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WO2007116997A1 - Instrument chirurgical anastomotique - Google Patents

Instrument chirurgical anastomotique Download PDF

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Publication number
WO2007116997A1
WO2007116997A1 PCT/JP2007/057831 JP2007057831W WO2007116997A1 WO 2007116997 A1 WO2007116997 A1 WO 2007116997A1 JP 2007057831 W JP2007057831 W JP 2007057831W WO 2007116997 A1 WO2007116997 A1 WO 2007116997A1
Authority
WO
WIPO (PCT)
Prior art keywords
needle
main body
anastomosis
guide portion
thread
Prior art date
Application number
PCT/JP2007/057831
Other languages
English (en)
Japanese (ja)
Inventor
Tomio Ueno
Original Assignee
Yamaguchi University
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from JP2006138206A external-priority patent/JP3867150B1/ja
Priority claimed from JP2006195379A external-priority patent/JP3867151B1/ja
Application filed by Yamaguchi University filed Critical Yamaguchi University
Publication of WO2007116997A1 publication Critical patent/WO2007116997A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0482—Needle or suture guides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/047—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0472—Multiple-needled, e.g. double-needled, instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/06057—Double-armed sutures, i.e. sutures having a needle attached to each end
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1107—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis for blood vessels

Definitions

  • the present invention relates to a surgical anastomosis instrument, and more particularly to a medical or veterinarian for performing an anastomosis between two organs in the body, such as an anastomosis between a small organ and a digestive tract.
  • the present invention relates to a surgical anastomosis instrument used for medical purposes.
  • splenic jejunal anastomosis at the time of kneecap duodenal resection is very dangerous if anastomotic suture failure occurs.
  • a tube was placed in the main knee canal and drainage of spleen was performed outside the body.
  • splenic jejunum full-thickness anastomosis is performed by reliably anastomosing the whole splenic tract, including a part of the splenic parenchyma, and the entire jejunum.
  • the frequency of postoperative anastomotic stenosis is low and the frequency of postoperative anastomotic stenosis is low.
  • the splenic duct is usually dilated and hardened, and mucosal anastomosis is relatively easy.
  • the diameter of the splenic duct at the splenic stump at the time of anastomosis, where the remaining spleen and main spleen are soft becomes as thin as 2 to 3 mm.
  • the anastomosis between the knee canal and the jejunum was a surgical operation that was very stressful for the skilled person.
  • the time required for anastomosis becomes longer. For example, in the case of eight stitches / ligation, a time of about 40 minutes is required.
  • Patent Documents 1 and 2 anastomosis is performed using a stable or clipped by stitching, and the stable or the like remains in the body for a long time or permanently.
  • Patent Document 3 shows a force that shows an anastomosis device by suturing. This is due to a purse string suturing of the rectum, esophagus, etc., and is limited in the application area, such as anastomosis between a small organ and a digestive tract. In some cases, it did not fit.
  • Patent Document 4 corrects gastroesophageal reflux by invading the anastomosis between the stomach and esophagus and bending the fundus wall inward. It is stable and the invagination device forces the needle to protrude, which complicates the anastomosis procedure and is appropriate for anastomosis between the small organ and the digestive tract.
  • Patent Document 5 is a device for suturing the end side of a transplanted blood vessel to the side of the aorta, and a needle connected with a suture thread in the housing of the suturing device passes near the end of the transplanted blood vessel, The direction is changed along the guide channel so that it is returned to the near side through the aorta.
  • This needle is made of a shape memory alloy and proceeds along the curved guide channel without any deformation force S, but the guide channel once approaches the vicinity of the central axis of the housing and then changes its direction in the radiation direction.
  • the guide channel has a large curvature, and when a shape memory alloy that is flexible enough to follow this curvature is used as the material of the needle, there is a problem that the suture cannot actually be performed. . If the curvature is to be increased to some extent, the diameter and dimensions of the housing must be increased, which is not appropriate for suture surgery.
  • the present inventor has provided a guide portion so that the curvature of the guide portion through which the needle advances is not so large in proportion to a small size suitable for performing anastomosis between the small organ and the digestive tract.
  • An application for Japanese Patent Application No. 2004-372723 was filed regarding the invention of a surgical anastomosis apparatus that can ensure anastomosis.
  • the curvature of the guide part has to be increased due to the shape and dimensions that are actually allowed as an anastomosis instrument, and there are difficulties in terms of design and operation. It was.
  • Patent Document 1 Japanese Patent Laid-Open No. 9 289991
  • Patent Document 2 Japanese Patent Laid-Open No. 10-118078
  • Patent Document 3 Japanese Patent Publication No. 5-79336
  • Patent Document 4 Japanese Patent Laid-Open No. 4-226644
  • Patent Document 5 Special Table 2003-509102
  • the present invention has been made to solve the above-mentioned problems, and the surgical anastomosis device according to the present invention has a generally cylindrical shape and a tapered shape that smoothly continues in front of the cylindrical shape.
  • the needle pushing member attached to the distal end side of the operation rod can be moved by the stroke required to engage and push the needle and perform the anastomosis. It gives space.
  • a conical surface is formed in a conical shape following the rear side of the tapered portion of the tip of the main body, and a side hole serving as an outlet of the guide unit is formed in the conical surface in the converging shape.
  • the needle pushing member may be formed of a material that is deformable and has a rigidity to push the needle when the needle pushing member is advanced through the guide portion. .
  • At least one vertically long recess in a direction parallel to the axis of the main body is formed on the outer peripheral surface near the boundary between the cylindrical portion and the tip portion of the main body, and the guide portion is formed in the main body.
  • the main body force also projects rearward, and the rear end becomes a free end and is directed toward the free end.
