WO2016189693A1

WO2016189693A1 - Medical stapler

Info

Publication number: WO2016189693A1
Application number: PCT/JP2015/065236
Authority: WO
Inventors: 雅之小林; 香由木村; 熊田　嘉之; 岡部　洋; 契介釣本
Original assignee: オリンパス株式会社
Priority date: 2015-05-27
Filing date: 2015-05-27
Publication date: 2016-12-01
Also published as: JPWO2016189693A1; JP6588541B2

Abstract

This medical stapler (1) is provided with: a cartridge (4) which has an annular or arcuate gripping surface (4a) and has a staple (6) accommodated within a slot (7) formed in the gripping surface (4a); an anvil (5) which has a gripping surface (5a) having substantially the same shape as the gripping surface (4a) and which is configured so that tissue is gripped between the gripping surfaces (4a, 5a); and a knife (9) which has an annular or arcuate edge (10A, 10B) disposed facing the anvil (5) and which is supported by the cartridge (4) so as to be capable of protruding in the direction along the center axis of the edge (10A, 10B) from the gripping surface (4a) toward the gripping surface (5a). The edge (10A, 10B) is shaped so that the position thereof along the center axis changes circumferentially.

Description

Medical stapler

The present invention relates to a medical stapler.

Conventionally, a medical stapler capable of suturing and cutting tissue has been used in a surgical operation. In order to sew tissue, staples need to penetrate and deform the tissue, and in order to cut tissue, a knife must penetrate the tissue. A normal medical stapler is generally configured to perform both the suturing and cutting at the same time, and in order to operate such a medical stapler, a large force such as several tens of kilograms is required. The In order to reduce such force, the medical stapler described in Patent Document 1 performs the operation of stitching and cutting the stapler by performing tissue stitching with staples and tissue cutting with a knife in separate steps. To save labor required.

JP 2014-133128 A

However, although a certain amount of manpower saving is recognized by the stapler of Patent Document 1, further labor saving is desired in the medical treatment field.
This invention is made | formed in view of the situation mentioned above, Comprising: It aims at providing the medical stapler which can reduce the force required for operation.

In order to achieve the above object, the present invention provides the following means.
According to a first aspect of the present invention, there is provided a cartridge having an annular or arc-shaped gripping surface, and staples accommodated in slots formed in rows in the circumferential direction on the gripping surface, and a gripping surface of the cartridge An anvil that has a gripping surface of substantially the same shape as that of the anvil gripping tissue between the gripping surfaces, and an annular or arcuate shape that extends in the circumferential direction in parallel with the row of slots and faces the anvil side A knife that is supported by the cartridge so as to protrude in a direction along a central axis of the blade from a gripping surface of the cartridge toward a gripping surface of the anvil, and the blade of the knife includes: The medical stapler has a shape in which a position in a direction along the central axis changes in a circumferential direction.

According to a second aspect of the present invention, there is provided a cartridge having an annular or arc-shaped gripping surface and staples accommodated in slots formed in rows in the circumferential direction on the gripping surface, and a gripping surface of the cartridge And an anvil that grips the tissue between the gripping surfaces, and a blade that is disposed facing the anvil side on a circumference concentric with the row of slots, A knife supported by the cartridge so as to protrude in a direction along a central axis of the blade from the gripping surface of the cartridge toward the gripping surface of the anvil, and the blade of the knife is on the circumference It is a medical stapler formed in a part and rotatably provided around the central axis.

According to the present invention, it is possible to reduce the amount of force required for the operation.

It is sectional drawing of the front-end | tip part of the medical stapler which concerns on one Embodiment of this invention. It is a perspective view of the knife in the medical stapler of FIG. It is a perspective view of the modification of the knife of FIG. It is a perspective view of another modification of the knife of FIG. It is a perspective view of another modification of the knife of FIG. It is a perspective view of another modification of the knife of FIG. It is a perspective view of another modification of the knife of FIG. It is a perspective view of another modification of the knife of FIG.

Hereinafter, a medical stapler 1 according to an embodiment of the present invention will be described with reference to the drawings.
As shown in FIG. 1, the medical stapler 1 according to the present embodiment includes an elongated insertion portion 2 that can be inserted into the body, and a suture portion 3 provided at the distal end of the insertion portion 2.

The suturing section 3 includes a cartridge 4 that accommodates a plurality of staples 6 in a releasable manner, and an anvil 5 that is located on the distal end side of the cartridge 4 and that deforms the staples 6 released from the cartridge 4. At the distal end of the cartridge 4 and the proximal end of the anvil 5, an annular distal end surface (gripping surface) 4a perpendicular to the longitudinal axis of the insertion portion 2 (hereinafter simply referred to as “longitudinal axis”) and centered on the longitudinal axis. And a base end surface (grip surface) 5a. The distal end surface 4a and the proximal end surface 5a are opposed to each other in the direction along the longitudinal axis, and can be gripped with a tissue (not shown) sandwiched between the distal end surface 4a and the proximal end surface 5a. .

