aspect, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.
A fourth aspect of the present invention is the suture instrument in accordance with any one of the first aspect to the third aspect, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.
A fifth aspect of the present invention is the suture instrument in accordance with any one of the first aspect to the third aspect, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.
A sixth aspect of the present invention is the suture instrument in accordance with any one of the first aspect to the fifth aspect, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward or backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.
A seventh aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, including a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is disposed at the remote end side of the base; a deflection mechanism that is provided for deflecting the tip position of the anchor holding instrument and causes the tip of the anchor holding instrument to deflect from the remote end of the base toward the direction that faces the proximal end; and a position operation device that operates the deflection mechanism at the hand side and operates the tip position of the anchor holding instrument.
An eighth aspect of the present instrument is the suture instrument in accordance with the seventh aspect, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.
A ninth aspect of the present invention is the suture instrument in accordance with the seventh aspect or the eighth aspect, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.
A tenth aspect of the present invention is the suture instrument in accordance with the seventh aspect or the eighth aspect, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.
An eleventh aspect of the present invention is the suture instrument in accordance with any one of the seventh aspect to the tenth aspect, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward or backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.
-
- 13 inner sheath (base, anchor holding instrument)
- 16 suture tool
- 17, 121, 145, 190 operation unit (position operation device)
- 27, 141, anchor
- 42 perforation
- 101, 131, 151, 161, 171, 181 suture instrument
- 102, 152, 162 sheath (base)
- 103 treatment portion (tip position changing mechanism)
- 112, 139, 163, 183, 193 needle (anchor holding instrument)
- 112A, 139A, 163A sharp tip
- 106 second forceps piece (opening-closing member)
- 134 lumen
- 140 operating wire (tip position changing mechanism)
- 153, 184 first lumen
- 154 second lumen
- 163A tip
- 164 curving portion (deflection mechanism)
- 168 curving control member (shape-memory alloy)
- 173 balloon
- 182 sheath (position operation device)
- 188 erecting hook
Next, each embodiment of the present invention shall be described with reference to the drawings. Note that in the descriptions of each embodiment, the same reference numbers shall be given to identical portions. Also, descriptions of overlapping portions shall be omitted.
First EmbodimentIn
As shown in
The operation unit 17 has a handle 19 which can freely slide with respect to a main body 18 of the operation unit. To the handle 19, a base end of a pusher 20 is fixed. The pusher 20 extends through the inside of the inner sheath 13 to the inside of the needle 14. A distal end portion 21 of the pusher 20 is pressed against an anchor 27 of the suture tool 16.
As shown in
As shown in
Next, a suturing method of this embodiment will be explained mainly with reference to
As shown in
The distal end of the observation device 50 is inserted into an abdominal cavity 44 from the perforation 42, and the distal end of the observation device 50 is bent back by a wire or the like which is not shown in the figures. By using the observation device 50, an area around the perforation 42 to be punctured with the needle 14 (referred also to as a puncture position or a position through which the needle 14 passes) is observed from an abdominal cavity 44 side (which is also the side at which the anchor 27 is placed), that is, from the outer side of the stomach 43 (referred also as a body cavity side of the hollow organ or the abdominal cavity side) to check that other tissues such as the small intestine, the liver, or the like do not exist at the position through which the needle 14 is passed in order to prevent these tissues from being punctured or sutured together.