  • An inner hole communicates to the free end of the cavity force and is parallel to the axis of the main body so as to reach the guide portion in the at least one vertically long recess from the rear end surface of the main body and communicate with the outside of the main body.
  • the auxiliary member When the auxiliary member is inserted into the vertical hole and the tip of the auxiliary member reaches the inner position of the guide portion, the auxiliary member is pushed forward.
  • the guide part is pushed outward by being pushed by the tip of Chiyoi in the memorial service.
  • a loop-shaped member is attached to the tip of the auxiliary member, the guide portion is slidably inserted into the loop-shaped member, and the guide portion is opened outward by pushing the auxiliary member! Then, the guide member may be pulled back by the loop-shaped member by a return operation of the auxiliary member.
  • a groove through which a thread pushed laterally by the needle pushing member is formed together with a passage through which the needle with the thread passes.
  • the operating rod is rod-shaped, and an axial groove of the main body or the operating rod is formed on the inner surface of the cylindrical portion of the main body and the outer surface of the operating rod of Z or the operating member.
  • the thread connected to the needle along the guide line may be guided rearward along the through hole in the cylindrical portion of the main body.
  • a convex portion is formed on one of the inner surface of the cylindrical portion of the main body and the peripheral surface of the operating rod of the operating member, and a groove is formed on the other side to guide the convex portion in the axial direction. You may do it.
  • a groove in the axial direction of the main body is formed on the inner surface of the through hole of the main body and the outer surface of the operating rod of Z or the operating member, and a thread connected to the needle is guided along the groove. You may do it.
  • the operating member has a cylindrical operating rod, and when the needle pushing member of the operating member advances through the guide portion, the needle can be deformed and deformed so as to correspond to the shape of the guide portion spreading.
  • the needle push-in member is formed of a rigid cylindrical member, the tip end side of the needle pushing member is attached to the tip side of the operating rod by a support member, and the thread attached to the needle passes through the needle pushing member and then You may make it pass through the cylindrical control rod from the tip side to the back! ,.
  • a convex portion is formed on one of the inner surface of the cylindrical portion of the main body and the peripheral surface of the operating rod of the operating member, and a groove is formed on the other side to guide the convex portion in the axial direction. You may do it.
  • the anastomosis instrument according to the present invention guarantees reliable needle operation without requiring a high degree of skill, can significantly reduce the incidence of anastomotic suture failure, and prevents a suture failure in advance. It has a great effect.
  • the surgical field where the small diameter tube is thin tends to be narrow, it greatly contributes to the reduction of the stress received by the operator, and the time required for the anastomosis can be significantly shortened, so the time required for the anastomosis is long. Therefore, it is possible to prevent leakage of organ secretion and adversely affect other organs, and it is safer in relation to the duration of anesthesia.
  • the curvature of the guide part can be reduced moderately in relation to the shape and dimensions allowed as an anastomosis instrument, and the needle can be reliably operated while maintaining the shape of the main body that can be easily inserted into an organ. As a result, it becomes easier to operate the anastomosis instrument, and the efficiency of hand movement is improved.
  • Fig. 1 (a) to (d) shows the overall configuration of the anastomosis device loaded with a single needle as a cross-sectional view.
  • Fig. 1 (a) is the operating member, and (b) is the main body.
  • (C) shows an anastomosis instrument having an operation member inserted into the main body, and (d) shows an anastomosis instrument in a state in which the state force of (c) is further pulled backward.
  • the operation member 4 includes a rod-shaped or cylindrical operation rod 7, a needle pushing member 6 attached to the distal end side of the operation rod 7, and an operation grip attached to the rear end side of the operation rod 7. It consists of part 9.
  • the operation grip portion 9 may be formed integrally with the operation rod 7.
  • the needle pushing member 6 has a rigidity necessary for pushing the needle during anastomosis, and is made of aluminum, a synthetic resin material, or the like that can be deformed to some extent during the pushing operation.
  • an anastomotic device main body 11 has a structure for inserting the operation member 4 of FIG. 1 (a), and has a cylindrical portion 12 and a tapered tip portion connected to the tip thereof.
  • the external shape is smooth so that it can be easily inserted into an organ. Since the cylindrical portion 12 is long, a part of it is indicated as V (hereinafter the same shall apply).
  • a hollow portion 15 is formed inside the front end portion 13 of the main body, and a through hole 16 is formed in the tubular portion 12 so as to communicate from the hollow portion 15 to the rear end of the main body.
  • a substantially conical surface 14 that extends outward is formed on the rear side of the tapered tip portion 13 of the main body, and a side hole 18 is formed in a portion that is subsequently reduced in diameter and continues to the cylindrical portion.
  • the hollow portion 15 in the distal end portion 13 communicates with the side hole 18 to become the guide portion 1 of the needle.
  • the guide 1 accommodates the needle before the anastomosis and guides the needle and the needle pushing member 6 that pushes the rear end during the anastomosis.
  • the needle 2 During anastomosis, it is desirable for the needle 2 to advance from the side hole 18 of the main body at an angle that loosely spreads outward. Therefore, the needle pushing member 6 moves from the inner surface of the cavity 15 on the distal end side of the main body to the side hole 18. It should be guided along the following guide part 1 and loosened outwards. Therefore, it is desirable that the inner surface force of the cavity portion 15 is such that the shape of the portion following the side hole 18 through the guide portion 1 advances at an angle that gently spreads the needle pushing member 6 outward. Also, the length of the cavity 15 in the axial direction of the main body is the length of the stroke in which the needle is advanced by the needle pushing member 6 during anastomosis (example: For example, it is necessary to secure only 10mm.
  • the guide portion 1 is formed so that the inner diameter is slightly larger than the diameter of the needle 2 and the needle pushing member 6.