The cartridge 4 includes a plurality of staples 6 accommodated in a plurality of slots 7 formed on the distal end surface 4 a, a plurality of pushers 8 for pushing the staples 6 from the slots 7, and a knife 9.
The slots 7 are arranged at intervals in the circumferential direction of the distal end surface 4a. In this embodiment, two rows of slots 7 are provided along two concentric circumferences. The staple 6 is formed of a fine line bent in a U-shape, and is supported in the slot 7 so as to be releasable from the opening of the slot 7 with two ends directed toward the anvil 5 side.

The pusher 8 is disposed on the proximal end side of each staple 6. A substantially cylindrical pusher holding member 11 is provided at the base end of the pusher 8 so as to be movable in the direction along the longitudinal axis, and the base ends of all the pushers 8 are connected to the common pusher holding member 11. Yes. The pusher holding member 11 is connected to an operation portion (not shown) provided at the proximal end of the insertion portion 2 via a cylindrical drive member 12 disposed in the longitudinal direction in the insertion portion 2. By moving the drive member 12 to the distal end side by the operation of the operation unit by the operator, all the pushers 8 are simultaneously moved to the distal end side, and all the staples 6 are simultaneously pushed out of the slot 7 toward the anvil 5. It has become.

The knife 9 has a cylindrical shape arranged coaxially with the longitudinal axis on the inner side in the radial direction of the tip surface 4a, and a blade 10 is formed over the entire circumference at the tip portion arranged facing the anvil 5 side. The blade 10 is disposed at a position retracted to the base end side from the front end surface 4 a of the cartridge 4. The proximal end of the knife 9 is held by a pusher holding member 11, and the blade 10 of the knife 9 protrudes from the distal end surface 4 a toward the anvil 5 almost simultaneously with the staple 6 by the movement of the pusher holding member 11.

As shown in FIG. 2, the blade 10 is formed in two steps in the direction along the central axis of the knife 9, and includes a peak portion 10 A composed of one half of the radial direction and a valley portion 10 B composed of the other half. Has been. The valley portion 10B is located closer to the base end side in the direction along the central axis than the mountain portion 10A. Thereby, when the knife 9 moves toward the front end toward the anvil 5, the peak portion 10A protrudes first from the front end surface 4a of the cartridge 4, and then the trough portion 10B protrudes from the front end surface 4a of the cartridge 4. It has become.

Here, the distance in the direction along the central axis between the cutting edge at the tip of the crest 10 A and the cutting edge at the tip of the trough 10 B is sandwiched between the tip surface 4 a of the cartridge 4 and the base end surface 5 a of the anvil 5. Less than the total thickness of the tissue.

1 and 2, the outer peripheral surface of the knife 9 is formed in a truncated cone shape whose diameter gradually decreases toward the tip, whereby the blade surfaces of the

blades

10A and 10B are formed on the outer peripheral surface. However, instead of this, the blade surface may be formed on the inner peripheral surface, or the blade surface may be formed on both the outer peripheral surface and the inner peripheral surface.

On the base end surface 5a of the anvil 5, an anvil pocket 13, which is a recess for deforming the staple 6 into a substantially B shape, is formed at a position facing the slot 7 in the direction along the longitudinal axis. Reference numeral 15 denotes a shaft that is disposed in the longitudinal direction in the insertion portion 2 and supports the anvil 5. The anvil 5 moves in the direction of approaching and separating from the cartridge 4 by movement in the direction along the longitudinal axis of the shaft 15. Reference numeral 16 denotes a sleeve for guiding movement in the direction along the longitudinal axis of the shaft 15.

A cylindrical knife receiving member 14 disposed coaxially with the longitudinal axis is provided at a position facing the knife 9 on the radially inner side of the proximal end surface 5a of the anvil 5 in the direction along the longitudinal axis. The knife receiving member 14 has two cylindrical

side wall portions

14a and 14b that are concentrically arranged with different radii, and an annular shape that connects the base ends of the two

side wall portions

14a and 14b in the radial direction. Receiving wall part 14c.

The surface on the base end side of the receiving wall portion 14c is a flat surface located on the same plane as the base end surface 5a. With the receiving wall 14c provided at a position facing the knife 9 in the direction along the longitudinal axis, the tissue cutting position by the knife 9 can be received and stably supported by the wall 14c. A cylindrical gap having a dimension larger than the thickness of the knife 9 in the radial direction is formed between the two

side wall parts

14a and 14b, and the blade 10 of the knife 9 penetrating the tissue and the receiving wall part 14c is a gap. To be inserted. Thereby, the blade 10 of the knife 9 can be surely penetrated into the tissue so that the tissue can be reliably cut.