As shown in
Moreover, the needle 14 is thrust again at an approximately symmetrical position with respect to the position at which the needle 14 is previously thrust centered about the perforation 42. In the same manner as when using the first anchor 27, when the needle 14 penetrates through the tissue, the pusher 20 is moved forward. The second anchor 27 is pushed out into the abdominal cavity 44. As shown in
Next, as shown in
After the knot 31 of the suture thread 25 of the suture tool 16 is gripped by the grip segments 64, the outer sheath 61 is moved forward to press the tip of the outer sheath 61 against the stopper 26. As shown in
When a hollow organ such as the small intestine large intestine or another organ such as the spleen or the liver (hereinafter, merely referred to as tissue) exists around the perforation 42 (the position through which the needle 14 is passed), the other tissue is excluded from the stomach 43 by inserting an excluding device. The excluding device used in this case is exemplified in
In this embodiment, the perforation 42 is observed from the inside of the stomach 43 by the observation device 7 of the endoscope 1 at first, and the perforation 42 is then observed from the abdominal cavity 44 side by the observation device 50. After that, the suture instrument 11 is made to penetrate through the tissue around the perforation 42 to mount the suture tool 16, and the perforation 42 is sutured by using this suture tool 16. Accordingly, it is possible to suture the perforation 42 after respectively checking from the inside (the side from which the needle 14 is thrust) and the outside (the side through which the needle 14 penetrates or at which the anchor 27 is placed) of the stomach 43 that another tissue does not exist around the perforation 42. According to a suturing method using an endoscope of the prior art, it is impossible to check the opposite side. According to the endoscopic suturing method in this embodiment, it is possible to easily and reliably check for the existence of other tissues, as a result of which procedure can be carried out with rapidity.
Modified examples of this embodiment are shown in
As shown in
As shown in
As shown in
As shown in
As shown in
In this embodiment, the same endoscope 1 and suture instrument 11 as in the first embodiment are used. Descriptions that overlap with the first embodiment will be omitted.
A suturing method of this embodiment will be explained. As shown in
As shown in
As shown in
In this embodiment, after observation of the inner side of the stomach 43 by using the endoscope 1, the endoscope 1 is moved to the outer side of the stomach 43 to check by the observation device 7 from the abdominal cavity 44 side that other tissues do not exist in the area around the perforation 42. After that, the needle 14 is thrust into the tissue from the outer side to mount the suture tool 16 and suture the perforation 42 while maintaining the endoscope 1 passing through the perforation 42. Accordingly, other tissues can be easily prevented from being sutured together when suturing by using the endoscope 1.
Third EmbodimentIn this embodiment, the same endoscope 1 and suture instrument 11 as in the first embodiment are used. Descriptions that overlap with the first embodiment will be omitted.
A suturing method of this embodiment will be explained. As shown in
As shown in
In this embodiment, after the inner side and the outer side of the stomach 43 are sequentially observed by the observation device 7 of the endoscope 1 to check that other tissues do not exist in an area around the perforation 42, the endoscope 1 is drawn back to the inside of the stomach 43, and the tissue is punctured with the needle 14 from the outer side of the stomach 43. Accordingly, other tissues can be easily prevented from being sutured together when suturing by using the endoscope 1.
Next, modified examples of this embodiment will be explained. As shown in
As shown in
In this embodiment, a preferred suture instrument for the suturing method of the third embodiment is described.
As shown in
Slits 110, 111 are formed in the pair of forceps pieces 105, 106, respectively, along the lengthwise direction thereof. A hollow needle 112 is disposed in the slit 111 of the second forceps piece 106. A tip 112A on the distal end side of the needle 112 that functions as an anchor holding instrument is disposed at the distal end portion of the second forceps piece 106, and is supported to rotate freely at the second forceps piece 106 by a pin 113. The base end side of the needle 112 is disposed at the base end side of the slit 111 and is a sharp tip 112B. In the state shown in
Two anchors 27 of the suture tool 16 are housed inside of the needle 112. A slit 112C extends to a predetermined length in the needle 112 from the sharp tip 112B to the tip 112A, and the suture thread 25 is drawn out from this slit 112C.
A pusher sheath 115 is connected to the side of the tip 112A of the needle 112. The pusher sheath 115 passes through the respective slits 110, 111 of the pair of forceps pieces 105, 106 and extends along the sheath 102 to be drawn out to the hand side. The pusher 20 that pushes out the anchors 27 of the suture tool 16 is passed in the pusher sheath 115 so as to be able to freely move forward or backward.
