WO2017154958A1 - Needle holder for endoscopic surgery and suturing method employing same - Google Patents
Needle holder for endoscopic surgery and suturing method employing same Download PDFInfo
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- WO2017154958A1 WO2017154958A1 PCT/JP2017/009170 JP2017009170W WO2017154958A1 WO 2017154958 A1 WO2017154958 A1 WO 2017154958A1 JP 2017009170 W JP2017009170 W JP 2017009170W WO 2017154958 A1 WO2017154958 A1 WO 2017154958A1
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- needle
- suture
- holding
- needle holder
- main body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/062—Needle manipulators
Definitions
- the present invention relates to a needle holder for endoscopic surgery used at the time of surgery using an endoscope and a suturing method using the same.
- the practitioner uses the suture 60, the needle holder 70, and the forceps 80 to which the needle 50 is attached via a trocar.
- the needle 50 is grasped by the needle grasping portion 71 of the needle holder 70 while the angle of the needle 50 is adjusted by the forceps grasping portion 81 of the forceps 80 (FIG. 11B).
- the needle 50 is inserted from the insertion side B1 (FIG. 11 (c)) and penetrated to the thread removal side B2 (FIG. 12 (d)).
- a region, a region C3 of a tissue penetrating portion, and a region C4 that has not yet penetrated the tissue are formed.
- the portion of the C2 region from the needle 50 is gripped by the forceps gripping portion 81 of the forceps 80, and the suture thread 60 near the central portion of the C2 region is It is wound around the needle holder 70 in a letter shape.
- FIG. 13 (h) A knot is made by pulling in the direction of the middle arrow P (FIG. 14 (i)), and ligation is completed once by tightening in the directions of the arrow Q direction and the arrow R direction shown in FIG. 14 (j) (FIG. 14). 15 (k)). Normally, as shown in FIGS. 15 (l) and 15 (m), the operations from FIG. 12 (f) to FIG. 15 (k) are repeated, and ligation is performed twice or more to prevent unraveling. .
- FIGS. 16 (n) and (o) the first suture is completed by cutting the thread removal side B2 side and the insertion side B1 side with scissors forceps 90.
- FIG. ) The second stitching is started as shown in FIG.
- Patent Documents 1 and 2 disclose a surgical needle holder in which a suture fixing means and a suture grasping means are provided on the outer peripheral surface of the needle holder shaft. Is described.
- the fixing means described in FIGS. 21 and 22 of Patent Document 1 has a configuration in which the suture is simply hooked and fixed, so that there is a possibility that the suture will come off even if the needle holder is moved a little. there were.
- the fixing means described in FIG. 17 or the like is configured to pinch and fix the suture. In this case, the suture is extremely difficult to come off, or the suture itself is bent to cause unnecessary folds. There was a problem that it was formed or was cut off during sewing.
- the present invention has been made in view of such a situation, and an object of the present invention is to easily and surely wrap a suture thread around a needle holder during a suturing process in endoscopic surgery, particularly during ligation. It is an object of the present invention to provide a needle holder for endoscopic surgery that can be operated and a suturing method using the same.
- a suturing instrument for endoscopic surgery includes a main body portion having a needle holding portion for holding a needle portion of a suture with a needle formed at a distal end portion, and the main body portion.
- a holding portion that forms a gap for holding a suture portion of the suture with a needle, and the holding portion is formed to be openable and closable with respect to the distal end portion direction. It is characterized by that.
- the suturing method using the endoscopic surgical suturing instrument includes a main body part having a needle holding part for holding a needle part of a needle-attached suture thread at a tip part, A holding portion that is formed on the side of the needle holding portion and forms a gap for holding a suture portion of the suture with a needle, and the holding portion is formed to be openable and closable with respect to the distal end portion direction.
- a suturing method in an endoscopic operation using a needle holder the step of penetrating the suture with a needle through a tissue to be sutured, and the step of holding a suture portion of the penetrated suture with a needle in the gap Winding the needle-attached suture around the needle holder with the suture portion of the needle-attached suture held in the gap, and applying the suture target tissue around the wound portion wound around the needle holder. Insert the unpenetrated part and tie the knot It is characterized in that it comprises the step of form ligated.
- a suturing instrument for endoscopic surgery capable of easily and surely winding a suture thread around a needle holder during a suturing process in endoscopic surgery, particularly at the time of ligation, and the same are used.
- a suturing method can be provided.
- FIG. 1 It is the schematic explaining the whole structure of the needle holder 100 which concerns on this embodiment. It is a figure explaining the structure of the holding
- FIG. 1 It is the schematic explaining the whole structure of the needle holder 100 which concerns on this embodiment. It is a figure explaining the structure of the holding
- FIG. It is a figure explaining operation
- FIG. It is a figure explaining suturing operation using the suturing instrument for endoscopic surgery which concerns on this embodiment, especially a ligation operation
- FIG. 1 is a schematic diagram illustrating the overall configuration of a needle holder 100 according to the present embodiment.
- 2A and 2B are diagrams illustrating in detail the configuration of the holding unit 130 included in the needle holder 100 according to the present embodiment.
- FIG. 3 is a diagram for explaining another form of the needle holding portion provided in the needle holder 100 according to the present embodiment.
- 4 and 5 are diagrams illustrating the configuration of the stopper portion 109 according to the present embodiment, including the operating state.
- the needle holder 100 is formed by a main body portion 101 formed in a hollow rod shape and extending in a substantially vertical direction from a longitudinal end portion of the main body portion 101.
- the first operation handle portion 102 having a finger insertion portion 102a through which the right index finger of the practitioner is inserted and the first shaft support portion 101a at the longitudinal end portion of the main body portion 101 are rotatably supported and operated.
- a second operation handle portion 103 having a finger insertion portion 103a for inserting the right thumb of a person and a distal end portion on the opposite side of the longitudinal end portion of the main body portion 101 on which the shaft support portion 101a is formed, and is sutured with a needle
- a needle holding part 104 for holding a needle of a thread and a substantially rounded rectangular gap 150 are formed along the longitudinal direction of the main body 101 on the side of the needle holding part 104 to hold a suture thread with a needle.
- Holding unit 130 and second operation And an operation wire 108 for transmitting the operation transmitting force by bundles 103 to needle holder grip portion 104.
- the holding part 130 includes a holding main body part 130a and a holding main body piece part 130b formed extending from the holding main body part 130a.
- the holding main body part 130a includes a holding main body shaft support part 130c. And is pivotally supported so as to be rotatable with respect to the main body 101.
- the holding main body piece 130 b is connected to the holding main body operation unit 140 via the holding main body wire portion 141.
- the holding main body operation unit 140 is pivotally supported so as to be rotatable with respect to the main body unit 101 via an operation shaft support unit 140a, and an urging spring material 142 provided in the first operation handle unit 102. Is biased in the direction opposite to the arrow Y direction.
- the holding main body operation unit 140 When the holding main body operation unit 140 is urged in the direction opposite to the arrow Y direction in the drawing by the biasing spring material 142, the holding main body wire portion 141 is pulled in the arrow Y direction in the drawing, and the holding main body portion 130a is shown in FIG. As shown in FIG. 1, the body portion 101 is closed, whereby a substantially rounded rectangular gap 150 capable of holding a suture with thread is formed.
- the holding main body operation unit 140 is operated in a direction opposite to the biasing direction by the biasing spring member 142 (in the arrow Y direction in the figure), the holding main body wire part 141 is slackened in the direction opposite to the arrow Y direction in the figure.
- the holding main body portion 130a is opened with respect to the distal end portion direction of the main body portion 101, and the suture thread with thread can be detached from the gap 150, and the suture thread with thread can be introduced into the gap 150. .
- the holding main body 130a of the holding unit 130 includes the needle holder 100 including the main body 101 with respect to the suture 20 held in the gap 150 of the holding unit 130.
- a movable lower surface portion 130d formed so as to be movable in a substantially horizontal direction or a vertical direction, and a movable upper surface portion 101b formed in a raised shape from the movable lower surface portion 130d, the apex portion of which is provided in the main body portion 101;
- a ridge line portion 130e configured to be able to come into contact, and a lower smooth surface portion 130f formed extending from the ridge line portion 130e are provided.
- the lower smooth surface portion 130f and the upper smooth surface portion 101c extending from the moving upper surface portion 101b are in a state in which the holding main body operation portion 140 is biased in the direction opposite to the arrow Y direction in the drawing by the biasing spring material 142. It is comprised so that it may fit. That is, in the present embodiment, the needle holder for the suture 20 held by the moving lower surface portion 130d, the ridge line portion 130e, and the moving upper surface portion 101b in a state where the upper smooth surface portion 101c and the lower smooth surface portion 130f are fitted. A gap 150 in which 100 can move is formed.
- the length of the gap 150 in the short direction in other words, the width of the gap 150 formed by the moving upper surface portion 101b and the moving lower surface portion 130d is wider than the diameter of the suture thread 20, and the suture thread 20 is in the gap 150 due to friction or the like.
- the width of the suture thread 20 is not limited so long as it does not become immovable, and can be appropriately changed depending on the type of suture 20 used.
- the bottom surface portion 130g of the holding main body portion 130a and the bottom surface portion 101d of the main body portion 101 are arranged in a substantially straight line so that no step is generated. Therefore, the configuration of the holding portion 130 does not hinder the winding operation of the suture thread 20.