Next, the operation of the medical stapler 1 configured as described above will be described.
In order to sew tissues with the medical stapler 1 according to the present embodiment, the two superimposed tissues are sandwiched between the distal end surface 4a of the cartridge 4 and the proximal end surface 5a of the anvil 5, and the operation unit is operated. . The pusher holding member 11 and the pusher 8 are moved to the distal end side by moving the drive member 12 toward the distal end side by operating the operation portion, and the staple 6 is pushed out of the slot 7 by the pusher 8. The end portion of the staple 6 pushed out from the inside of the slot 7 penetrates the tissue and is then pushed against the anvil pocket 13 so that the staple 6 is deformed into a B shape. Thereby, two tissues can be sutured along an annular suture line.

When the pusher holding member 11 is moved to the front end side, the knife 9 is pushed out to the front end side substantially simultaneously with the staple 6. The blades 10 A and 10 B of the knife 9 protruding from the front end surface 4 a of the cartridge 4 penetrate the two tissues and the receiving wall portion 14 c in order, and are inserted into the gap between the knife receiving members 14. As a result, the two tissues are cut along an annular cutting line inside the suture line.

In this case, in the process in which the knife 9 cuts the tissue, first, only the mountain portion 10A of the blade 10 of the knife 9 comes into contact with the tissue and starts cutting the tissue. Subsequently, before the crest 10A penetrates the two tissues, the trough 10B of the knife 9 contacts the tissue and starts cutting the tissue. In this way, the crest portion 10A and the trough portion 10B cut the tissue in two stages, that is, the entire blade 10 does not contact the tissue evenly at once, but a plurality of positions of the blade 10 are temporally The force acting on the knife 9 from the tissue is dispersed in a plurality of stages (in this case, two stages) in time by contacting the tissue by shifting. Thereby, there is an advantage that the driving force for moving the driving member 12 toward the distal end, that is, the amount of force required for cutting the tissue can be reduced, and therefore the maximum amount of force required for operating the operation unit can be reduced.

Particularly, since the contact area of the knife 9 with the tissue is larger than that of the thin staple 6, the ratio of the force required for cutting the tissue out of the total force required for suturing and cutting the medical stapler 1 is large. According to the present embodiment, the amount of force required to operate the medical stapler 1 can be effectively reduced by reducing the amount of force required to cut the tissue.

Furthermore, the valley 10B is stabbed into the tissue before the mountain 10A penetrates the tissue. Since the wet tissue is easily slidable with respect to the distal end surface 4a and the proximal end surface 5a, if the valley portion 10B contacts the tissue after the peak portion 10A penetrates the tissue, the tissue may be displaced. According to the present embodiment, there is an advantage that the tissue can be cut along a desired cutting line by preventing such positional displacement of the tissue.

In the present embodiment, the blade 10 of the knife 9 is formed in two stages in the direction along the central axis. However, the shape of the blade 10 is not limited to this, and the blade 10 has a central axis. Any shape may be used as long as the position along the direction changes in the circumferential direction. 3 to 5 show modifications of the shape of the blade 10.
The blade 101 of the knife 91 in FIG. 3 is formed of three

portions

101A, 101B, and 101C that are formed in three stages in the direction along the central axis, and that have different positions in the central axis direction. In this case, since the tissue is cut in three stages, the force required for cutting the tissue can be further reduced.

The blade of the knife 92 in FIG. 4 is common to the knife 9 in FIG. 2 in that it is formed in two steps in the direction along the central axis, but a plurality of crests 102A and troughs 102B are provided. The portions 102A and the valleys 102B have a concavo-convex shape that is alternately arranged in the circumferential direction. In this way, the crests 102A and the troughs 102B are evenly distributed in the circumferential direction of the knife 92, so that a force acts equally from the knife 92 to the tissue during the cutting process. Thereby, the position shift of the tissue can be prevented.

The blade of the knife 93 in FIG. 5 is the same as the knife 9 in FIG. 2 in that it is formed in two steps in the direction along the central axis, but the central axis is between the peak portion 103A and the valley portion 103B. An inclined portion 103C that is inclined with respect to the upper surface and connects the peak portion 103A and the valley portion 103B is provided. In this case, the tissue can be cut continuously.

In the present embodiment, the distal end surface 4a and the proximal end surface 5a, which are gripping surfaces, are annular, but the distal end surface 4a and the proximal end surface 5a may be arcuate. In this case, the knife 9 may have a partially cylindrical shape in which a part of the circumferential direction of the cylinder is cut out in a direction along the central axis in accordance with the shapes of the distal end surface 4a and the proximal end surface 5a, and the blade 10 has a circular shape. It may be arcuate.