  • this example is a case where one needle is loaded, there is one side hole 18, and the substantially conical surface 14 extending outward is on one side with respect to the axis of the cylindrical portion 12 of the main body. Overhangs the shape.
  • FIG. 1 (c) shows the whole anastomosis instrument in which the operation member 4 of (a) is inserted into the main body 11 of (b) and the needle 2 with the thread 3 is loaded.
  • the thread 3 connected to the needle 2 is guided from the guide portion 1 through the hollow portion 15 in the distal end side of the main body into the through hole 16 in the cylindrical portion 12.
  • the needle 2 is formed of a shape memory alloy when the guide portion 1 is made of steel or the like when the guide portion 1 is linear.
  • a TiNi alloy or a superelastic TiNi alloy can be used as the shape memory alloy.
  • the needle 2 has a length of 10 mm, and the diameter of the rear end to which the thread 3 is connected is about 0.5 mm.
  • Thread 3 is used to suture the small organ and the digestive tract of the organ.
  • a thread made of polypropylene or the like is used as a non-absorbable thread in the body.
  • a thread made of material such as nylon or polyethylene dallic can be used.
  • the specific size of the thread 3 that can be used for the surgery is USP-2-0 to USP-5-0, etc.
  • the size of the thread 3 that can be used as appropriate is left to the judgment of the doctor who performs the operation.
  • the distance between the rear end force of the cylindrical portion 12 of the main body 11 and the side hole 18 is the same as that of the rear end force needle 2 of the main body 11 during anastomosis.
  • the total length of the main body must be greater than the total length of the forward stroke and the gripping part of the main body, and the axial length required for the cavity 15 on the tip side of the main body. The length is determined.
  • the length of thread 3 needs to be long enough to tie thread 3 after penetrating needle 2 through the anastomosis.
  • FIG. 1 (d) shows a state in which the operation grip 4 of the operation member 4 is held and pulled backward during the anastomosis from the state of (c).
  • the attached needle pushing member 6 moves rearward and pushes the needle 2 placed in the guide portion 1 outward together with the thread 3 connected thereto.
  • the needle pushing member 6 is made of a material with a certain degree of rigidity and cannot be deformed so much.
  • the guide portion 1 is shaped so as to release the needle in a state of loosely spreading outward. Therefore, a portion where the guide portion 1 of the distal end portion 13 is slightly protruded outward.
  • the needle pushing member 6 should be made of a synthetic resin material that has the rigidity necessary for pushing the needle and that can be further deformed. Yes.
  • the anastomosis device can be shaped so that the distal end portion 13 does not protrude outwardly as shown in FIG. 2 (a).
  • the guide portion 1 mainly guides the needle 2 and the needle pushing member 6 with the curved shape of the surface located to the right of the needle 2 in FIG. Since the needle 2 is placed in the curved portion of the guide portion 1, it is a curved needle. This curve has a larger curvature than in the case of Fig. 1 (b). At the left side of the needle 2, the thickness of the guide portion 1 is reduced to some extent. For this reason, the side hole 18 has a long slit shape when viewed from the side.
  • FIG. 3 (a) shows an enlarged view of the needle and the needle pushing member at the tip of the main body in FIG. 1 (c).
  • the needle 2 is placed in the guide portion 1 of the distal end portion 13 of the main body and does not come out in the vicinity of the side hole 18 and is left in the position.
  • the guide 1 has an inner diameter that is slightly larger than the diameter of the needle 2 so that the needle 2 can pass smoothly.
  • the guide section 1 does not swing as much as about 0.7 mm.
  • the rod-shaped needle pushing member 6 that pushes the needle 2 from the rear end side also has the same diameter as the needle 2.
  • the guide portion 1 is provided with a groove la through which the thread 2 passes, as shown in FIG. 3 (b) showing a cross section taken along line BB in FIG. 3 (a).
  • the thread can pass through the groove portion la provided in the guide portion 1, so that the needle 2 connected with the yarn 3 can be pushed smoothly. This point is similar to that shown in Figure 2 (a). The same applies to cases.
  • a groove 7 a parallel to the axial direction is provided on the peripheral surface of the operating rod 7. If the thread 3 is guided along the groove 7a, interference between the operation rod 7 and the thread 3 can be avoided.
  • the groove portion 7a through which the thread 3 passes may be provided on the inner surface side of the force passage hole 16 shown in the example provided on the operation rod 7 side, or may be provided partially on both sides to provide a thread path by combining both. You may do it.
  • an axial groove 12a is formed on the inner surface side of the through hole 16 in the cylindrical portion of the main body, and a projection 7b is formed on the peripheral surface of the operation rod 7 at a position corresponding to this. It shows what was formed. This is to prevent the operation member 4 from rotating about the axis relative to the main body 11 when the operation unit 4 is pulled toward the front side. Basically, there is no problem if the operating member 4 can be pulled in the axial direction without fail, but if the rotation around the shaft is applied even slightly, the needle 2 may not be smoothly pushed by the needle pushing member. Therefore, it is preferable to appropriately provide a means for preventing such rotation of the operation member 4 around the axis.
  • the anastomosis device is configured by placing the needle 2 connected with the thread 3 in the guide portion 1 of the main body 11 of the anastomosis device in Fig. 1 (b) and inserting the operation member 4 in Fig. 1 (a). (Same as in Fig. 2 (a)).
  • the main body 11 is formed in a divided type instead of an integral type, and is integrally joined after the operation member 4 is inserted.
  • the main body 11 is a flat surface passing through the axis.
  • the two parts can be joined together, or the tubular part 12 and the tip part 13 can be joined.
  • the operation grip portion 9 of the operation member 4 may be formed integrally with the operation rod 7, but when a separate one is attached, the portion of the operation member 4 other than the operation grip portion 9 is inserted into the main body 11. You can attach the operation grip 9 at the end later.