- the practitioner can remove the suture 20 from the needle holder 100 by pulling out the needle holder 100 in the direction of arrow Y in FIG. 2B.
- the suture 20 moves on the moving lower surface portion 130d and the ridge line portion 130e, and reaches the fitting surface between the lower smooth surface portion 130f and the upper smooth surface portion 101c.
- the force for pulling out the needle holder 100 exceeds the biasing force by the biasing spring member 142, and the suture 20 pushes the holding main body 130a in the direction of arrow H in the figure. While sliding between the lower smooth surface portion 130f and the upper smooth surface portion 101c.
- the practitioner can easily remove the suture 20 from the needle holder 100. It is also possible to remove the suture 20 from the needle holder 100 by operating the holding main body operation unit 140 in the direction opposite to the biasing direction by the biasing spring member 142 (the arrow Y direction in the figure). .
- the needle holding portion 104 that holds the needle-attached suture includes an upper holding portion 104a and a lower holding portion 104b.
- a gripping piece portion 106 a formed extending from the upper gripping portion 104 a and a gripping piece portion 106 b formed extending from the lower gripping portion 104 b are pivotable via the second shaft support portion 105. It is supported. That is, the gripping piece portion 106a and the gripping piece portion 106b are connected to the operation wire portion 108, and when the second operation handle portion 103 is driven in the direction of the arrow X in the drawing, the operation wire portion 108 is moved to the arrow in the drawing.
- the gripping piece portion 106a and the gripping side portion 106b rotate via the second shaft support portion 105, and from the upper gripping portion 104a and the gripping piece portion 106b extending from the gripping piece portion 106a.
- the extended lower grip 104b is fitted to each other.
- the needle can be gripped by fitting the upper grip 104a and the lower grip 104b.
- the operation handle portion 103 by operating the operation handle portion 103 in the direction opposite to the arrow X direction in the drawing, the upper grip portion 104a and the lower grip portion 104b are separated from each other, and the needle can be released.
- FIGS. 3A and 3B a permanent magnet or the like is provided on one or both of the upper gripping part 121a and the lower gripping part 121b.
- You may comprise as the needle holding part 121 which has this magnetic body 121c.
- FIG. 3A is a diagram illustrating a state in which the needle 10 of the suture with thread 1 is gripped by the needle holding grip portion 121 in which the magnetic body 121c is provided in the upper grip portion 121a, and FIG. It is a figure explaining the state which removed the lower side grip part 121b for description.
- the magnetic body 121c has a predetermined magnetic force enough to attract the needle 10 of the suture thread 1 with thread.
- the magnetic body 121c it is possible to attach the magnet itself to one or both of the upper gripping portion 121a and the lower gripping portion 121b, or it is possible to configure the corresponding portion with a material kneaded with a magnetic material. . Further, a so-called magnet sheet formed by mixing resin with ferrite powder or the like into a sheet shape may be cut into a predetermined size and attached by an adhesive means such as an adhesive. Furthermore, it is good also as an electromagnetic type which can switch generation
- the needle holder 100 includes a stopper member 109 that controls the opening / closing degree of the needle holding portion 104 in the second operation handle portion 103.
- the stopper member 109 is formed in a substantially U shape and is configured to be able to come into contact with the first operation handle portion 102, and a supported portion 109b extending from the spring material 109a.
- the second operation handle portion 103 is screwed into the support portion 110 and the support portion 110 that supports the spring material 109a via the supported portion 109b, and the position of the support portion 110 on the second operation handle portion 103 is determined.
- an adjustment knob portion 111 for adjustment.
- the stopper member 109 is configured to be movable on the second operation handle portion 103 in the direction of arrow Z in the drawing by the rotation operation of the adjustment knob 111 provided on the support portion 110.
- FIG. 4 is a diagram illustrating a semi-closed state of the needle holding grip 104
- FIG. 5 is a diagram illustrating a fully closed state of the needle holding grip 104.
- the practitioner inserts the right index finger into the finger insertion portion 102 a of the first operation handle portion 102, and inserts the right thumb into the finger insertion portion 103 a of the second operation handle portion 103. Then, the first operation handle portion 102 and the second operation handle portion 103 are gripped in the direction of the arrow X in the drawing with a light force. Then, the spring material 109 a of the stopper member 109 abuts on the first operation handle portion 102, so that the pulling of the operation wire portion 108 in the arrow Y direction in FIG. 1 is restricted, and the upper grip portion 104 a of the needle holding grip portion 104. And the lower grip 104b are not completely fitted together, and the open / close state of the needle gripper 104 is in a semi-closed state (FIG. 4B).
- the first operation handle portion 102 and the second operation handle portion 103 are moved in the direction indicated by the arrow X in the drawing with a stronger force than the state shown in FIG. Grip to. Then, the spring material 109a of the stopper member 109 is deformed after coming into contact with the first operation handle portion 102, whereby the operation wire portion 108 is completely pulled in the arrow Y direction in FIG. As a result, the upper gripping portion 104a and the lower gripping portion 104b of the needle holding grip portion 104 are completely fitted, and the open / close state of the needle gripping portion 104 is completely closed (FIG. 5B).
- the open / close state of the needle holding part 104 is determined by the strength of the gripping force of the practitioner with respect to the first operation handle part 102 and the second operation handle part 103. Can be controlled easily.
- FIGS. 6 (a) to 6 (c) show the distal end of the suture thread 1 with a needle described with reference to FIG. 12 (e) using the needle holder 100 for endoscopic surgery according to the present embodiment.
- FIG. 6 is a diagram illustrating a state in which a part of the suture thread 1 with a thread 1 is left without being completely penetrated and held in a gap 150 of the needle holder 100.
- FIG. 6A shows a state in which the suture thread 1 with a needle is held in the gap 150 of the needle holder 100.
- the forceps holding portion 201 of the forceps 200 to the needle holder 100. Is too short than the distance E from the thread removal side A2 to the needle holder 100, it is difficult to wind the suture 20 around the needle holder 100 in an ⁇ -shape.
- FIG. 6B shows a state in which the suture thread 1 with the needle is held in the gap 150 of the needle holder 100, as in FIG. 6A.
- the forceps gripping portion 201 of the forceps 200 is shown. Since the distance F from the grasping position to the needle holder 100 is too longer than the distance G from the thread removal side A2 to the needle holder 100, it is difficult to wind the suture 20 around the needle holder 100 in an ⁇ shape. .
- the practitioner moves from the grasping position by the forceps grasping portion 201 of the forceps 200 to the needle holder 100 as shown in FIG. 6 (c).
- the needle holder 100 is slid to such a position that the distance H of the thread and the distance I from the yarn removal side A2 to the needle holder 100 are substantially equal.
- the winding length of the suture 20 around the needle holder 100 becomes a suitable length, and it becomes easy to wind the suture 20 around the needle holder 100 in an ⁇ -shape.
- the practitioner wraps the suture 20 around the needle holder 100 in an ⁇ -shape in the direction of arrow W in the drawing (FIG. 7 (d)).
- the bottom surface portion 130g of the holding main body portion 130a and the bottom surface portion 101d of the main body portion 101 are different in level. Therefore, the structure of the holding portion 130 does not hinder the winding operation of the suture thread 20.
- the practitioner moves the distal end portion of the needle holder 100 around which the suture thread 20 is wound in the direction of arrow O shown in FIG. Pull the knot in the direction indicated by the arrow P in Fig. 7 (f) (Fig. 8 (g)), and tighten once in the directions indicated by the arrows Q and R shown in Fig. 8 (h). Complete. At this time, the suture thread 20 slides between the lower smooth surface portion 130f and the upper smooth surface portion 101c. In this way, the practitioner can easily remove the suture 20 from the needle holder 100.
- the suture thread 20 slides between the lower sliding surface portion 130f of the holding portion 130 and the upper sliding surface portion 101c of the main body portion 101 as the operator pulls out the needle holder 100. Therefore, the practitioner can easily remove the suture 20 from the needle holder 100. Therefore, in the operations shown in FIGS. 7 (f) to 8 (h), the knot formation and the needle-attached suture thread 1 can be easily pulled out.
- the gripping surface on which the upper gripping portion 104a and the lower gripping portion 104b included in the needle holding gripping portion 104 according to the present invention grip the needle has been described as a planar shape, the present invention is not limited to this. .
- the upper holding portion 120a and the lower holding portion 120d included in the needle holding portion 120 do not completely bite the suture with needle 21 when fitted. It is good also as a form provided with the holding surfaces 120b and 120e which each have the meshing parts 120c and 120f which can form a simple clearance gap.
- the needle-attached suture thread 21 is not completely locked by the needle holder grip 120, and therefore, for example, with a needle as shown in FIG.
- the slip knot 22 formed on the suture thread 21 can be easily pulled down to the ligation surface in the direction of arrow M (FIG. 10B).
- FIG. A ligation can be easily performed by gripping the end and pulling it in the direction of arrow N in the figure.
- the needle holder according to the present invention includes a main body portion in which the needle holding portion for holding the needle portion of the suture with a needle is formed at the distal end portion, and the needle holding portion side of the main body portion. And a holding portion that forms a gap for holding the suture portion of the suture with a needle, and the holding portion is configured to be openable and closable with respect to the distal end portion direction.
