US20030144673A1 - Medical ligating apparatus - Google Patents

Abstract

A medical ligating apparatus comprises a medical ligating device consisting of a ligating member which consists of a flexible wire rod and ligates living tissues, and a fixing member which is movably provided at the ligating member and fixes the living tissues in a ligated state, a manipulating device having a flexible sheath and a proximal manipulating section, and cutting means for cutting the ligating member, the cutting means being provided on the manipulating device and being movably provided on the ligating member.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is based upon and claims the benefit of priority from the prior Japanese Patent Application No. 2002-7687, filed Jan. 16, 2002, the entire contents of which are incorporated herein by reference.[0001]
BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0002]
• The present invention relates to a medical ligating apparatus for ligating living tissues by inserting the apparatus into a body in a trans-endoscopic manner.[0003]
• 2. Description of the Related Art[0004]
• Conventionally, medical ligating apparatuses for ligating a lesion of a living tissue, such as polyp, by inserting the apparatuses through endoscope channels, and inserting them into cavities in a trans-endoscopic manner are known from Jpn. Pat. Appln. KOKAI Publication Nos. 10-194, 10-277046, 11-244294, 48-71090, 8-98840, and 54-30692 and the like. These medical ligating apparatuses are composed of: a sheath that can be inserted through an endoscope channel; a manipulating wire movably inserted through this sheath; a loop shaped ligating wire removably connected to a distal end of this manipulating wire; and a stopper provided at a proximal end of this ligating wire.[0005]
• In this medical ligating apparatus, when a ligating wire is hooked on a lesion of a living tissue, such as polyp and a manipulating wire is pulled toward a proximal manipulating section side, a stopper moves relatively to the distal end side of the ligating wire. As a result, the loop of the ligating wire is reduced in diameter. Then, the lesion is tightly bound. A blood flow at the lesion is stopped by this ligation, and thus, the lesion tissue necroses and slips off several days later in a ligated state. Then, a ligating device consisting of the ligating wire and the stopper slips off at the same time, and is naturally discharged from the anus.[0006]
• The ligating wire is formed of, for example, a synthetic resin such as nylon or polyolefin, or alternatively, stainless steel. The stopper is formed of a thin tube consisting of an elastic element such as silicon rubber. In addition, the stopper is a knot formed at a part of the ligating wire as disclosed in Jpn. Pat. Appln. KOKAI Publication No. 48-71090.[0007]
• After the ligating wire has been tightly bound on the lesion, it is required to isolate the ligating wire and manipulating wire connected to each other. Therefore, as disclosed in Jpn. Pat. Appln. KOKAI Publication No. 48-71090, a scissors is inserted through the endoscope channel, and a proximal end of the ligating wire is cut by the scissors. As disclosed in Jpn. Pat. Appln. KOKAI Publication No. 54-30692, a cutter member is provided at the distal end of a sheath, and a ligating wire is cut by the cutter member.[0008]
• However, as described previously, after the ligating wire has been tightly bound on the lesion, the scissors is inserted through the endoscope channel in order to isolate the ligating wire and manipulating wire connected with each other. In a manipulation for cutting the proximal end of the ligating wire by the scissors, it is required to replace the medical ligating device with the scissors, and insert it into a body cavity in a trans-endoscopic manner. Thus, there is a problem that an operation time is extended.[0009]
• In addition, with a structure in which an openable cutter member is provided in the distal end of the sheath as shown in FIG. 7 of Jpn. Pat. Appln. KOKAI Publication No. 54-30692, a large number of parts are required, resulting in higher manufacturing cost. In addition to wires of the ligating device, the manipulating wire for actuating the cutter member is inserted into the sheath. Thus, the sheath is increased in diameter, making it difficult to insert the sheath into an endoscope having a channel with its small internal diameter.[0010]
• In the case of the cutter member in which a blade oriented in the transverse direction at a proximal end side as shown in FIG. 8 of Jpn. Pat. Appln. KOKAI Publication No. 54-30692 is provided in a cylindrically shaped member, there is a problem that its manufacture is very difficult, and the sheath is increased in diameter.[0011]
• Further, in the conventional medical ligating apparatuses, the proximal end of the ligating wire is cut, thereby isolating the ligating wire and manipulating wire connected with each other. Thus, the ligating wire remains in the body cavity while this wire is extended from a ligating section. Therefore, for example, interference with another treatment device or endoscope may occur.[0012]
BRIEF SUMMARY OF THE INVENTION
• It is an object of the present invention to provide a medical ligating apparatus in which a fixing member for fixing living tissues while they are ligated by a ligating member is provided, ligation is carried out by the ligating member, and then, the ligating member can be cut at a proximal end of the fixing member by a series of manipulations.[0013]