  • Fig. 4 (a) shows the configuration of an anastomosis device loaded with a plurality of needles.
  • the components are indicated by the same numbers as those of an anastomosis device loaded with a single needle. Insert operation member 4 into the inside. It is shown in the on state.
  • the number of needles to be loaded is the number of needles that can be moved simultaneously at the time of anastomosis, and it should be an appropriate number such as 2, 4, 6, etc.
  • the side hole 18 through which the needle is discharged in the main body 11 and the guide portion 1 following the side hole 18 are preferably arranged at equiangular intervals around the axial direction, and the outer shape of the front end portion 13 of the main body is rotationally symmetric.
  • Each guide portion is formed with a groove la for guiding the yarn 3 as shown in FIG. 3 (b). Also, it is preferable to provide the same number of axial grooves 7a as the number of needles 2 on the circumferential surface of the operating rod 7 of the operating member 4 or the inner surface of the cylindrical portion 12 of the main body.
  • the same number of rod-shaped needle pushing members 6 as the number of needles to be loaded for pushing the needle 2 placed in the guide portion 1 are aligned in the direction of the guide portion 1. It is fixed in this way.
  • the needle pushing member 6 is made of a material having a certain degree of rigidity.
  • the tip 13 has a shape that spreads outward slightly, but by using a material that is less rigid and easily deformed as the needle pushing member 6, the curvature of the guide 1 is increased, and FIG. 4 (b) As shown in the figure, the tip 13 of the main body can be shaped so as not to spread outward.
  • each side hole 18 has a slit-like shape that is long in the axial direction, and the needle 2 is placed in the curved portion of the guide portion 1, so that a curved needle is used.
  • FIGS. 5 (a) to 5 (d) are examples of an anastomosis device in which the operation rod 7 of the operation member 4 and the needle pushing member 6 are formed in a cylindrical shape, and a case where a plurality of needles are loaded is shown. It is substantially shown in a sectional view.
  • Fig. 5 (a) shows the operating member 4 with only the needle to which the thread is connected.
  • the operating rod 7 of the operating member 4 and the needle pushing member 6 are respectively connected. It is formed of a cylindrical member so that the thread 3 can pass through the cylindrical member.
  • the operation rod 7 has an inner diameter that allows the thread to pass through, and has a rigidity that does not substantially deform.
  • the needle pushing member 6 has an outer diameter approximately equal to the diameter of the needle 2, and the inner diameter is large enough to allow one thread connected to the needle 2 to pass through, as many as the number of needles to be moved simultaneously. Provided. Further, when the guide portion 1 is formed in a smooth curved shape, the needle pushing member 6 needs to bend along the guide portion, and the needle pushing member 6 has flexibility that can be bent along the guide portion 1. It is made of a material that has enough rigidity to push in the needle 2 with the thread 3. Needle push-in As shown in Fig. 5 (a), the flange member 5 as the support member for the needle pusher member 6 is attached to the front end of the operation rod 7 and the needle pusher is pushed into the flange member 5, as shown in Fig. 5 (a). Install part 6. A hole is formed in the flange member 5 at a position where the needle pushing member 6 is attached, and the end side of the needle pushing member 6 is inserted into and fixed to each hole.
  • FIG. 5 (b) conceptually shows the force guide portion 1 showing the main body 11 of the anastomosis instrument in a cross section substantially passing through the central axis.
  • the main body 11 has a cylindrical portion 12 and a tapered tip portion 13 connected to the tip thereof, and is formed so as to have a smooth outer shape as a whole.
  • a hollow portion 15 is formed in the inside of the main body 11 from the cylindrical portion 12 to the tip portion 13 so that the central through hole 16 penetrates between the hollow portion 15 and the rear end of the main body 11 in the cylindrical portion 12. Is formed.
  • the guide portion 1 that continues from the hole 17 in the bottom of the cavity 15 to the side hole 18 in the peripheral surface of the cylindrical portion 11 of the main body 15 is connected to the side hole 18 in the peripheral surface of the cylindrical portion 12 from the hole 17 in the bottom of the cavity 15.
  • the guide portion 1 is formed as many as the number of needles that move at the same time.
  • the guide unit 1 guides the needle along a straight or loosely bent path from the state in which the needle is housed inside.
  • the guide portion 1 has a curved path, and the side hole follows the path that slowly turns around the hole 16 at the bottom from the hole 17 at the bottom of the cavity 15 and turns slowly.
  • the shape of the guide portion 1 is set such that the needle 2 connected to the thread 3 is released from the side hole 18 at a gentle angle with respect to the peripheral surface of the cylindrical portion 12 of the main body and spreads backward.
  • the needle 2 should be formed of a shape memory alloy.
  • the needle 2 is made of another metal.
  • the hollow portion 15 in the main body 11 should be a space in which the flange portion 5 of the operation member 4 can move by the stroke of pushing out the needle during anastomosis, and the rear end force of this pair of cylindrical portions 12 can also reach the side holes 18. This distance is equal to or longer than the combined length of the stroke of the rear end force needle 2 of the main body 11 during the anastomosis and the portion gripping the main body, as in the above example.
  • FIG. 5 (c) is a cross-sectional view taken along a line DD in the main body 11 of FIG. 5 (b), and shows a case where one guide force S6 is provided.
  • FIG. 5 (d) shows an anastomosis instrument in which the operation member 4 shown in FIG. 5 (a) is inserted into the main body 11 shown in FIG. 5 (b).
  • the main body 11 is not formed as a single unit but as a split type. Joined integrally after the member 4 is inserted, for example, a form in which the main body 11 is divided into two parts by a plane passing through the axis, or a part divided into the cylindrical part 12 and the tip part 13 is joined.