Abstract
The present invention addresses the problem of providing a needle holder for endoscopic surgery and a suturing method employing the same with which it is possible for a suture thread to be wound simply and reliably around a needle holder during a suturing process in endoscopic surgery, in particular during ligation. The present invention provides a needle holder for endoscopic surgery characterized in that the needle holder is provided with a main body portion in a distal end part of which is formed a needle-holding grip portion which grips a needle part of a needle-equipped suture thread, and a holding portion which is formed on the needle-holding grip portion side of the main body portion and which forms a gap for holding the suture thread part of the needle-equipped suture thread, and in that the holding portion is formed in such a way as to open and close freely in the direction of the distal end part. The present invention also provides a suturing method employing this needle holder.
Description
本発明は、内視鏡を用いた手術時に使用される内視鏡手術用の持針器及びこれを用いた縫合方法に関するものである。
The present invention relates to a needle holder for endoscopic surgery used at the time of surgery using an endoscope and a suturing method using the same.
従来、腹腔鏡や胸腔鏡等を用いた内視鏡手術では、腹壁に装着したトロカールを介してスコープ、鉗子、電気メス、縫合器具等を挿入し、狭い体腔内において外科的処置が行われる。内視鏡手術は、一般的な開腹手術と比べて患者への負担は小さいものの、施術者は内視鏡を介し、且つ遠隔的に様々な操作を行う必要があるため、高度な技術と経験を要するものである。
Conventionally, in endoscopic surgery using a laparoscope or thoracoscope, a scope, forceps, electric scalpel, suture instrument, etc. are inserted through a trocar attached to the abdominal wall, and a surgical procedure is performed in a narrow body cavity. Endoscopic surgery is less burdensome on the patient than general laparotomy, but the practitioner needs to perform various operations remotely through the endoscope, so advanced technology and experience Is required.
特に、図１１（ａ）に示すように、針付き縫合糸で組織Ｂを縫合する場合、施術者は、針５０が装着された縫合糸６０、持針器７０、及び鉗子８０をトロカールを介して体腔内に挿入後、鉗子８０の鉗子把持部８１で針５０の角度を調整しながら、持針器７０の持針把持部７１で針５０を把持する（図１１（ｂ））。そして、針５０を刺入側Ｂ１から刺入し（図１１（ｃ））、抜糸側Ｂ２に貫通させる（図１２（ｄ））。
In particular, as shown in FIG. 11 (a), when the tissue B is sutured with a suture with a needle, the practitioner uses the suture 60, the needle holder 70, and the forceps 80 to which the needle 50 is attached via a trocar. After insertion into the body cavity, the needle 50 is grasped by the needle grasping portion 71 of the needle holder 70 while the angle of the needle 50 is adjusted by the forceps grasping portion 81 of the forceps 80 (FIG. 11B). Then, the needle 50 is inserted from the insertion side B1 (FIG. 11 (c)) and penetrated to the thread removal side B2 (FIG. 12 (d)).
縫合糸６０の末端の一部を完全に貫通させずに残した状態にすると、図１２（ｅ）に示すように、針５０部分であるＣ１領域、針５０から組織貫通部分の間であるＣ２領域、組織貫通部分の領域Ｃ３、まだ組織を貫通していない領域Ｃ４が形成される。そして、図１２（ｆ）に示すようにＣ２領域の針５０よりの部分を鉗子８０の鉗子把持部８１で把持し、当該Ｃ２領域の中央部分近傍の縫合糸６０を図中矢印Ｗ方向のα字型に持針器７０に巻き付ける。次に、縫合糸６０を巻きつけた持針器７０の先端部分を図１３（ｇ）に示す矢印Ｏ方向に移動させ、持針把持部７１でＣ４領域を把持した後、図１３（ｈ）中矢印Ｐ方向に引き抜くことで結び目を作り（図１４（ｉ））、図１４（ｊ）に示す、矢印Ｑ方向、矢印Ｒ方向のそれぞれの方向に締め付けることで結紮が１回完了する（図１５（ｋ））。通常は、図１５（ｌ）、（ｍ）に示すように、図１２（ｆ）～図１５（ｋ）までの操作を繰り返し、結紮を２回以上行うことで縫合がほどけないようにしている。
When a part of the end of the suture thread 60 is left without being completely penetrated, as shown in FIG. 12 (e), as shown in FIG. 12E, the C1 region that is the needle 50 portion, C2 that is between the needle 50 and the tissue penetrating portion. A region, a region C3 of a tissue penetrating portion, and a region C4 that has not yet penetrated the tissue are formed. Then, as shown in FIG. 12 (f), the portion of the C2 region from the needle 50 is gripped by the forceps gripping portion 81 of the forceps 80, and the suture thread 60 near the central portion of the C2 region is It is wound around the needle holder 70 in a letter shape. Next, after the distal end portion of the needle holder 70 around which the suture thread 60 is wound is moved in the direction of arrow O shown in FIG. 13 (g), the needle holding portion 71 holds the C4 region, and then FIG. 13 (h) A knot is made by pulling in the direction of the middle arrow P (FIG. 14 (i)), and ligation is completed once by tightening in the directions of the arrow Q direction and the arrow R direction shown in FIG. 14 (j) (FIG. 14). 15 (k)). Normally, as shown in FIGS. 15 (l) and 15 (m), the operations from FIG. 12 (f) to FIG. 15 (k) are repeated, and ligation is performed twice or more to prevent unraveling. .
そして、図１６（ｎ）、（ｏ）に示すように、抜糸側Ｂ２側、刺入側Ｂ１側をハサミ鉗子９０で切断することにより１箇所目の縫合が終了し、次に図１６（ｐ）に示すように２箇所目の縫合を開始する。
Then, as shown in FIGS. 16 (n) and (o), the first suture is completed by cutting the thread removal side B2 side and the insertion side B1 side with scissors forceps 90. Next, FIG. ) The second stitching is started as shown in FIG.
このように、針付き縫合糸を結紮するには、右手に持つ持針器と左手に持つ鉗子との協調動作が必要である。開腹手術では持針器と鉗子との方向は自由に変えることができるが、体腔内ではトロカールを支点としてしか操作することができないため、持針器と鉗子との操作には制限がある。このため、前述したように、内視鏡手術での結紮は開腹手術においての結紮よりも格段に難しい。
Thus, in order to ligate a suture with a needle, a coordinated operation of the needle holder in the right hand and the forceps in the left hand is necessary. In laparotomy, the direction of the needle holder and forceps can be freely changed. However, since the trocar can only be operated as a fulcrum in the body cavity, the operation of the needle holder and forceps is limited. For this reason, as described above, ligation in endoscopic surgery is much more difficult than ligation in open surgery.
特に、内視鏡手術における結紮の工程では、図１２（ｆ）で示した持針器に縫合糸をα字型に巻き付けることが難しい。これは、縫合糸には弾力があり持針器（通常の内視鏡手術用の持針器の直径は５ｍｍ程度）に巻き付けようとすると、ほどける力が働くためである。
Especially, in the ligation process in endoscopic surgery, it is difficult to wrap the suture around the needle holder shown in FIG. This is because the suture thread has elasticity, and unwinding force works when it is wound around a needle holder (the diameter of a normal endoscope surgical needle holder is about 5 mm).
持針器への縫合糸の巻き付けを簡便とするため、例えば、特許文献１及び２には、持針器軸の外周面に縫合糸固定手段や縫合糸把持手段を設けた手術用持針器について記載されている。
In order to simplify the winding of the suture thread around the needle holder, for example, Patent Documents 1 and 2 disclose a surgical needle holder in which a suture fixing means and a suture grasping means are provided on the outer peripheral surface of the needle holder shaft. Is described.
しかしながら、特許文献１の図２１、２２等に記載されている固定手段は、単に縫合糸を引っ掛けて固定する構成であるため、持針器を少し動かしただけで縫合糸が外れてしまう恐れがあった。また、図１７等に記載されている固定手段は、縫合糸を挟み込んで固定する構成であり、この場合、極端に縫合糸が外れにくくなったり、縫合糸自身が屈曲して不要な折り癖が形成されたり、縫合途中で切断されてしまうといった問題があった。
However, the fixing means described in FIGS. 21 and 22 of Patent Document 1 has a configuration in which the suture is simply hooked and fixed, so that there is a possibility that the suture will come off even if the needle holder is moved a little. there were. In addition, the fixing means described in FIG. 17 or the like is configured to pinch and fix the suture. In this case, the suture is extremely difficult to come off, or the suture itself is bent to cause unnecessary folds. There was a problem that it was formed or was cut off during sewing.
また、特許文献２に記載の手術用持針器では、縫合糸は確実に把持されるものの、必要以上な把持力が縫合糸にかかるため、最悪な場合、手術中に縫合糸が切断される恐れがあった。
Further, in the surgical needle holder described in Patent Document 2, although the suture is securely grasped, an unnecessary grasping force is applied to the suture, and in the worst case, the suture is cut during the operation. There was a fear.
本発明はこのような実状に鑑みてなされたものであり、本発明の課題は、内視鏡手術における縫合工程、特に結紮時において、持針器に縫合糸を簡便に、且つ確実に巻き付けることが可能な内視鏡手術用の持針器及びこれを用いた縫合方法を提供することである。
The present invention has been made in view of such a situation, and an object of the present invention is to easily and surely wrap a suture thread around a needle holder during a suturing process in endoscopic surgery, particularly during ligation. It is an object of the present invention to provide a needle holder for endoscopic surgery that can be operated and a suturing method using the same.