• According to the present invention, there is provided a medical ligating apparatus comprising: a medical ligating device consisting of a ligating member which consists of a flexible wire rod and ligates living tissues, and a fixing member which is movably provided at the ligating member and fixes the living tissues in a ligated state; and a manipulating device having a flexible sheath and a proximal manipulating section, wherein the manipulating device comprises cutting means for cutting the ligating member, the cutting means movably provided on the ligating member and can move back and forth.[0014]
• According to the present invention, in the medical ligating apparatus, the manipulating device comprises cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member, and the cutting means is advanced and retracted or rotated so that the ligating member can be cut at a proximal end of the fixing member.[0015]
• Further, according to the present invention, in the medical ligating apparatus, the manipulating device comprises cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member, and the medical ligating device comprises a receiving member for receiving the cutting means, the receiving member being movably provided on the ligating member.[0016]
• According to the invention, there is provided a medical ligating device, a ligating member which includes a flexible wire rod and ligates living tissues; a fixing member which is movably provided on the ligating member that fixes the living tissues in a ligated state; and cutting means for cutting the ligating member, the cutting means being provided on the fixing member.[0017]
• Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.[0018]
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
• The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate presently preferred embodiment of the invention, and together with the general description given above and the detailed description of the preferred embodiment given below, serve to explain the principles of the invention.[0019]
• FIG. 1 is a structural view showing an entire medical ligating apparatus according to a first embodiment of the present invention, in which its distal end is cross-sectioned;[0020]
• FIG. 2 is a longitudinal side cross section showing a distal end of the medical ligating apparatus according to the first embodiment;[0021]
• FIG. 3 is a longitudinal side cross section showing a distal end of the medical ligating apparatus according to the same embodiment;[0022]
• FIG. 4 is a longitudinal side cross section showing a distal end of the medical ligating apparatus according to the first embodiment;[0023]
• FIG. 5 is a perspective view showing a state in which a lesion is ligated by a ligating wire according to the first embodiment;[0024]
• FIG. 6 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a second embodiment of the present invention;[0025]
• FIG. 7 shows the second embodiment and is a longitudinal, side cross-sectional view of the distal end of the medical ligating apparatus;[0026]
• FIG. 8 shows a third embodiment and is a longitudinal, side cross-sectional view of the distal end of the medical ligating apparatus;[0027]
• FIG. 9 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a fourth embodiment of the present invention;[0028]
• FIG. 10 is a plan view showing a distal end of the medical ligating apparatus according to the fourth embodiment;[0029]
• FIG. 11 is a sectional view taken along the line XI-XI of FIG. 9;[0030]
• FIG. 12 is a sectional view taken along the line XII-XII of FIG. 9;[0031]
• FIG. 13 is a sectional view taken along the line XIII-XIII of FIG. 9;[0032]
• FIG. 14 is a longitudinal side cross section showing a distal end of the medical ligating apparatus in a state in which the ligating wire of the fourth embodiment is cut.[0033]
• FIG. 15 is a longitudinal side cross section showing a distal end of a medical ligating apparatus showing a modified example of the first embodiment of the present invention;[0034]
• FIG. 16 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a fifth embodiment of the present invention;[0035]
• FIG. 17 is an external view showing a distal end of a cutting sheath according to the fifth embodiment;[0036]
• FIG. 18A and FIG. 18B are perspective views showing a state during ligation according to the fifth embodiment;[0037]
• FIG. 19 is a longitudinal side cross section showing a distal end of a medical ligating apparatus according to a sixth embodiment of the present invention; and[0038]
• FIG. 20 is an external view showing the apparatus in a direction indicated by the arrow XX in FIG. 19 according to the sixth embodiment.[0039]
DETAILED DESCRIPTION OF THE INVENTION
• Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings.[0040]
• FIG. 1 to FIG. 5 show a first embodiment of the present invention. FIG. 1 is a structural view showing an entire medical ligating apparatus, in which its distal end is cross-sectioned. FIG. 2 to FIG. 4 are longitudinal side cross sections of the distal end. FIG. 5 is a perspective view showing a state in which a lesion is ligated by a ligating wire.[0041]
• As shown in FIG. 1, a[0042]medical ligating apparatus1 is composed of: amedical ligating device2 retained in a living body; and a manipulatingdevice3 for guiding themedical ligating device2 into the living body, thereby carrying out ligating manipulation. The manipulatingdevice3 is composed of: aninsert section4 having flexibility, the insert section being inserted into an endoscope channel; and a proximal manipulatingsection5.