In the present embodiment, the blade 10 is formed over the entire circumference of the knife 9 so that the blade 10 is parallel to the row of slots 7 over the entire length of the row of slots 7. Instead, as shown in FIG. 6, the blade 104 is formed on only a part of the knife 94 in the circumferential direction so that the blade 104 is parallel to the row of the slot 7 in a part of the row of the slot 7. May be.

In this case, the driving member for the staple 6 and the driving member for the knife 94 are provided separately, and the staple 6 and the knife 94 can be pushed out to the front end side independently of each other. Further, a rotation mechanism (not shown) for rotating the knife 94 around the central axis of the knife 94 is provided, and the knife 94 can be rotated by operating the operation unit.

6 has a concavo-convex shape at the tip, similarly to the knife 92 in FIG. 4, but the blade 104 is formed only in the portion corresponding to the peak portion 102A. According to the medical stapler 1 including the knife 94 of FIG. 6, the knife 94 is replaced with the tissue and the receiving wall portion 14c in the same manner as the medical stapler 1 including the

knife

9, 91, 92, 93 of FIGS. After cutting through the tissue, the knife 94 alone is moved to the proximal end side and the knife 94 is pulled out of the tissue. As a result, a broken cutting line is formed in the tissue.

Next, the knife 94 is rotated around the central axis so that the blade 104 and the concave portion between the blade 104 and the blade 104 are interchanged, and the knife 94 is again passed through the tissue and the receiving wall portion 14c. As a result, the tissue is cut over the entire circumference of the annular cutting line.
In this way, by forming the blade 104 only in a part of the circumferential direction of the knife 94 and cutting the tissue in multiple steps, the force acting on the knife 94 is temporally dispersed to cut the tissue. The amount of force required can be reduced.

In this modification, the blade of the knife 94 may be modified as shown in FIGS.
In the knife 95 of FIG. 7, a blade 105 extending in the direction along the central axis is also formed on the side surface adjacent to the blade 104 at the tip. According to the knife 95 of FIG. 7, the uncut portion of the tissue can be cut by the side blade 105 by rotating the knife 95 around the central axis after passing the blade 104 at the distal end through the tissue. it can.

8 has a triangular wave-shaped tip, and triangular protrusions that narrow toward the tip are arranged in the circumferential direction. The tip of the protrusion is sharply formed. The blade 106 is formed on the side surface of the protrusion. According to the knife 96 of FIG. 8, the amount of force for penetrating the knife 96 into the tissue can be further reduced.

In the above-described embodiment and its modifications, the holding

surfaces

4a and 5a of the cartridge 4 and the anvil 5 and the

blades

10, 101, 102A, 102B, and 103A of the

knives

9, 91, 92, 93, 94, 95, 96 are used. , 103B, 103C, 104, 105, 106 have an annular shape or an arc shape, but the shapes of the gripping surface and the blade of the knife are not limited thereto, and the polygonal annular shape or the polygonal shape is not limited thereto. An arc shape formed of a part of the ring may be used.

DESCRIPTION OF SYMBOLS 1 Medical stapler 4 Cartridge 4a Tip surface (grip surface)
5 Anvil 5a Base end surface (grip surface)
6 Staple 7

Slot

9, 91, 92, 93, 94, 95, 96

Knife

10, 10A, 10B, 101, 101A, 101B, 101C, 102A, 102B, 103A, 103B, 103C, 104, 105, 106 Blade

Claims

A cartridge having an annular or arcuate gripping surface and staples housed in slots formed in rows circumferentially on the gripping surface;
An anvil having a gripping surface having substantially the same shape as the gripping surface of the cartridge, and gripping tissue between the gripping surfaces;
A center axis of the blade having an annular or arcuate blade extending in the circumferential direction in parallel with the row of slots and facing the anvil side, from the gripping surface of the cartridge toward the gripping surface of the anvil A knife supported by the cartridge so as to protrude in a direction along
The knife blade is a medical stapler whose shape in the direction along the central axis changes in the circumferential direction.
The medical stapler according to claim 1, wherein the blades of the knife are formed in a plurality of stages in a direction along the central axis.
The medical stapler according to claim 1, wherein the blade of the knife is formed to be inclined with respect to a direction along the central axis.
The distance along the central axis between the position of the knife blade closest to the anvil and the position farthest from the anvil is less than the thickness of the tissue grasped between the grasping surfaces. The medical stapler according to any one of claims 1 to 3.
A cartridge having an annular or arcuate gripping surface and staples housed in slots formed in rows circumferentially on the gripping surface;
An anvil having a gripping surface having substantially the same shape as the gripping surface of the cartridge, and gripping tissue between the gripping surfaces;
It has a blade arranged facing the anvil side on a circumference concentric with the row of slots, and protrudes in a direction along the central axis of the blade from the grip surface of the cartridge toward the grip surface of the anvil. A knife supported on the cartridge,
A medical stapler in which a blade of the knife is formed on a part of the circumference and is rotatable about the central axis.