As shown in
When suturing a perforation, as shown in
The treatment portion 103 is protruded through the perforation 42 to the outer side of the organ that is the suture object (for example, the stomach 43) with the pair of forceps pieces 105, 106 closed. By pushing in the slider 123 of the operation unit 121, the second forceps piece 106 opens with respect to the first forceps piece 105. The second forceps piece 106 that include the needle 112 moves in a direction intersecting with the axial line of the sheath 102. Moreover, by gripping the pusher sheath knob 124, the pusher sheath 115 is pushed out. As shown in
When the entire suture instrument 101 is moved backward out after aligning with the position where the sharp tip 112B of the needle 112 is to be thrust in, the needle 112 penetrates the stomach 43 from the outer side to the inner side. By grasping the pusher knob 125, as shown in
Next, the suture instrument 101 is rotated about its axial line, and the needle 112 is moved to the opposite side of the location where the suture thread 25 was passed centered about the perforation 42. Once again, when the suture instrument 101 is moved backward, the needle 112 penetrates the stomach 43 from the outer side to the inner side. As shown in
When the suture instrument 101 is pulled out of the perforation 42 into the stomach 43, the perforation 42 is closed by tightening the suture tool 16 with the forceps 60 similarly to
According to this embodiment, in a suture method that passes the needle 112 from the outer side to the inner side of the tissue, it is possible to reliably pierce the needle 112. Since it is possible to place the suture tool 16 just by the opening-closing operation and the extending and retracting of the pusher sheath 115 and the pusher 20, the operation is simple. Note that the pair of forceps pieces 105, 106 can be used for holding tissue.
Fifth EmbodimentIn this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
As shown in
At the distal end of the sheath 132, a support portion 137 extends approximately along the lengthwise direction so as to avoid the opening of the lumen 134. At the distal end of the support portion 137, a hollow needle 139 is supported so at to rotate freely by a pin 138. The needle 139 extends in an elongated manner from the end portion of the distal end side that is supported by the pin 138, and the other end portion at the base end side becomes a sharp tip 139A. In the initial state, the needle 139 is approximately parallel to the sheath 132, and the sharp tip 139A is aimed at the base end side of the sheath 132, that is, the proximal end side.
An operation wire 140 that constitutes the tip position changing mechanism is fixed to the sharp tip 139A of the needle 139. The operation wire 140 passes through the distal end of the support portion 137 to be drawn out to the hand side. When the operation wire 140 is pulled, the needle 139 rotates about the pin 138, and rises as shown by the virtual lines. The operation wire 140 has a predetermined hardness, and so by pushing in the operation wire 140, the needle 139 is housed so as to approximately follow the support portion 137, that is, to become approximately parallel to the lengthwise direction of the sheath 132. Note that by providing a groove in the support portion 137, the operation wire 140 passes along the groove, and so dropping out of the operation wire 140 is prevented.
Anchors 141 of the suture tool 16 are housed in the needle 139. In the suture tool 16, besides the two anchors 141 being manufactured from permanent magnets, it is the same as the suture tool 16. The anchors 141 are housed in the needle 139 so that the same magnetic poles face each other. In
As shown in
The procedure when suturing the perforation 42 with this suture tool 131 involves sequentially observing the inner side and outer side of the stomach 43 similarly to the third embodiment. When piercing the needle 139, the treatment portion 133 is protruded from the perforation 42 to the outer side. When the operation wire 140 is pulled by operating the slider 147 of the operation unit 145, the needle 139 deploys by inclining in the direction intersecting with the axial line of the sheath 132 centered on the pin 138. As shown in
After removing the needle 139 from the tissue by moving the entire suture instrument 131 forward, it is rotated about its axial line, to move the needle 139 to the opposite side centered about the perforation 42. Similarly, by moving the suture instrument 131 backward, the needle 139 penetrates the stomach 43 from the outer side to the inner side. By bringing the attraction instrument 136 closer, the second anchor 141 is pulled out. By moving forward the entire suture tool 131, the needle 139 is removed from the tissue, and after the needle 139 is aligned with the support portion 137, the suture tool 131 is removed from the endoscope 1. Then, the perforation 42 is closed by tightening the suture tool 16 with the forceps 60 similarly to
According to this embodiment, in a suture method that passes the needle 139 from the outer side to the inner side of the tissue, it is possible to reliably pierce the needle 139. Since only a rotation operation of the needle 139 and forward-backward movement of the attraction instrument 136 are required, the operation is simple.