• The[0043]insert section4 is composed of: anouter sheath6 that consists of a flexible sheath; aninner sheath7 that consists of a flexible sheath and is movably inserted into theouter sheath6 in an axial direction; a cuttingsheath8 engaged with the outer of theinner sheath7, the cutting sheath being movably inserted in an axial direction; and a manipulatingwire9 that is retractable in an axial direction, the manipulating wire being inserted through theinner sheath7.
• The[0044]outer sheath6 is made of, for example, a plastic having flexibility such as polyethylene or PTFE, and is 2 mm to 5 mm in diameter. In addition, theinner sheath7 is made of, for example, a plastic having flexibility such as polyethylene or PTFE. A metallic-meshed sheath may be inserted in a plastic sheath. The manipulatingwire9 is formed of a metal twist wire such as stainless steel.
• The[0045]proximal manipulating section5 is composed of: agrip10 fixed to a proximal end of theouter sheath6; aslider12 fixed to a proximal end of the manipulatingwire9, the slider being retractable relative to a manipulating sectionmain body11; acutting manipulating section13 fixed to a proximal end of the cuttingsheath8; and a finger hook ring14. Theouter sheath6, manipulatingwire9, and cuttingsheath8 can be moved relatively in the forward and backward direction by means of thegrip10,slider12, and cutting manipulatingsection13.
• At a distal end of the cutting[0046]sheath8, there is provided anannular cutting member15 made of a metal such as stainless steel, the cutting member serving as cutting means. Asharp cutting blade16 is provided all around the distal end of the cuttingmember15. In addition, a hook shapedengagement member17 is securely fixed to the distal end of the manipulatingwire9.
• Next, a description of the[0047]medical ligating device2 will be given. In themedical ligating device2, there is provided a loop shaped ligatingwire18 serving as a ligating member for ligating living tissues at the distal end portion of the device. The ligatingwire18 is formed of a synthetic resin such as nylon or polyolefin, a metal thin wire such as stainless, a silk yarn, or biologically absorptive yarn, and is 0.2 mm to 1 mm in wire diameter. The ligatingwire18 may be in any form of a single wire, twist wire, or knitted wire. In addition, the proximal end side of theligating wire18 is folded, and afold section19 is formed. Both ends of theligating wire18 and the parallel two wires are fixed to an internal cavity of a connectingpipe20 serving as a fixing parts by means of adhesive bonding or the like.
• At the intermediate portion of the[0048]ligating wire18, atubular stopper21 serving as a fixing member that is retractable on the wire is movably engaged. Thestopper21 is made of, for example, a rubber such as silicon rubber or fluorine rubber or a variety of thermoplastic elastomers, or a knot of theligating wire18. Thestopper21 is advanced, whereby a loop section is reduced in diameter. Thestopper21 is retracted, whereby the loop section is increased in diameter.
• A receiving[0049]member22 for receiving the cuttingmember15 is provided at theligating wire18 at the proximal end of thestopper21. The receivingmember22 is formed in a cylindrical shape, and is formed of a metal such as stainless or a plastic such as polypropylene, ABS, polyacetal, polycarbonate or the like. Anannular protrusion23 is integrally provided at a substantially intermediate portion in an axial direction. A convergingsection24 is provided at the proximal end of the receivingmember22. The convergingsection24 is designed so as to be supported after being inserted into the distal end of theinner sheath7. Therefore, there is no step between an outer periphery face of theinner sheath7 and an outer periphery face of the receivingmember22 so that the cuttingsheath8 can be advanced and retracted smoothly.
• A pair of distal end holes[0050]25a,25bthrough which theligating wire18 can be inserted are punched at the distal end side more than theannular protrusion23 of the receivingmember22. A pair of proximal end holes26a,26bthrough which theligating wire18 can be inserted are punched at the proximal end side more than theannular protrusion23. The inner face at the distal end side of the distal end holes25a,25band the inner face at the proximal end side of the proximal end holes26a,26bare formed on an incline face so that the ligatingwire18 can be easily inserted and withdrawn. Further, a side face at the proximal end side of theannular protrusion23 is formed as anabutment face27 of the cuttingmember15.