  • the operation grip portion 9 of the operation member 4 may be formed integrally with the operation rod 7, but when a separate one is attached, the portion of the operation member 4 other than the operation grip portion 9 is inserted into the main body 11. You can attach the operation grip 9 at the end later.
  • the operating rod 7 of the operating member 4 associated with the needle 2 connected to the thread 3 is passed through the through hole 16 of the main body 11 without the operating gripping portion 9 attached, and the pushing member 6 and The needle 2 on the distal end side is inserted into the guide portion 1 from the hole 17, and is left in the guide portion 1 so that the distal end of the needle 2 does not protrude outward from the side hole 18.
  • the needle 2 is inserted into the guide portion 1, the needle 2 formed of the shape memory alloy is deformed according to the smooth bent shape of the guide portion 1.
  • each needle 2 is inserted into the guide portion 1, and when the rear end of the operation rod 7 comes out from the rear end of the main body 11, the operation gripping portion 9 is attached to the end portion of the operation rod 7.
  • the divided main body 11 is brought together to be ready for anastomosis.
  • a thin sheet (not shown) is attached to the outside of the side hole 18. It ’s best to remove this sheet when performing anastomosis!
  • At least one recess 21 is formed at a position near the rear end of the main body 11, and a retaining member 9a provided with a projecting portion that engages with the recess 21 can be attached to the operation gripping portion 9. It is better to form them integrally.
  • the operation gripping part 9 can be pulled out by removing the convex part of the retaining member 9a by removing the force of the concave part 21 or by folding it.
  • FIGS. 6A to 6D show still another form of anastomosis apparatus.
  • Fig. 6 (a) shows the overall configuration of the anastomosis apparatus in cross section
  • Fig. 6 (b) shows the section of the main body in cross section
  • Fig. 6 (c) shows the operation member and auxiliary member.
  • FIG. 6 (d) is an enlarged perspective view of the vicinity of the front end of the auxiliary member.
  • the anastomosis apparatus shown in FIG. 6 (a) is schematically composed of a main body 11, a manipulation member 4 and a needle 2 connected to a thread 3, and an auxiliary member 18 in FIG. 6 (b).
  • the body 11 of the vessel is for giving the structure of the anastomosis device by inserting the operation member 4 and the auxiliary member 18 in FIG. 6 (c), and the outer shape is a cylindrical portion 12 having a substantially circular cross section. And a tapered tip portion 13 at the tip thereof, and can be deformed in a vertically long recess on the peripheral surface of the main body at a position between or near the cylindrical portion 12 and the tip portion 13.
  • a plurality of cylindrical guide portions 1 are formed!
  • the guide section 1 has a needle with a thread in its inner hole and guides the needle when it is released. It has become.
  • the number of guide parts 1 is the number that guides and releases the needle with the thread at the same time in one hand movement operation.
  • the guide portion 1 is formed so that the inner diameter is slightly larger than the diameter of the needle and the needle pushing member 6.
  • the main body 11 is formed of a synthetic resin as a whole, and is inserted into an anastomosis site in an organ and formed of a material having rigidity necessary for performing the anastomosis operation.
  • the guide portion 1 is used during the anastomosis operation. It must be deformed and has a thin cylindrical shape. For this reason, a stepped portion 13a is partially formed between the front end portion 13 and the guide portion 1 of the main body, but the guide portion 1 is not deformed.
  • the outer shape of the main body 11 is generally smooth so that it can be easily inserted into the organ during anastomosis.
  • the guide part 1 is formed integrally with the main body 11 so that it can be deformed by the difference in thickness.
  • the guide part 1 may be formed of a material that is easily deformable and different from the main part of the main body 11, and may be attached by bonding or the like in such a form that does not separate.
  • a synthetic resin may be used, or a shape memory alloy may be used.
  • the guide portion 1 is formed of a shape memory alloy, the anastomosis operation described later is performed. Thus, it is possible to obtain the characteristic that the guide part 1 is kept open.
  • the shape of the guide part 1 and the deformation conditions are as follows. As shown in Fig. 6 (b), the guide part 1 smoothly and loosely outwards according to the outline of the tip part 13 of the main body 11. It bends in a convex shape and tilts inward by applying force from below to above, and at the base of the anastomosis, which will be spread outward while maintaining this bent state during the anastomosis operation described below It is desirable that a nearby portion (a portion near the step portion 13a) is deformed. For this reason, in order to satisfy such a deformation condition, the guide portion 1 should have a lower rigidity in the vicinity of the base portion and a slightly higher rigidity in the other portions. This condition can be satisfied by changing the wall thickness with the same material as the material that forms the guide 1 by joining the base part and other parts differently.
  • the rear end side of the cylindrical portion 12 of the main body is a gripping portion 12a, which is a portion that grips the anastomosis device during anastomosis.
  • a hollow portion 15 is formed inside the front end portion 13 of the main body, and a through hole 16 coaxial with the main body reaching the hollow portion 15 from the rear end surface of the grip portion 12a of the main body is formed.
  • the operation member 4 is inserted into the hollow portion 15 and the through-hole 16 so as to be movable in the axial direction, and the hollow portion 15 has a cross section and a shaft that allow the operation member 4 to move in the axial direction during anastomosis. It gives a space with the size of the direction.
  • a vertical hole 19 is formed at a position inside the guide portion 1 and between the through hole 16 and parallel to the axis of the main body, that is, parallel to the through hole 16.
  • the vertical hole 19 reaches the rear end portion of the position force main body 11 inside the guide portion 1, and has a size and shape that allows the auxiliary member 20 to move in the axial direction.
  • the portion of the vertical hole 19 inside the guide portion 1 communicates with the outside of the main body 11 on the lower side of the guide portion 1 as shown in FIG. 6B.