Sixth EmbodimentIn this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
As shown in
The needle 155 is hollow and long, and is made from a shape-memory alloy. A sharp tip 155A of the needle 155 protrudes from the distal end opening 153A of the first lumen 153, and after being elastically deformed in an approximate U-shape, is inserted from the distal end opening 154A to the second lumen 154 so as to be capable of being freely taken out and put in. That is, the sharp tip 155A is disposed approximately parallel with the sheath 152 and disposed facing the proximal end of the sheath 152. The needle 155 is an anchor housing tool in which two anchors 27 (not illustrated in
The procedure when suturing the perforation 42 with this suture tool 151 involves sequentially observing the inner side and outer side of the stomach 43 similarly to the third embodiment. As shown in
According to this embodiment, the needle 155 that is made to have a shape memory is curved to be housed in the second lumen 154, whereby the suture instrument 151 can be readily passed through the endoscope 1 and the perforation 42. When deploying the needle 155, it only needs to be moved forward, so the operation is easy.
Note that instead of the anchors 27 and the pusher 20, it is possible to use the anchors 141 and the attraction instrument 136 of the fourth embodiment.
Seventh EmbodimentIn this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
As shown in
The procedure when suturing the perforation 42 with this suture instrument 161 involves sequentially observing the inner side and outer side of the stomach 43 similarly to the third embodiment.
In the state of contracting the curving control members 168 into a coil shape, that is, in the state of the needle 163 being disposed so as to be approximately parallel to the sheath 162, the needle 163 is passed through the perforation 42. When the curving portion 164 is projected to the outer side from the perforation 42, electrical current is supplied to the curving control members 168 or the curving control members 168 are heated. When each curving control members 168 is extended by reverting to the original shape, as shown in
By extending and retracting movement of the needle 163, the needle 163 penetrates the stomach 43 from the outer side to the inner side, and the first anchor 27 is pushed out from the needle 163 by the pusher 20. When the suture thread 25 is passed through at two locations that sandwich the perforation 42 and the anchors 27 are pushed out and released into the inner side of the stomach 43, the suture instrument 161 is withdrawn from the endoscope 1. Then, the perforation 42 is closed by tightening the suture tool 16 with the forceps 60 similarly to
According to this embodiment, by using a shape-memory alloy in a portion of the curving portion 164 of the needle 163 to perform curving in the body, when withdrawing the suture instrument 161, it is possible to perform handling with the needle 163 in a straight line, and so the operation is easy.
Here, the curving control members 168 that consist of a shape-memory metal are not limited to a shape that winds a coil in a coil shape. Also, the curving control members 168 may be a plate-shaped member that curves by being supplied electrical current or the like. It is possible to use the plate-shaped curving control members 168 together with the curving pieces 165 or in place of the curving pieces 165.
Eighth EmbodimentIn this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
As shown in
Accordingly, in the state of the sharp tip of the needle 14 being protruded to the outer side from the perforation 427 a fluid supply device (position operation device) is attached to the end portion of a lumen that is not illustrated, and so when a fluid is supplied, the balloon 173 swells as shown in
In this embodiment, since it is possible to curve the needle 14 in an approximate U-shape by swelling the balloon 173, it becomes possible to pierce through the tissue from the outer side to the inner side with a simple operation. Moreover, since the balloon 173 excludes the outside organ 175, it is possible to simply perform suturing even at locations that are in the proximity of the outside organ 175.
Ninth EmbodimentIn this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
As shown in
The second lumen 185 is curved by approximately 90 degrees by the curving portion 182A, and at further to the base end side than the first lumen 185, an opening 185A is formed at the same side portion in the circumferential direction. An operation wire 186 is passed through the second lumen 185 so as to be able to freely move forward or backward. The operation wire 186 is fixed to the distal end portion of an erecting hook 188 that is supported in the sheath 182 so as to freely rotate by a pin 187 further to the base end side than the opening 185A. The erecting book 188 can be housed in a recessed portion 189 that is formed in the sheath 182 so that the distal end portion thereof faces the hand side. Thereby, when the operation wire 186 is pulled, the erecting hook 188 deploys to the outer side as shown by the virtual lines.