上記課題を解決するために、本発明に係る内視鏡手術用の縫合器具は、針付き縫合糸の針部分を把持する持針把持部が先端部分に形成された本体部と、前記本体部の前記持針把持部側に形成され、前記針付き縫合糸の縫合糸部分を保持する空隙を形成する保持部とを備え、前記保持部は、前記先端部分方向に対して開閉自在に形成されることを特徴としている。
In order to solve the above-mentioned problems, a suturing instrument for endoscopic surgery according to the present invention includes a main body portion having a needle holding portion for holding a needle portion of a suture with a needle formed at a distal end portion, and the main body portion. A holding portion that forms a gap for holding a suture portion of the suture with a needle, and the holding portion is formed to be openable and closable with respect to the distal end portion direction. It is characterized by that.
また、本発明に係る内視鏡手術用の縫合器具を用いた縫合方法は、針付き縫合糸の針部分を把持する持針把持部が先端部分に形成された本体部と、前記本体部の前記持針把持部側に形成され、前記針付き縫合糸の縫合糸部分を保持する空隙を形成する保持部とを備え、前記保持部は、前記先端部分方向に対して開閉自在に形成される持針器を用いた内視鏡手術における縫合方法であって、縫合対象組織に前記針付き縫合糸を貫通させるステップと、貫通した前記針付き縫合糸の縫合糸部分を前記空隙に保持させるステップと、前記針付き縫合糸の縫合糸部分を前記空隙に保持させた状態で前記持針器に前記針付き縫合糸を巻き付けるステップと、前記持針器に巻き付けた巻き付け部分に前記縫合対象組織に未貫通部分を挿通させて結び目を形成し結紮するステップとを備えることを特徴としている。
Further, the suturing method using the endoscopic surgical suturing instrument according to the present invention includes a main body part having a needle holding part for holding a needle part of a needle-attached suture thread at a tip part, A holding portion that is formed on the side of the needle holding portion and forms a gap for holding a suture portion of the suture with a needle, and the holding portion is formed to be openable and closable with respect to the distal end portion direction. A suturing method in an endoscopic operation using a needle holder, the step of penetrating the suture with a needle through a tissue to be sutured, and the step of holding a suture portion of the penetrated suture with a needle in the gap Winding the needle-attached suture around the needle holder with the suture portion of the needle-attached suture held in the gap, and applying the suture target tissue around the wound portion wound around the needle holder. Insert the unpenetrated part and tie the knot It is characterized in that it comprises the step of form ligated.
本発明によれば、内視鏡手術における縫合工程、特に結紮時において、持針器に縫合糸を簡便に、且つ確実に巻き付けることが可能な内視鏡手術用の縫合器具及びこれを用いた縫合方法を提供することができる。
According to the present invention, a suturing instrument for endoscopic surgery capable of easily and surely winding a suture thread around a needle holder during a suturing process in endoscopic surgery, particularly at the time of ligation, and the same are used. A suturing method can be provided.
以下、本発明の実施形態について図面を用いて説明する。なお、本発明は以下の記述に限定されるものではなく、本発明の要旨を逸脱しない範囲において適宜変更可能である。
Hereinafter, embodiments of the present invention will be described with reference to the drawings. In addition, this invention is not limited to the following description, In the range which does not deviate from the summary of this invention, it can change suitably.
まず、本実施形態に係る持針器１００の構成について図１～図５用いて説明する。図１は、本実施形態に係る持針器１００の全体構成を説明する概略図である。図２Ａ、図２Ｂは本実施形態に係る持針器１００が備える保持部１３０の構成を詳細に説明する図である。図３は、本実施形態に係る持針器１００が備える持針把持部の他の形態を説明する図である。図４、図５は、本実施形態に係るストッパ部１０９の構成を動作状態を含めて説明する図である。
First, the configuration of the needle holder 100 according to the present embodiment will be described with reference to FIGS. FIG. 1 is a schematic diagram illustrating the overall configuration of a needle holder 100 according to the present embodiment. 2A and 2B are diagrams illustrating in detail the configuration of the holding unit 130 included in the needle holder 100 according to the present embodiment. FIG. 3 is a diagram for explaining another form of the needle holding portion provided in the needle holder 100 according to the present embodiment. 4 and 5 are diagrams illustrating the configuration of the stopper portion 109 according to the present embodiment, including the operating state.
本実施形態に係る持針器１００は、図１に示すように、中空のロッド状に形成された本体部１０１と、本体部１０１の長手方向端部から略垂直方向に延在して形成され、施術者の右手人差し指を挿通させる指挿通部１０２ａを備えた第１の操作ハンドル部１０２と、本体部１０１の長手方向端部の第１の軸支部１０１ａに回動自在に軸支され、施術者の右手親指を挿通させる指挿通部１０３ａを備えた第２の操作ハンドル部１０３と、軸支部１０１ａが形成された本体部１０１の長手方向端部の反対側先端部分に形成され、針付き縫合糸の針を把持する持針把持部１０４と、持針把持部１０４側の本体部１０１長手方向に沿って略角丸長方形状の空隙１５０を形成するように構成され、針付き縫合糸を保持する保持部１３０と、第２の操作ハンドル部１０３による操作伝達力を持針把持部１０４に伝達する操作ワイヤ部１０８とを備える。
As shown in FIG. 1, the needle holder 100 according to the present embodiment is formed by a main body portion 101 formed in a hollow rod shape and extending in a substantially vertical direction from a longitudinal end portion of the main body portion 101. The first operation handle portion 102 having a finger insertion portion 102a through which the right index finger of the practitioner is inserted and the first shaft support portion 101a at the longitudinal end portion of the main body portion 101 are rotatably supported and operated. A second operation handle portion 103 having a finger insertion portion 103a for inserting the right thumb of a person and a distal end portion on the opposite side of the longitudinal end portion of the main body portion 101 on which the shaft support portion 101a is formed, and is sutured with a needle A needle holding part 104 for holding a needle of a thread and a substantially rounded rectangular gap 150 are formed along the longitudinal direction of the main body 101 on the side of the needle holding part 104 to hold a suture thread with a needle. Holding unit 130 and second operation And an operation wire 108 for transmitting the operation transmitting force by bundles 103 to needle holder grip portion 104.
本実施形態に係る保持部１３０は、保持本体部１３０ａと、保持本体部１３０ａから延在して形成された保持本体片部１３０ｂとを有し、当該保持本体部１３０ａは保持本体軸支部１３０ｃを介し本体部１０１に対して回動可能となるように軸支されている。保持本体片部１３０ｂは保持本体ワイヤ部１４１を介して保持本体操作部１４０に接続されている。保持本体操作部１４０は、操作軸支部１４０ａを介して本体部１０１に対して回動可能となるように軸支されているとともに、第１の操作ハンドル部１０２に設けられた付勢バネ材１４２によって図中矢印Ｙ方向とは逆方向に付勢されている。付勢バネ材１４２によって保持本体操作部１４０が図中矢印Ｙ方向とは逆方向に付勢されている場合、保持本体ワイヤ部１４１は図中矢印Ｙ方向に引っ張られ、保持本体部１３０ａは図１に示すように本体部１０１に対して閉状態となり、これにより糸付き縫合糸を保持可能な略角丸長方形状の空隙１５０が形成される。一方、付勢バネ材１４２による付勢方向に対して逆方向（図中矢印Ｙ方向）に保持本体操作部１４０を操作すると、保持本体ワイヤ部１４１は図中矢印Ｙ方向とは逆方向に弛み、これにより保持本体部１３０ａは本体部１０１の先端部分方向に対して開状態となり、糸付き縫合糸を空隙１５０から離脱させることができると共に、空隙１５０に糸付き縫合糸を導入することができる。
The holding part 130 according to the present embodiment includes a holding main body part 130a and a holding main body piece part 130b formed extending from the holding main body part 130a. The holding main body part 130a includes a holding main body shaft support part 130c. And is pivotally supported so as to be rotatable with respect to the main body 101. The holding main body piece 130 b is connected to the holding main body operation unit 140 via the holding main body wire portion 141. The holding main body operation unit 140 is pivotally supported so as to be rotatable with respect to the main body unit 101 via an operation shaft support unit 140a, and an urging spring material 142 provided in the first operation handle unit 102. Is biased in the direction opposite to the arrow Y direction. When the holding main body operation unit 140 is urged in the direction opposite to the arrow Y direction in the drawing by the biasing spring material 142, the holding main body wire portion 141 is pulled in the arrow Y direction in the drawing, and the holding main body portion 130a is shown in FIG. As shown in FIG. 1, the body portion 101 is closed, whereby a substantially rounded rectangular gap 150 capable of holding a suture with thread is formed. On the other hand, when the holding main body operation unit 140 is operated in a direction opposite to the biasing direction by the biasing spring member 142 (in the arrow Y direction in the figure), the holding main body wire part 141 is slackened in the direction opposite to the arrow Y direction in the figure. As a result, the holding main body portion 130a is opened with respect to the distal end portion direction of the main body portion 101, and the suture thread with thread can be detached from the gap 150, and the suture thread with thread can be introduced into the gap 150. .