  • the guide portion 1 When viewed from the outside of the main body 1 1, the guide portion 1 is in a state where the guide portion 1 is suspended from the step portion 13 a in the vertically long recess and the vertical hole 19 is provided inside thereof.
  • FIG. 6 (c) shows the needle 2 to which the operating member 4, the auxiliary member 20, and the thread 3 to be inserted into the main body 11 are connected.
  • the operation member 4 includes a rod-like or cylindrical operation rod 7, a needle pushing member 6 attached to the distal end side of the operation rod 7, and an operation gripping portion 9 attached to the rear end side of the operation rod 7.
  • the operation grip portion 9 may be formed integrally with the operation rod 7.
  • the needle pushing member 6 has the rigidity necessary for pushing the needle during anastomosis, and the guide portion 1 is used for pushing the needle. It is made of a synthetic resin material that can be deformed to the extent of its shape and movement, and is attached to the tip of the operation rod 7 by the number of guide portions 1.
  • the auxiliary member 20 is used to push the guide part 1 outward at the front end during the anastomosis operation, and is formed into a rod shape with a material having rigidity for that purpose, and has the same number as the guide part 1 Is formed by a disk-shaped or ring-shaped connecting portion 20a having a hole in the center on the rear end side.
  • the auxiliary member 20 is pulled out from the main body 11. The force that pushes the auxiliary member 20 into the main body 11 and pushes the guide part 1 outward.
  • FIG. 6 (d) shows an enlarged portion of the tip portion of the auxiliary member 20, but it is necessary to push the cylindrical guide portion 1 at this portion to open it outwardly, A loop that forms a concave portion corresponding to the convex shape of the guide portion 1 and passes the guide portion 1 so that the cylindrical guide portion 1 does not deviate at the time. It ’s better to attach the shaped member 20b!
  • the loop-shaped member 20b should be sized so that it can pass through the guide portion 1 slidably, and the material should be thin or thin so as not to break. This loop-shaped member 20b ensures that the guide part 1 can be opened and returned to the outside by the movement of the auxiliary member 20.
  • needle 2 and thread 3 are the same as in the previous example.
  • Fig. 6 (a) shows that the auxiliary member 20 and the operating member 4 shown in Fig. 6 (c) are inserted into the main body 11 shown in Fig. 6 (b), and the needle 2 with the thread 3 is loaded.
  • This shows the anastomosis instrument in a state where the anastomosis operation can be performed.
  • the main body 11 formed in a divided type instead of a single type is joined integrally after the operation member 4 and the auxiliary member 20 are inserted.
  • the operation gripping part 9 of the control member 4 may be formed integrally with the control rod 7, but when a separate part is attached, the part of the control member 4 other than the control gripping part 9 is inserted into the main body 11. After that, attach the operation grip 9 last.
  • a click means for lightly locking the operation member 4 and the auxiliary member 20 to the main body or a detachable holding means may be provided as appropriate.
  • a movement preventing member may be interposed between the connecting portion 20a and the rear end surface of the main body 11 and removed during use.
  • FIGS. 7 (a), (b), and (c) are cross-sectional views taken along lines E-E, F-F, and G-G in FIG. 6 (a), respectively. Force indicating the case of having two guide parts 1 each loaded with three needles 2 If the number of guide parts 1 is increased, guide parts 1, auxiliary parts 20 etc. It is preferable that the main body 11 has an axially symmetrical arrangement with the same positional relationship as the axial force.
  • FIGS. 7 (a) to (c) are force guides when there are two guide parts 1. For example, in the case of an anastomosis device having six guide parts 1 provided and simultaneously moving six needles, The cross section on EE is shown in Fig. 7
  • the needle 2 with the thread is released from the guide portion 1 by the needle pushing member 6. At that time, the needle 2 is pushed in securely until the needle 2 penetrates the anastomosis site of the organ. It is necessary that the leading end of the insertion member 6 does not shift the rear end force of the needle 2.
  • a recess 2a is formed on the rear end surface of the needle 2, and the tip of the needle push-in member 6 is loosely fitted into the recess 2a. If it is formed to be, This fitting is such that when the needle 2 is released by the needle push-in member 6, the rear end of the needle 2 does not deviate from the tip force of the needle push-in member 2.
  • the needle 2 After the needle 2 is released, the needle 2 is pulled and the needle push-in member Scrape so that it can be removed from 6.
  • the rear end side of the needle 2 is formed in a tip-like shape, and the tip 6a of the needle pushing member 6 is caught by the rear part of the tip-like shape of the needle so that the needle 2 is not displaced by the holding force. May be.
  • the tip of the needle push-in member 6 is shaped to be slightly loosened, and a recess 6b is formed at the tip, and the rear end of the needle 2 is formed in the recess 6b. You may make it fit loosely.
  • the auxiliary member 20 is pulled back to return the guide portion 1 to its original position, and then the force that takes the anastomotic device body 11 out of the organ. Since the portion on the side that has been forced to remain in the body 11 from the guide portion 1, it is necessary to carefully and gently pull it out so that force from the thread is not applied to the organ as much as possible.
  • the middle point of the thread 3 is pulled out as a connecting point P as shown in FIG. 10 (a).
  • the thread 3a is connected, and when the needle 2 is loaded into the anastomosis device as shown in FIG.
  • the end of the pull-out thread 3a remains outside the organ, and the pull-out thread 3a is pulled before removing the main body 11.
  • the posterior thread portion remaining in the main body 11 may be pulled out.
  • the length of the thread from needle 2 to connecting point P should be sufficient for anastomosis.
  • the pull-out thread is connected to another thread so that it is folded back leaving a sufficient length behind it, and the rear end is guided outward from the guide section 1 instead of the pull-out thread 3a.