As shown in
As shown in
When the needle 183 is pierced through and the first anchor 27 has been pushed out and released, after the needle 183 is removed the entire suture instrument 181 is moved forward. The engagement between the erecting hook 188 and the tissue is thus released. The needle 183 is then pieced through the tissue on the opposite side viewed from the perforation 42 while similarly drawing in the tissue with the erecting hook 188 and the second anchor 27 is pushed out. After the suture instrument 181 has been removed from the endoscope 1, the perforation 42 is closed by tightening the suture tool 16 with the forceps 60 similarly to
According to this embodiment, since the needle 183 is pierced through the tissue after it has been drawn in with the erecting hook 188, it is possible to place the suture tool 16 with a simple operation. Moreover, by drawing in the tissue with the erecting hook 188, it is possible to observe with the endoscope 1 the position and piercing process when thrusting the needle 183 without curved deformation of the needle 183 by approximately 180 degrees as in other embodiments. Instead of hooking the tissue on the erecting hook 188, the tissue may also be sandwiched between the erecting hook 188 and the sheath 182.
Here, since the curving portion 182A at the distal end of the sheath 182 may be an angle that allows the needle 183 to pierce through the tissue in cooperation with the erecting hook 188, and may be greater than 0 degrees and equal to or less than 90 degrees, compared to the case of curving by approximately 180 degrees, the operation of moving the pusher 20 forward and backward and pushing out of the anchors 27 can be reasonably performed with a light force.
Ninth EmbodimentIn this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
As shown in
In this suture instrument 201, a treatment instrument such as a high-frequency knife and the like is used for passing the suture thread 25 of the suture tool 16.
As shown in
Next, the suture thread 25 is passed through the small incision hole 220 and then anchors 27 are placed one at a time. The suture instrument 201 is passed through the endoscope 1, and the inner sheath 13 is protruded from the outer sheath 12. At this time, the inner sheath 13 abuts the stopper 26 with a wide area, and pushes out the stopper 26 from the outer sheath 12 into the stomach 43.
As shown in
Since this suture instrument 201 is of a constitution that does not have a needle, a wide contact surface with the stopper 26 is provided, and so the stopper 26 can easily and reliably be pushed out from the outer sheath 12.
This invention can be widely applied without being limited to the above-mentioned embodiments.
For example, in each suture instrument from the fourth embodiment to the eight embodiment, it is possible to use an anchor holding instrument such as shown in the ninth embodiment in place of a needle, with the anchors being released after passing the anchor holding instrument through a small incision hole that is formed with another treatment tool.
For example, the endoscope 1 may be inserted from the anus into the large intestine which is an example of a hollow organ. In this case, a perforation formed in the large intestine is sutured. Although the perforation 42 is described as being already formed, the procedure of the above-mentioned embodiment may be carried out after forming the perforation 42 by using the endoscope 1. In this case, the endoscope 1 is inserted from a natural opening into the inside of the stomach 43, and a predetermined incision portion is checked by the observation device 7 provided at the tip of the endoscope insertion part 6. After that, the predetermined incision portion is incised after passing a high-frequency knife or the like through the channel 9 of the endoscope 1 to form the perforation 42.
When the stomach 43 is widely incised and the perforation 42 is sutured by using at least three suture tools 16, suture tools 16 plurally lined up are preferably sequentially tightened up from one end thereof. In an example shown in
In the suture instrument in accordance with the first aspect of the present invention, when the anchor holding instrument is passed through a perforation and placed on the outer side, by driving the tip position changing mechanism with the position operation device, the anchor holding instrument is moved in a direction that intersects with the axial line in the lengthwise direction of the base. When the base is pulled back in this state, since the anchor holding instrument passes through the tissue around the perforation from the outer side to the inner side, when the anchors are pushed out from the tip of the anchor holding instrument, it is possible to eject the anchors in the state of the suture thread passing through the tissue.
In the suture instrument in accordance with the second aspect of the present invention, by offsetting the anchor holding instrument with respect to the axial line of the base, it is possible to point the tip of the anchor holding instrument toward the tissue around the
In the suture instrument in accordance with the third aspect of the present invention, by inclining the anchor holding instrument, it is possible to point the tip of the anchor holding instrument toward the tissue around the perforation.