そして、図２Ａに示すように、本実施形態に係る保持部１３０の保持本体部１３０ａは、保持部１３０の空隙１５０に保持させた縫合糸２０に対して本体部１０１を含めた持針器１００が略水平方向又は垂直方向に移動可能となるように形成された移動下面部１３０ｄと、移動下面部１３０ｄから隆起状に形成され、その頂点部分が本体部１０１に設けられた移動上面部１０１ｂと当接可能となるように構成された稜線部１３０ｅと、稜線部１３０ｅから延在して形成された下滑面部１３０ｆとを備える。なお、下滑面部１３０ｆと移動上面部１０１ｂから延在する上滑面部１０１ｃとは、付勢バネ材１４２によって保持本体操作部１４０が図中矢印Ｙ方向とは逆方向に付勢されている状態において嵌合するように構成されている。すなわち、本実施形態においては、上滑面部１０１ｃと下滑面部１３０ｆとが嵌合した状態において、移動下面部１３０ｄ、稜線部１３０ｅ、及び移動上面部１０１ｂにより保持した縫合糸２０に対して持針器１００が移動可能となる空隙１５０が形成されることになる。なお、空隙１５０の短手方向長さ、換言すると、移動上面部１０１ｂと移動下面部１３０ｄとからなる空隙１５０幅は、縫合糸２０の直径よりも広く、縫合糸２０が摩擦等により空隙１５０内を移動不能とならない程度の広さであればその制限は無く、用いる縫合糸２０の種類によって適宜変更可能である。
2A, the holding main body 130a of the holding unit 130 according to the present embodiment includes the needle holder 100 including the main body 101 with respect to the suture 20 held in the gap 150 of the holding unit 130. A movable lower surface portion 130d formed so as to be movable in a substantially horizontal direction or a vertical direction, and a movable upper surface portion 101b formed in a raised shape from the movable lower surface portion 130d, the apex portion of which is provided in the main body portion 101; A ridge line portion 130e configured to be able to come into contact, and a lower smooth surface portion 130f formed extending from the ridge line portion 130e are provided. The lower smooth surface portion 130f and the upper smooth surface portion 101c extending from the moving upper surface portion 101b are in a state in which the holding main body operation portion 140 is biased in the direction opposite to the arrow Y direction in the drawing by the biasing spring material 142. It is comprised so that it may fit. That is, in the present embodiment, the needle holder for the suture 20 held by the moving lower surface portion 130d, the ridge line portion 130e, and the moving upper surface portion 101b in a state where the upper smooth surface portion 101c and the lower smooth surface portion 130f are fitted. A gap 150 in which 100 can move is formed. The length of the gap 150 in the short direction, in other words, the width of the gap 150 formed by the moving upper surface portion 101b and the moving lower surface portion 130d is wider than the diameter of the suture thread 20, and the suture thread 20 is in the gap 150 due to friction or the like. The width of the suture thread 20 is not limited so long as it does not become immovable, and can be appropriately changed depending on the type of suture 20 used.
ところで、下滑面部１３０ｆと上滑面部１０１ｃとが嵌合している状態では、保持本体部１３０ａの底面部１３０ｇと本体部１０１の底面部１０１ｄとは段差が生じないように略一直線上に配置されることになるため、保持部１３０の構成が縫合糸２０の巻き付け動作に支障をきたすことはない。
By the way, in a state where the lower smooth surface portion 130f and the upper smooth surface portion 101c are fitted, the bottom surface portion 130g of the holding main body portion 130a and the bottom surface portion 101d of the main body portion 101 are arranged in a substantially straight line so that no step is generated. Therefore, the configuration of the holding portion 130 does not hinder the winding operation of the suture thread 20.
次に、保持された縫合糸２０を空隙１５０から取り外す場合、施術者は持針器１００を図２Ｂ中矢印Ｙ方向に引き抜くことで当該縫合糸２０を持針器１００から取り外すことができる。施術者による持針器１００の引き抜き動作に伴い、縫合糸２０は移動下面部１３０ｄ、稜線部１３０ｅを移動し、下滑面部１３０ｆと上滑面部１０１ｃとの嵌合面に至る。持針器１００の引き抜き動作が継続されると、持針器１００の引き抜きに係る力が付勢バネ材１４２による付勢力に勝り、縫合糸２０は保持本体部１３０ａを図中矢印Ｈ方向に押しのけながら下滑面部１３０ｆと上滑面部１０１ｃとの間を滑り抜ける。このようにして、施術者は縫合糸２０を持針器１００から容易に取り外すことができる。また、付勢バネ材１４２による付勢方向に対して逆方向（図中矢印Ｙ方向）に保持本体操作部１４０を操作することによって、縫合糸２０を持針器１００から取り外すことも可能である。
Next, when removing the held suture 20 from the gap 150, the practitioner can remove the suture 20 from the needle holder 100 by pulling out the needle holder 100 in the direction of arrow Y in FIG. 2B. As the practitioner pulls out the needle holder 100, the suture 20 moves on the moving lower surface portion 130d and the ridge line portion 130e, and reaches the fitting surface between the lower smooth surface portion 130f and the upper smooth surface portion 101c. When the pulling operation of the needle holder 100 is continued, the force for pulling out the needle holder 100 exceeds the biasing force by the biasing spring member 142, and the suture 20 pushes the holding main body 130a in the direction of arrow H in the figure. While sliding between the lower smooth surface portion 130f and the upper smooth surface portion 101c. In this way, the practitioner can easily remove the suture 20 from the needle holder 100. It is also possible to remove the suture 20 from the needle holder 100 by operating the holding main body operation unit 140 in the direction opposite to the biasing direction by the biasing spring member 142 (the arrow Y direction in the figure). .
ところで、針付き縫合糸を把持する持針把持部１０４は、図１に示すように、上側把持部１０４ａと下側把持部１０４ｂとから構成されている。上側把持部１０４ａから延在して形成された把持片部１０６ａと下側把持部１０４ｂから延在して形成された把持片部１０６ｂとは第２の軸支部１０５を介して回動自在に軸支されている。すなわち、把持片部１０６ａと把持片部１０６ｂとは操作ワイヤ部１０８に接続されており、第２の操作ハンドル部１０３の図中矢印Ｘ方向への駆動に伴い当該操作ワイヤ部１０８が図中矢印Ｙ方向に引っ張られることにより、把持片部１０６ａと把持辺部１０６ｂとは第２の軸支部１０５を介して回動し、把持片部１０６ａから延在する上側把持部１０４ａと把持片部１０６ｂから延在する下側把持部１０４ｂとは互いに嵌合する。上側把持部１０４ａと下側把持部１０４ｂとが嵌合することにより、針を把持することができる。一方、操作ハンドル部１０３を図中矢印Ｘ方向とは逆方向に操作することにより上側把持部１０４ａと下側把持部１０４ｂとは離間し、針を離すことができる。
By the way, as shown in FIG. 1, the needle holding portion 104 that holds the needle-attached suture includes an upper holding portion 104a and a lower holding portion 104b. A gripping piece portion 106 a formed extending from the upper gripping portion 104 a and a gripping piece portion 106 b formed extending from the lower gripping portion 104 b are pivotable via the second shaft support portion 105. It is supported. That is, the gripping piece portion 106a and the gripping piece portion 106b are connected to the operation wire portion 108, and when the second operation handle portion 103 is driven in the direction of the arrow X in the drawing, the operation wire portion 108 is moved to the arrow in the drawing. By being pulled in the Y direction, the gripping piece portion 106a and the gripping side portion 106b rotate via the second shaft support portion 105, and from the upper gripping portion 104a and the gripping piece portion 106b extending from the gripping piece portion 106a. The extended lower grip 104b is fitted to each other. The needle can be gripped by fitting the upper grip 104a and the lower grip 104b. On the other hand, by operating the operation handle portion 103 in the direction opposite to the arrow X direction in the drawing, the upper grip portion 104a and the lower grip portion 104b are separated from each other, and the needle can be released.
なお、本実施形態においては、持針把持部の他の形態として、図３（ａ）、（ｂ）に示すように、上側把持部１２１ａ又は下側把持部１２１ｂの片方又は両方に永久磁石等の磁性体１２１ｃを有する持針把持部１２１として構成してもよい。図３（ａ）は、上側把持部１２１ａに磁性体１２１ｃを設けた持針把持部１２１で糸付き縫合糸１の針１０を把持した状態を説明する図であり、図３（ｂ）は、説明のために、下側把持部１２１ｂを取り外した状態を説明する図である。磁性体１２１ｃは、糸付き縫合糸１の針１０を引き付ける程度の所定の磁力を有している。磁性体１２１ｃとしては、磁石そのものを上側把持部１２１ａ又は下側把持部１２１ｂの片方又は両方に取り付けることも可能であるし、該当部分を磁性材質を練り込んだ材料で構成することも可能である。また、樹脂にフェライト粉末等を混ぜてシート状にした、所謂、マグネットシートを所定のサイズに裁断し接着剤等の接着手段で取り付けてもよい。さらに、磁性体１２１ｃでの磁力の発生・停止を本体部１０１に設けられた図示せぬ操作スイッチによって切替可能とする電磁式としてもよい。
In this embodiment, as another form of the needle holding gripper, as shown in FIGS. 3A and 3B, a permanent magnet or the like is provided on one or both of the upper gripping part 121a and the lower gripping part 121b. You may comprise as the needle holding part 121 which has this magnetic body 121c. FIG. 3A is a diagram illustrating a state in which the needle 10 of the suture with thread 1 is gripped by the needle holding grip portion 121 in which the magnetic body 121c is provided in the upper grip portion 121a, and FIG. It is a figure explaining the state which removed the lower side grip part 121b for description. The magnetic body 121c has a predetermined magnetic force enough to attract the needle 10 of the suture thread 1 with thread. As the magnetic body 121c, it is possible to attach the magnet itself to one or both of the upper gripping portion 121a and the lower gripping portion 121b, or it is possible to configure the corresponding portion with a material kneaded with a magnetic material. . Further, a so-called magnet sheet formed by mixing resin with ferrite powder or the like into a sheet shape may be cut into a predetermined size and attached by an adhesive means such as an adhesive. Furthermore, it is good also as an electromagnetic type which can switch generation | occurrence | production / stop of the magnetic force in the magnetic body 121c with the operation switch which is not provided in the main-body part 101.