  • the needle 2 Before the anastomosis operation is performed, the needle 2 is placed at a position in the inner hole of the guide portion 1 of the distal end portion 13 of the main body that is close to the free end and does not protrude outward.
  • the guide 1 has an inner diameter that is slightly larger than the diameter of the needle 2 so that the needle 2 can pass smoothly. If the diameter of the needle 2 is 0.5 mm, the guide section 1 should be about 0.7 mm so that it does not swing as much as possible in the lateral direction. .
  • the rod-shaped needle pushing member 6 that pushes the needle 2 from the rear end side has the same diameter as the needle 2. When the needle pushing member 6 pushes the needle 2 from the rear side, the thread 3 connected to the rear end side of the needle 2 is pushed sideways.
  • grooves la and lb through which the thread 2 passes are inserted in the guide part 1 as shown in FIG. 11 (a) showing a cross section taken on H-H in FIG. 10 (b). It is good to provide.
  • the groove portions la and 1 b have a cross-sectional size that allows a single thread to move, and are disposed at a distance from each other, and the tip force of the guide portion 1 is also provided up to the hollow portion 15 in the main body 11.
  • the thickness of this portion of the guide portion may be added to form a section that protrudes slightly outward. Route the thread so that thread 3 from needle 2 passes through groove 2a and thread 3a for withdrawal passes through groove lb, and when thread 3a is pulled out after needle 2 is ejected, thread 3a for removal comes into the needle Make sure that the following thread 3 has sufficient force.
  • the groove 7a through which the yarn 3 passes may be provided on the inner surface side of the force hole 16 shown in the example provided on the operation rod 7 side, or may be provided partially on both sides, and both may be combined to provide a yarn path. You may make it give.
  • an axial groove 16a is formed on the inner surface side of the through hole 16 in the cylindrical portion of the main body, and the peripheral surface of the operation rod 7 at a position corresponding to this is formed.
  • Protrusion 7b should be formed on the surface.
  • the procedure for anastomosing the remaining splenic main spleen and jejunum at the time of splenic duodenal excision will be described below for the anastomosis between the internal organ and the digestive tract using the anastomosis instrument of the present invention.
  • the anastomosis procedure when using the anastomosis instrument shown in FIGS. 4 (a), 4 (b) and 5 (d) is as follows.
  • the anastomosis is performed by the procedures (a) to (h) described above.
  • the operation of the anastomosis with the anastomosis device is the stage (d) in the above procedure, (a) to (c) being the previous stage, and (e) to (h) being the latter stage.
  • the stage (d) it is necessary to push the needle 2 until the needle 2 is penetrated to the jejunal mucosa side by pulling the operation gripping part 9, and the needle 2 advances in accordance with this operation.
  • the stroke corresponds to the stroke in which the operation rod 7 moves in the cavity 15 in the main body 11 of the anastomosis instrument.
  • the pusher member 6 has a needle pusher member 6 attached to the distal end portion of the operating rod 7, and the lower side of the place where the pusher member 6 is located (the flange portion 5) is below the cavity portion 15 in the main body 11. At the reached stage, it is necessary to secure a length that allows the tip of the pushing member 6 to come out of the side hole 18 of the main body 11 and penetrate the needle 2 to the jejunal mucosa side. Further, the pushing member 6 needs to be made of a material having rigidity and flexibility suitable for performing the pushing operation of the needle 2 while passing through the guide portion 1. Further, the guide portion 1 is moved while the needle 2 is pushed into the pushing member 6.
  • the needle 2 is released from the guide part 1 so as to draw a parabola in a diagonally backward direction while being pushed by the tip of the pushing member 6, and penetrates through the main spleen and the parenchyma of the remaining spleen, and is brought into close contact with the remaining spleen cross section. It penetrates from the jejunal choriomuscle layer to the jejunal mucosa (Fig. 13).
  • a loop-shaped member 20b through which the guide portion 1 passes is attached to the tip of the auxiliary member 20, and in this case, the auxiliary member 20 is pulled back and the guide portion 1 is surely placed in the first position.
  • the pull-out thread 3a is provided as shown in FIG. After inserting the anastomosis device into the jejunal small hole, bow the end of the pull-out thread 3a after the step (e-1), pull out the remaining thread in the body, and then perform the anastomosis. It is better to remove the vessel.
  • ligation is performed for each thread 3. Force to penetrate the needle 2 through the anastomosis site is connected to the thread 3 loaded in the anastomosis instrument. This can be done for multiple needles 2 at the same time. For example, when needles 2 are pierced for each one and sewing is performed at 8 locations, it took about 40 minutes in the past, but 8 needles 2 were simultaneously penetrated using the anastomosis device of the present invention. If ligated, the time can be shortened by more than 30 minutes.
  • FIG. 1 (a) is a view showing an operation member in a surgical anastomosis instrument according to the present invention loaded with a single needle substantially in an axial cross section.
  • (B) A view of the body in a surgical anastomosis instrument according to the present invention loaded with a single needle in a substantially axial section.
  • (c) It is a figure which shows the surgical anastomosis instrument in the state which inserted the operation member of (a) in the main body of (b).
  • FIG. 2 (a) A view showing a surgical anastomosis instrument of another form according to the present invention loaded with one needle in a substantially axial cross section before anastomosis. (b) From the state of (a), it is a view showing a state where the operation member is bowed back IV at the time of anastomosis.
  • FIG. 3 (a) An enlarged view of the needle and the needle pushing member at the tip of the main body in FIG. 1 (c). (b) It is a figure which shows the cross section taken on the BB line of (a). (C) It is a figure which shows the cross section taken on the CC line in FIG. L (c).
  • a surgical anastomosis instrument according to the present invention loaded with a plurality of needles is shown in a substantially axial section.