In the suture instrument in accordance with the fourth aspect of the present invention, since it is possible to pierce the tissue with the anchor holding instrument, there is no need to form a hole in the tissue in advance with another treatment tool or the like.
In this suture instrument in accordance with the fifth aspect of the present invention, when having pierced through the tissue with the anchor holding instrument, it is possible to push out and eject the anchors as is.
In this suture instrument in accordance with the sixth aspect of the present invention, when the attraction instrument is brought near an anchor, the anchor is ejected from the anchor holding instrument.
In this suture instrument in accordance with the seventh aspect of the present invention, when the anchor holding instrument is passed through a perforation and placed on the outer side, by driving the deflection mechanism with the position operation device, the orientation of the anchor holding instrument is made to point to the proximal end side of the base. When the base is pulled back in this state, since the anchor holding instrument passes through the tissue around the perforation from the outer side to the inner side, when the anchors are pushed out from the tip of the anchor holding instrument, the
In this suture instrument in accordance with the eighth aspect of the present invention, by inclining the anchor holding instrument, it is possible to point the distal end of the anchor holding instrument to the tissue around the perforation.
In this suture instrument in accordance with the ninth aspect of the present invention, since it is possible to pierce through the tissue with the anchor holding instrument, there is no need to form a hole in the tissue in advance with another treatment tool or the like. instrument consists of a hollow needle, and the anchors are disposed in the needle.
In this suture instrument in accordance with the tenth aspect of the present invention, when having pierced through the tissue with the anchor holding instrument, it is possible to push out and eject the anchors as is.
In this suture instrument in accordance with the eleventh aspect of the present invention, when the attraction instrument is brought near an anchor, the anchor is ejected from the anchor holding instrument.
In accordance with the present invention, since it is possible to deploy the anchor holding instrument to make it point toward tissue around a perforation in the state of the base being passed through the perforation, if the anchor holding instrument is moved toward the tissue in this state, it is possible to make it pass from the outer side to the inner side of the tissue. Accordingly, it is possible to eject the anchors from the outer side to the inner side of the tissue with a simple operation.
INDUSTRIAL APPLICABILITYThe suture method and suture instrument according to this invention may be preferably utilized for medical applications.
Claims
1. A suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, comprising:
- a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility;
- an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is approximately pointed in the direction of the proximal end of the base;
- a tip position changing mechanism that is provided for changing the tip position of the anchor holding instrument and causes the anchor holding instrument to move in a direction that intersects with the axial line of the lengthwise direction of the base; and
- a position operation device that operates the tip position changing mechanism at the hand side and operates the tip position of the anchor holding instrument.
2. The suture instrument according to claim 1, wherein the tip position changing mechanism changes the position by causing the anchor holding instrument to move to a position that is offset from the axial line in the lengthwise direction of the base.
3. The suture instrument according to claim 1, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.
4. The suture instrument according to any one of claims 1 to 3, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.
5. The suture instrument according to any one of claims 1 to 3, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.
6. The suture instrument according to any one of claims 1 to 5, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward and backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.
7. A suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, comprising:
- a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility;
- an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is disposed at the remote end side of the base;
- a deflection mechanism that is provided for deflecting the tip position of the anchor holding instrument and causes the tip of the anchor holding instrument to deflect from the remote end of the base toward the direction that faces the proximal end; and
- a position operation device that operates the deflection mechanism at the hand side and operates the tip position of the anchor holding instrument.
8. The suture instrument according to claim 7, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.
9. The suture instrument according to claim 7 or 8, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.
10. The suture instrument according to claim 7 or 8, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.
11. The suture instrument according to any one of claims 7 to 10, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward and backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.
Type: Application
Filed: Mar 28, 2008
Publication Date: May 14, 2009
Applicant: OLYMPUS MEDICAL SYSTEMS CORP. (Tokyo)
Inventors: Takayasu MIKKAICHI (Tokyo), Masayuki IWASAKA (Tokyo), Takayuki SUZUKI (Yokohama-shi), Kunihide KAJI (Tokyo), Junji SHIONO (Yokohama-shi), Kensuke HAYASHI (Yokohama-shi), Masatoshi SATO (Yokohama-shi)
Application Number: 12/057,971
International Classification: A61B 17/062 (20060101);