次に、本実施形態に係るストッパ部材１０９について説明する。図１に示すように、本実施形態に係る持針器１００は、第２の操作ハンドル部１０３に持針把持部１０４の開閉度合いを制御するストッパ部材１０９を備える。ストッパ部材１０９は、略Ｕ字状に形成され、第１の操作ハンドル部１０２に対して当接可能となるように構成されたバネ材１０９ａと、バネ材１０９ａから延在する被支持部１０９ｂと、第２の操作ハンドル部１０３に被支持部１０９ｂを介してバネ材１０９ａを支持する支持部１１０と、支持部１１０に螺合され、第２の操作ハンドル部１０３上における支持部１１０の位置を調整する調整ノブ部１１１とを備える。
Next, the stopper member 109 according to this embodiment will be described. As shown in FIG. 1, the needle holder 100 according to the present embodiment includes a stopper member 109 that controls the opening / closing degree of the needle holding portion 104 in the second operation handle portion 103. The stopper member 109 is formed in a substantially U shape and is configured to be able to come into contact with the first operation handle portion 102, and a supported portion 109b extending from the spring material 109a. The second operation handle portion 103 is screwed into the support portion 110 and the support portion 110 that supports the spring material 109a via the supported portion 109b, and the position of the support portion 110 on the second operation handle portion 103 is determined. And an adjustment knob portion 111 for adjustment.
ストッパ部材１０９は、支持部１１０上に設けられた調整ノブ１１１の回動動作により第２の操作ハンドル部１０３上を図中矢印Ｚ方向に移動可能となるように構成されている。
The stopper member 109 is configured to be movable on the second operation handle portion 103 in the direction of arrow Z in the drawing by the rotation operation of the adjustment knob 111 provided on the support portion 110.
ここで、図４及び図５を用いて本実施形態に係るストッパ部材１０９の動作について説明する。図４は、持針把持部１０４のセミクローズ状態を説明する図であり、図５は、持針把持部１０４の完全クローズ状態を説明する図である。
Here, the operation of the stopper member 109 according to this embodiment will be described with reference to FIGS. 4 and 5. FIG. 4 is a diagram illustrating a semi-closed state of the needle holding grip 104, and FIG. 5 is a diagram illustrating a fully closed state of the needle holding grip 104.
図４（ａ）に示すように、施術者は第１の操作ハンドル部１０２の指挿通部１０２ａに右手人差し指を挿通するとともに、第２の操作ハンドル部１０３の指挿通部１０３ａに右手親指を挿通し、軽い力で第１の操作ハンドル部１０２と第２の操作ハンドル部１０３を図中矢印Ｘ方向に把持する。するとストッパ部材１０９のバネ材１０９ａが第１の操作ハンドル部１０２に当接することで、操作ワイヤ部１０８の図１中矢印Ｙ方向への引っ張りが制限され、持針把持部１０４の上側把持部１０４ａと下側把持部１０４ｂとが完全に嵌合せず、持針把持部１０４の開閉状態はセミクローズ状態となる（図４（ｂ））。
As shown in FIG. 4A, the practitioner inserts the right index finger into the finger insertion portion 102 a of the first operation handle portion 102, and inserts the right thumb into the finger insertion portion 103 a of the second operation handle portion 103. Then, the first operation handle portion 102 and the second operation handle portion 103 are gripped in the direction of the arrow X in the drawing with a light force. Then, the spring material 109 a of the stopper member 109 abuts on the first operation handle portion 102, so that the pulling of the operation wire portion 108 in the arrow Y direction in FIG. 1 is restricted, and the upper grip portion 104 a of the needle holding grip portion 104. And the lower grip 104b are not completely fitted together, and the open / close state of the needle gripper 104 is in a semi-closed state (FIG. 4B).
これに対して、図５（ａ）に示すように、図４（ａ）で示した状態よりも強い力で第１の操作ハンドル部１０２と第２の操作ハンドル部１０３を図中矢印Ｘ方向に把持する。するとストッパ部材１０９のバネ材１０９ａは第１の操作ハンドル部１０２に当接後、変形することで、操作ワイヤ部１０８が図１中矢印Ｙ方向へ完全に引っ張られる。その結果、持針把持部１０４の上側把持部１０４ａと下側把持部１０４ｂとが完全に嵌合し、持針把持部１０４の開閉状態は完全クローズ状態となる（図５（ｂ））。
On the other hand, as shown in FIG. 5A, the first operation handle portion 102 and the second operation handle portion 103 are moved in the direction indicated by the arrow X in the drawing with a stronger force than the state shown in FIG. Grip to. Then, the spring material 109a of the stopper member 109 is deformed after coming into contact with the first operation handle portion 102, whereby the operation wire portion 108 is completely pulled in the arrow Y direction in FIG. As a result, the upper gripping portion 104a and the lower gripping portion 104b of the needle holding grip portion 104 are completely fitted, and the open / close state of the needle gripping portion 104 is completely closed (FIG. 5B).
このように、本実施形態に係る持針器１００によれば、施術者の第１の操作ハンドル部１０２及び第２の操作ハンドル部１０３に対する把持力の強弱によって、持針把持部１０４の開閉状態を簡単に制御することができる。
As described above, according to the needle holder 100 according to the present embodiment, the open / close state of the needle holding part 104 is determined by the strength of the gripping force of the practitioner with respect to the first operation handle part 102 and the second operation handle part 103. Can be controlled easily.
次に、本実施形態に係る内視鏡手術用の持針器１００を用いた縫合操作、特に結紮動作について説明する。図１１（ａ）から図１２（ｄ）で説明した操作と同様に、施術者は、組織Ａを縫合する場合、針付き縫合糸１、持針器１００、及び鉗子２００をトロカールを介して体腔内に挿入後、鉗子２００の鉗子把持部２０１で針１０の角度を調整しながら、持針器１００の持針把持部１０４で針１０を把持する。そして、針１０を刺入側Ａ１から刺入し、抜糸側Ａ２に貫通させる。次いで、施術者は、付勢バネ材１４２による付勢方向に対して逆方向（図１中矢印Ｙ方向）に保持本体操作部１４０を操作することにより、保持本体部１３０ａを本体部１０１に対して開状態とし、糸付き縫合糸１の縫合糸２０を空隙１５０に保持させる。ここで、図６（ａ）～図６（ｃ）は、本実施形態に係る内視鏡手術用の持針器１００を用い、図１２（ｅ）で説明した針付き縫合糸１の末端の一部を完全に貫通させずに残し、糸付き縫合糸１の縫合糸２０を持針器１００の空隙１５０に保持させた状態を説明する図である。
Next, a suturing operation using the needle holder 100 for endoscopic surgery according to the present embodiment, particularly a ligation operation will be described. Similar to the operation described with reference to FIGS. 11A to 12D, when the operator sutures the tissue A, the operator inserts the suture thread with needle 1, the needle holder 100, and the forceps 200 through the trocar. After insertion, the needle 10 is gripped by the needle gripping part 104 of the needle holder 100 while the angle of the needle 10 is adjusted by the forceps gripping part 201 of the forceps 200. Then, the needle 10 is inserted from the insertion side A1 and penetrated to the yarn removal side A2. Next, the practitioner operates the holding main body operation unit 140 in a direction opposite to the biasing direction by the biasing spring member 142 (the arrow Y direction in FIG. 1), thereby moving the holding main body portion 130 a relative to the main body portion 101. Thus, the suture 20 of the suture with thread 1 is held in the gap 150. Here, FIGS. 6 (a) to 6 (c) show the distal end of the suture thread 1 with a needle described with reference to FIG. 12 (e) using the needle holder 100 for endoscopic surgery according to the present embodiment. FIG. 6 is a diagram illustrating a state in which a part of the suture thread 1 with a thread 1 is left without being completely penetrated and held in a gap 150 of the needle holder 100.
図６（ａ）は、持針器１００の空隙１５０において針付き縫合糸１が保持された状態を表しているが、この場合、鉗子２００の鉗子把持部２０１による把持位置から持針器１００までの距離Ｄが抜糸側Ａ２から持針器１００までの距離Ｅよりも短すぎるため、縫合糸２０をα字型に持針器１００に巻き付けることが困難である。
FIG. 6A shows a state in which the suture thread 1 with a needle is held in the gap 150 of the needle holder 100. In this case, from the holding position by the forceps holding portion 201 of the forceps 200 to the needle holder 100. Is too short than the distance E from the thread removal side A2 to the needle holder 100, it is difficult to wind the suture 20 around the needle holder 100 in an α-shape.