  • Another form of surgical anastomosis instrument according to the present invention loaded with a plurality of needles is shown in a substantially axial cross-section.
  • FIG. 5 (a) is a view showing an operation member in a surgical anastomosis instrument according to another embodiment of the present invention, in which a plurality of needles are loaded, in a substantially axial cross section.
  • B Substantially the main body of the surgical anastomosis instrument according to the present invention, which is loaded with a plurality of needles.
  • C Surgical anastomosis with the operation member (a) inserted into the main body of (b).
  • FIG. 6 (a) is a diagram showing the overall configuration of a surgical anastomosis instrument according to still another embodiment of the present invention in a substantially sectional view, and (b) the main body of the surgical anastomosis instrument of (a) is substantially (C) is a diagram showing an operation member in the surgical anastomosis instrument of (a), and (d) a perspective view showing an enlarged portion of the tip of the auxiliary member 1 It is.
  • FIG. 7 (a) A cross-sectional view along E-E in Fig. 6 (a), (b) A cross-sectional view along FF in Fig. 6 (a), (c) Fig. 6 ( It is a cross-sectional view on GG of (a), and (d) is the same view as (a) when there are six guide parts.
  • FIG. 8 (a) is a view showing a state of the guide portion before the anastomosis instrument is inserted into the anastomosis site and the needle is released. (b) It is a figure which shows the state before pushing in an auxiliary member, and a guide part opens outward and discharge
  • FIG. 9 is a view showing a state in which, from the state of FIG. 6 (a), the auxiliary member is pushed in, the guide part is opened outward, and the operating member is pulled backward to release the needle.
  • FIG. 10 (a) is a diagram showing a thread that is connected to a drawing thread at a thread connecting point. (b) A diagram showing a state in which the needle with the thread shown in (a) is loaded into the anastomosis instrument body and the pulling-out thread is guided outward from the guide section.
  • FIG. 11 (a) is a cross-sectional view taken along the line H—H in FIG. 10 (b).
  • (B) A cross-sectional view taken along the line II in FIG. 10 (B).
  • FIG. 12 is a view showing a state in which the anastomosis apparatus of the present invention is inserted into the anastomosis site during anastomosis.
  • FIG. 13 is a view showing a state where the operation gripping portion is pulled and the needle penetrates the anastomosis portion.
  • FIG. 14 is a view showing a state in which the anastomosis apparatus is removed, the needle is removed from the thread and the thread remains.

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  • Health & Medical Sciences (AREA)
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  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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Abstract

L'invention permet, lorsqu'une voie de petit diamètre d'un organe solide et une voie digestive doivent être anastomosées, de minimiser les lésions à l'organe à anastomoser, de réaliser positivement l'anastomose sans aptitudes de haut niveau et de raccourcir le temps opératoire pour réduire le stress de l'opérateur. Le corps (11) de l'instrument comprend une unité tubulaire (12) et une extrémité à pointe effilée (13) la prolongeant sans heurt, ledit corps présente une cavité (15) sur le côté de l'extrémité en pointe, est muni d'un trou (16) le traversant s'étendant dans la direction axiale de la cavité (15) à l'extrémité arrière et est muni d'un guide (1) s'étendant obliquement vers l'arrière, de la cavité (15) à un trou latéral (18). La tige de manœuvre (7) du membre de commande (4) est insérée dans le trou (16) traversant le corps (11) et un membre (6) pour pousser vers l'extérieur une aiguille (2) à demeure dans le guide (1) et connecté par un fil est attaché à l'extrémité en pointe de la tige de manœuvre (7) et passé à travers le guide (1).
PCT/JP2007/057831 2006-04-10 2007-04-09 Instrument chirurgical anastomotique WO2007116997A1 (fr)

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
JP2006-107167 2006-04-10
JP2006107167 2006-04-10
JP2006138206A JP3867150B1 (ja) 2006-05-17 2006-05-17 外科用吻合器
JP2006-138206 2006-05-17
JP2006-195379 2006-07-18
JP2006195379A JP3867151B1 (ja) 2006-04-10 2006-07-18 外科用吻合器

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008051439A1 (fr) * 2006-10-20 2008-05-02 St. Jude Medical, Cardiology Division, Inc. Système de suspension de patte pour un dispositif de suture interne et procédé pour son utilisation
US9433421B2 (en) 2010-03-12 2016-09-06 Jms Co., Ltd. Surgical tool for anastomosis

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003509102A (ja) * 1999-09-14 2003-03-11 アボット・ラボラトリーズ 端部側部間吻合を行うための装置および方法
WO2004098417A1 (fr) * 2003-04-16 2004-11-18 Tyco Healthcare Group Lp Methode et appareil pour anastomose apres prostatectomie radicale faisant appel a un element d'ancrage destine a entrer en prise avec un vaisseau du corps et a des fils de suture deployables

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003509102A (ja) * 1999-09-14 2003-03-11 アボット・ラボラトリーズ 端部側部間吻合を行うための装置および方法
WO2004098417A1 (fr) * 2003-04-16 2004-11-18 Tyco Healthcare Group Lp Methode et appareil pour anastomose apres prostatectomie radicale faisant appel a un element d'ancrage destine a entrer en prise avec un vaisseau du corps et a des fils de suture deployables

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2008051439A1 (fr) * 2006-10-20 2008-05-02 St. Jude Medical, Cardiology Division, Inc. Système de suspension de patte pour un dispositif de suture interne et procédé pour son utilisation
US9107656B2 (en) 2006-10-20 2015-08-18 St. Jude Medical, Cardiovascular Division, Inc. Internal suturing device leg suspension system and method of use
US9433421B2 (en) 2010-03-12 2016-09-06 Jms Co., Ltd. Surgical tool for anastomosis

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