図６（ｂ）は、図６（ａ）と同様に、持針器１００の空隙１５０において針付き縫合糸１が保持された状態を表しているが、この場合、鉗子２００の鉗子把持部２０１による把持位置から持針器１００までの距離Ｆが抜糸側Ａ２から持針器１００までの距離Ｇよりも長すぎるため、縫合糸２０をα字型に持針器１００に巻き付けることが困難である。
6B shows a state in which the suture thread 1 with the needle is held in the gap 150 of the needle holder 100, as in FIG. 6A. In this case, the forceps gripping portion 201 of the forceps 200 is shown. Since the distance F from the grasping position to the needle holder 100 is too longer than the distance G from the thread removal side A2 to the needle holder 100, it is difficult to wind the suture 20 around the needle holder 100 in an α shape. .
図６（ａ）及び図６（ｂ）に示したような状況に対して、施術者は図６（ｃ）に示すように、鉗子２００の鉗子把持部２０１による把持位置から持針器１００までの距離Ｈと抜糸側Ａ２から持針器１００までの距離Ｉとが略等しくなるような位置に持針器１００をスライドさせる。この場合、持針器１００に対する縫合糸２０の巻き付け長さが好適な長さとなり、縫合糸２０をα字型に持針器１００に巻き付けることが容易となる。
6 (a) and 6 (b), the practitioner moves from the grasping position by the forceps grasping portion 201 of the forceps 200 to the needle holder 100 as shown in FIG. 6 (c). The needle holder 100 is slid to such a position that the distance H of the thread and the distance I from the yarn removal side A2 to the needle holder 100 are substantially equal. In this case, the winding length of the suture 20 around the needle holder 100 becomes a suitable length, and it becomes easy to wind the suture 20 around the needle holder 100 in an α-shape.
そして、施術者は、縫合糸２０を図中矢印Ｗ方向のα字型に持針器１００に巻き付ける（図７（ｄ））。前述したように、保持部材３０の下滑面部１３０ｆと本体部１０１の上滑面部１０１ｃとが嵌合している状態では、保持本体部１３０ａの底面部１３０ｇと本体部１０１の底面部１０１ｄとは段差が生じないように略一直線上に配置されることになるため、保持部１３０の構成が縫合糸２０の巻き付け動作に支障をきたすことはない。
Then, the practitioner wraps the suture 20 around the needle holder 100 in an α-shape in the direction of arrow W in the drawing (FIG. 7 (d)). As described above, when the lower smooth surface portion 130f of the holding member 30 and the upper smooth surface portion 101c of the main body portion 101 are fitted, the bottom surface portion 130g of the holding main body portion 130a and the bottom surface portion 101d of the main body portion 101 are different in level. Therefore, the structure of the holding portion 130 does not hinder the winding operation of the suture thread 20.
次に、施術者は、縫合糸２０を巻きつけた持針器１００の先端部分を図７（ｅ）に示す矢印Ｏ方向に移動させ、持針把持部１０４でＣ４領域を把持した後、図７（ｆ）中矢印Ｐ方向に引き抜くことで結び目を作り（図８（ｇ））、図８（ｈ）に示す、矢印Ｑ方向、矢印Ｒ方向のそれぞれの方向に締め付けることで結紮が１回完了する。この際、縫合糸２０は下滑面部１３０ｆと上滑面部１０１ｃとの間を滑り抜ける。このようにして、施術者は縫合糸２０を持針器１００から容易に取り外すことができる。
Next, the practitioner moves the distal end portion of the needle holder 100 around which the suture thread 20 is wound in the direction of arrow O shown in FIG. Pull the knot in the direction indicated by the arrow P in Fig. 7 (f) (Fig. 8 (g)), and tighten once in the directions indicated by the arrows Q and R shown in Fig. 8 (h). Complete. At this time, the suture thread 20 slides between the lower smooth surface portion 130f and the upper smooth surface portion 101c. In this way, the practitioner can easily remove the suture 20 from the needle holder 100.
前述したように、本実施形態においては、施術者による持針器１００の引き抜き動作に伴い、縫合糸２０は保持部１３０の下滑面部１３０ｆと本体部１０１の上滑面部１０１ｃとの間を滑り抜けるため、施術者は縫合糸２０を持針器１００から容易に取り外すことができる。したがって、図７（ｆ）～図８（ｈ）に示した操作における、結び目形成、針付き縫合糸１の引き抜き操作では、簡便に針付き縫合糸１を引き抜くことができる。
As described above, in this embodiment, the suture thread 20 slides between the lower sliding surface portion 130f of the holding portion 130 and the upper sliding surface portion 101c of the main body portion 101 as the operator pulls out the needle holder 100. Therefore, the practitioner can easily remove the suture 20 from the needle holder 100. Therefore, in the operations shown in FIGS. 7 (f) to 8 (h), the knot formation and the needle-attached suture thread 1 can be easily pulled out.
なお、本発明に係る持針把持部１０４が備える上側把持部１０４ａと下側把持部１０４ｂとが針を把持する把持面は平面形状として説明したが、本発明はこれに限定されるものではない。例えば、図９に示す持針器１００’のように、持針把持部１２０が備える上側把持部１２０ａ及び下側把持部１２０ｄは、嵌合の際に針付き縫合糸２１を完全に咬合しないような隙間を形成可能な噛合部１２０ｃ及び１２０ｆをそれぞれ有する把持面１２０ｂ及び１２０ｅを備える形態としてもよい。
In addition, although the gripping surface on which the upper gripping portion 104a and the lower gripping portion 104b included in the needle holding gripping portion 104 according to the present invention grip the needle has been described as a planar shape, the present invention is not limited to this. . For example, like the needle holder 100 ′ shown in FIG. 9, the upper holding portion 120a and the lower holding portion 120d included in the needle holding portion 120 do not completely bite the suture with needle 21 when fitted. It is good also as a form provided with the holding surfaces 120b and 120e which each have the meshing parts 120c and 120f which can form a simple clearance gap.
このような構成の持針器１００’によれば、針付き縫合糸２１は持針把持部１２０によって完全に繋止されるわけではないので、例えば、図１０（ａ）に示すような針付き縫合糸２１に形成されたスリップノット２２を矢印Ｍ方向の結紮面に容易に引き下ろすことができ（図１０（ｂ））、最後に、図１０（ｃ）に示すように針付き縫合糸２１端部を把持し図中矢印Ｎ方向に引っ張ることで容易に結紮を行うことができる。
According to the needle holder 100 ′ having such a configuration, the needle-attached suture thread 21 is not completely locked by the needle holder grip 120, and therefore, for example, with a needle as shown in FIG. The slip knot 22 formed on the suture thread 21 can be easily pulled down to the ligation surface in the direction of arrow M (FIG. 10B). Finally, as shown in FIG. A ligation can be easily performed by gripping the end and pulling it in the direction of arrow N in the figure.
以上のように、本発明に係る持針器は、針付き縫合糸の針部分を把持する持針把持部が先端部分に形成された本体部と、前記本体部の前記持針把持部側に形成され、前記針付き縫合糸の縫合糸部分を保持する空隙を形成する保持部とを備え、前記保持部は、前記先端部分方向に対して開閉自在に形成された構成であるため、内視鏡手術における縫合工程、特に結紮時において、持針器に縫合糸を簡便に、且つ確実に巻き付けることが可能となり、縫合工程を円滑、且つ安全に行うことができる。
As described above, the needle holder according to the present invention includes a main body portion in which the needle holding portion for holding the needle portion of the suture with a needle is formed at the distal end portion, and the needle holding portion side of the main body portion. And a holding portion that forms a gap for holding the suture portion of the suture with a needle, and the holding portion is configured to be openable and closable with respect to the distal end portion direction. In a suturing process in mirror surgery, particularly at the time of ligation, a suture can be easily and reliably wound around a needle holder, and the suturing process can be performed smoothly and safely.
１ 針付き縫合糸
１０ 針
２０ 縫合糸
５０ 針
６０ 縫合糸
７０ 持針器
７１ 持針把持部
８０ 鉗子
８１ 鉗子把持部
１００ 持針器
１００’ 持針器
１０１ 本体部
１０１ａ 第１の軸支部
１０１ｂ 移動上面部
１０１ｃ 上滑面部
１０１ ｄ 底面部
１０２ 第１の操作ハンドル部
１０２ａ 指挿通部
１０３ 第２の操作ハンドル部
１０３ａ 指挿通部
１０４ 持針把持部
１０４ａ 上側把持部
１０４ｂ 下側把持部
１０５ 第２の軸支部
１０６ａ 把持片部
１０６ｂ 把持片部
１０８ 操作ワイヤ部
１０９ ストッパ部
１０９ａ バネ材
１０９ｂ 被支持部
１１０ 支持部
１１１ 調整ノブ部
１２０ 持針把持部
１２０ａ 上側把持部
１２０ｂ 把持面
１２０ｃ 噛合部
１２０ｄ 下側把持部
１２０ｅ 把持面
１２０ｆ 噛合部
１２１ 持針把持部
１２１ａ 上側把持部
１２１ｂ 下側把持部
１２１ｃ 磁性体
１３０ 保持部
１３０ａ 保持本体部
１３０ｂ 保持本体片部
１３０ｃ 保持本体軸支部
１３０ｄ 移動下面部
１３０ｅ 稜線部
１３０ｆ 下滑面部
１３０ｇ 底面部
１４０ 保持本体操作部
１４０ａ 操作軸支部
１４１ 保持本体ワイヤ部
１４２ 付勢バネ材
１５０ 空隙 DESCRIPTION OFSYMBOLS 1 Suture with needle 10 Needle 20 Suture 50 Needle 60 Suture 70 Needle holder 71 Needle holding part 80 Forceps 81 Forceps holding part 100 Needle holder 100 'Needle holder 101 Main body part 101a First shaft support part 101b Movement Upper surface portion 101c Upper smooth surface portion 101d Bottom surface portion 102 First operation handle portion 102a Finger insertion portion 103 Second operation handle portion 103a Finger insertion portion 104 Needle gripping portion 104a Upper gripping portion 104b Lower gripping portion 105 Second Axis support portion 106a Grip piece portion 106b Grip piece portion 108 Operation wire portion 109 Stopper portion 109a Spring material 109b Supported portion 110 Support portion 111 Adjustment knob portion 120 Needle grip portion 120a Upper grip portion 120b Grip surface 120c Engagement portion 120d Lower grip Portion 120e gripping surface 120f meshing portion 121 needle holding gripper 121a upper gripping portion 121b lower gripping portion 1 1c Magnetic body 130 Holding portion 130a Holding main body portion 130b Holding main body piece portion 130c Holding main body shaft support portion 130d Moving lower surface portion 130e Edge line portion 130f Lower smooth surface portion 130g Bottom surface portion 140 Holding main body operation portion 140a Operation shaft supporting portion 141 Holding main body wire portion 142 Energizing Spring material 150
１０ 針
２０ 縫合糸
５０ 針
６０ 縫合糸
７０ 持針器
７１ 持針把持部
８０ 鉗子
８１ 鉗子把持部
１００ 持針器
１００’ 持針器
１０１ 本体部
１０１ａ 第１の軸支部
１０１ｂ 移動上面部
１０１ｃ 上滑面部
１０１ ｄ 底面部
１０２ 第１の操作ハンドル部
１０２ａ 指挿通部
１０３ 第２の操作ハンドル部
１０３ａ 指挿通部
１０４ 持針把持部
１０４ａ 上側把持部
１０４ｂ 下側把持部
１０５ 第２の軸支部
１０６ａ 把持片部
１０６ｂ 把持片部
１０８ 操作ワイヤ部
１０９ ストッパ部
１０９ａ バネ材
１０９ｂ 被支持部
１１０ 支持部
１１１ 調整ノブ部
１２０ 持針把持部
１２０ａ 上側把持部
１２０ｂ 把持面
１２０ｃ 噛合部
１２０ｄ 下側把持部
１２０ｅ 把持面
１２０ｆ 噛合部
１２１ 持針把持部
１２１ａ 上側把持部
１２１ｂ 下側把持部
１２１ｃ 磁性体
１３０ 保持部
１３０ａ 保持本体部
１３０ｂ 保持本体片部
１３０ｃ 保持本体軸支部
１３０ｄ 移動下面部
１３０ｅ 稜線部
１３０ｆ 下滑面部
１３０ｇ 底面部
１４０ 保持本体操作部
１４０ａ 操作軸支部
１４１ 保持本体ワイヤ部
１４２ 付勢バネ材
１５０ 空隙 DESCRIPTION OF
Claims (8)
- 針付き縫合糸の針部分を把持する持針把持部が先端部分に形成された本体部と、
前記本体部の前記持針把持部側に形成され、前記針付き縫合糸の縫合糸部分を保持する空隙を形成する保持部とを備え、
前記保持部は、前記先端部分方向に対して開閉自在に形成されること
を特徴とする内視鏡手術用の持針器。 A main body part in which a needle holding part for holding a needle part of a suture with a needle is formed at a tip part;
A holding portion that is formed on the side of the needle holding portion of the main body portion and forms a gap that holds a suture portion of the suture with a needle,
The needle holder for endoscopic surgery, wherein the holding portion is formed to be openable and closable with respect to the distal end portion direction. - 前記保持部は、前記針付き縫合糸が離間する際に滑り抜ける滑面部を備えること
を特徴とする請求項１に記載の内視鏡手術用の持針器。 The needle holder for endoscopic surgery according to claim 1, wherein the holding portion includes a smooth surface portion that slides through when the suture with a needle is separated. - 前記空隙は、前記本体部の長手方向に沿って形成された角丸長方形状であること
を特徴とする請求項１又は請求項２に記載の内視鏡手術用の持針器。 The needle holder for endoscopic surgery according to claim 1 or 2, wherein the gap is a rounded rectangular shape formed along the longitudinal direction of the main body. - 前記本体部に対する前記保持部の開閉を制御する付勢部材を備え、
前記付勢部材の付勢力は前記空隙から前記縫合糸部分を引き抜く力よりも弱いこと
を特徴とする請求項１乃至請求項３の何れか１項に記載の内視鏡手術用の持針器。 An urging member for controlling the opening and closing of the holding portion with respect to the main body portion;
The needle holder for endoscopic surgery according to any one of claims 1 to 3, wherein the urging force of the urging member is weaker than a force for pulling out the suture thread portion from the gap. . - 前記持針把持部は、磁性体を備えること
を特徴とする請求項１乃至請求項４の何れか１項に記載の内視鏡手術用の持針器。 The needle holder for endoscopic surgery according to any one of claims 1 to 4, wherein the needle holding portion includes a magnetic body. - 前記本体部端部から延在して形成された第１の操作ハンドル部と、
前記本体部端部に軸支された第２の操作ハンドル部と、
前記第２の操作ハンドル部上に形成され、前記第１の操作ハンドル部と当接することにより、前記持針把持部の嵌合を制御するストッパ部材とを備えること
を特徴とする請求項１乃至請求項５の何れか１項に記載の内視鏡手術用の持針器。 A first operation handle portion formed extending from the end of the main body portion;
A second operation handle portion pivotally supported at the end of the main body portion;
A stopper member that is formed on the second operation handle portion and that controls the fitting of the needle holding portion by contacting the first operation handle portion. The needle holder for endoscopic surgery according to any one of claims 5 to 6. - 前記持針把持部は、前記針付き縫合糸の縫合糸部分を把持した際に、当該縫合糸部分を完全に咬合しない隙間を有する噛合部を備えること
を特徴とする請求項１乃至請求項６の何れか１項に記載の内視鏡手術用の持針器。 The said holding needle holding part is provided with the meshing part which has a clearance gap which does not bite the said suture part completely, when the suture part of the said suture with a needle | hook is hold | gripped. A needle holder for endoscopic surgery according to any one of the above. - 針付き縫合糸の針部分を把持する持針把持部が先端部分に形成された本体部と、
前記本体部の前記持針把持部側に形成され、前記針付き縫合糸の縫合糸部分を保持する空隙を形成する保持部とを備え、
前記保持部は、前記先端部分方向に対して開閉自在に形成される持針器を用いた内視鏡手術における縫合方法であって、
縫合対象組織に前記針付き縫合糸を貫通させるステップと、
貫通した前記針付き縫合糸の縫合糸部分を前記空隙に保持させるステップと、
前記針付き縫合糸の縫合糸部分を前記空隙に保持させた状態で前記持針器に前記針付き縫合糸を巻き付けるステップと、
前記持針器に巻き付けた巻き付け部分に前記縫合対象組織に未貫通部分を挿通させて結び目を形成し結紮するステップとを備えること
を特徴とする内視鏡手術における縫合方法。 A main body part in which a needle holding part for holding a needle part of a suture with a needle is formed at a tip part;
A holding portion that is formed on the side of the needle holding portion of the main body portion and forms a gap that holds a suture portion of the suture with a needle,
The holding portion is a suturing method in an endoscopic operation using a needle holder that is formed to be openable and closable with respect to the distal end portion direction,
Passing the needled suture through the tissue to be sutured;
Holding the suture portion of the needled suture penetrating in the gap;
Winding the needle-attached suture around the needle holder with the suture portion of the suture with needle held in the gap;
A suturing method in endoscopic surgery, comprising: a step of inserting a non-penetrating portion through the tissue to be sutured into a wound portion wound around the needle holder and forming a knot.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2016044893A JP2017158722A (en) | 2016-03-08 | 2016-03-08 | Needle holder for endoscopic surgery and suturing method using the same |
| JP2016-044893 | 2016-03-08 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| WO2017154958A1 true WO2017154958A1 (en) | 2017-09-14 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/JP2017/009170 WO2017154958A1 (en) | 2016-03-08 | 2017-03-08 | Needle holder for endoscopic surgery and suturing method employing same |
Country Status (2)
| Country | Link |
|---|---|
| JP (1) | JP2017158722A (en) |
| WO (1) | WO2017154958A1 (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111867488A (en) * | 2018-03-22 | 2020-10-30 | 奥林巴斯株式会社 | Needle holder and method of use thereof |
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| DE4127812A1 (en) * | 1991-08-22 | 1993-02-25 | Storz Karl Gmbh & Co | Needle holder for use with endoscope - has jaws which can be manipulated to form knot in surgical thread |
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| CN111867488A (en) * | 2018-03-22 | 2020-10-30 | 奥林巴斯株式会社 | Needle holder and method of use thereof |
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| Publication number | Publication date |
|---|---|
| JP2017158722A (en) | 2017-09-14 |
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