• Each of the folded portions of the[0051]ligating wire18 is led from a proximal opening of the receivingmember22 to the inner of the receivingmember22. Next, these portions each are led from the proximal end holes26a,26bto the outer of the receivingmember22. Then, these portions each are led from the distal end holes25a,25bto the inner of the receivingmember22 via the outer of theannular protrusion23. Finally, these portions each are led from the distal opening to the outer. At the distal end side of the receivingmember22, the ligatingwire18 is pressed into an internal cavity of thestopper21 in a bound state. Further, the full length of the receivingmember22 is about 5 mm to 10 mm. The length of the remaining wire after cut is determined depending on a dimension L between its distal face of receivingmember22 and proximal end holes26a,26beach. Thus, the shorter L is desirable, and is set to about 2 mm to 5 mm.
• Now, dimensions of the receiving[0052]member22,annular protrusion23, and cuttingmember15 will be described here. Assume that an external diameter of the receivingmember22 is A, an external diameter of theannular protrusion23 is B, and an internal diameter of the cuttingmember15 is C. These diameters are about 1 mm to 3 mm, and a relationship of A<C, B>C, and B−A=about 0.2 mm to 1 mm is established. In addition, the proximal end holes26a,26b, as shown in FIG. 15, may be spaced forwardly or backwardly, respectively.
• Now, an operation of the first embodiment will be described here.[0053]
• First, the[0054]slider12 is manipulated, whereby the manipulatingwire9 is advanced, and theengagement member17 is protruded from distal openings of theouter sheath6 andinner sheath7. In this state, thefold section19 at the proximal end of theligating wire18 is hooked on a hook section of theengagement member17. When theslider12 is manipulated, thereby retracting the manipulatingwire9 and introducing theengagement member17 into the inner of theinner sheath7, the convergingsection24 of the receivingmember22 is supported after being inserted into the distal opening of theinner sheath7. In this state, when thegrip10 is manipulated, thereby advancing theouter sheath6, the ligatingwire18 is housed into the inner of theouter sheath6, and a loop section is reduced in diameter, as shown in FIG. 2.
• In this state, the[0055]insert section4 is inserted through the endoscope channel, and is inserted into a body cavity. Then, a distal end of theinsert section4 is guided to a target site in the body cavity. While alesion28 such as polyp is observed by means of an endoscope, when thegrip10 is manipulated, thereby retracting theouter sheath6, the ligatingwire18 is protruded from the distal opening of theouter sheath6. Then, the loop section of theligating wire18 is elastically restored, and is increased in diameter, as shown in FIG. 1.
• Next, while the[0056]lesion28 is observed by means of the endoscope, after the loop section of theligating wire18 has been hooked on a root of thelesion28, theslider12 is manipulated, thereby retracting the manipulatingwire9. Then, the proximal end of theligating wire18 is introduced into the inner of theinner sheath7 via theengagement member17, and thestopper21 and receivingmember22 move in a distal end direction of theligating wire18. Therefore, the loop section of theligating wire18 is reduced in diameter, as shown in FIG. 3, and thelesion28 is tightly bound. The blood flow to thelesion28 is stopped by this ligation.
• Next, while the[0057]slider12 is held, when thecutting manipulating section13 is manipulated, thereby advancing the cuttingsheath8, the cuttingsheath8 is advanced while it is guided to theinner sheath7. Then, the cuttingmember15 is engaged with the proximal end of the receivingmember22, and thecutting blade16 abuts against theabutment face27. Therefore, the proximal end side of theligating wire18 inserted into the receivingmember22 is cut in the vicinity of the proximal end holes26a,26b, as shown in FIG. 4.
• At this time, the proximal end side of the[0058]ligating wire18 is pulled by the manipulatingwire9, and a tensile stress is applied. Thus, thecutting blade16 cuts well. In FIG. 4, a time difference may occur without the two top andbottom ligating wires18 being cut at the same time. However, the two top andbottom ligating wires18 are connected to each other by means of the connectingpipe20. Even if these wires are cut one by one, a tensile stress is maintained, and thus, the cutting performance is not degraded.
• In the case where the proximal end holes[0059]26a,26bare displaced forwardly and backwardly, after one of the ligatingwires18 has been cut by thecutting blade16, theother ligating wire18 is cut. As a result, both of the ligatingwires18 and thecutting blade16 do not come into contact with each other at the same time. Thus, the cutting force applied to theligating wire18 is not dispersed, and the cutting is made easy.
• When the proximal end side of the[0060]ligating wire18 is cut, theinner sheath7 and receivingmember22 are separated from each other. Then, the ligatingdevice2 and manipulatingdevice3 are completely separated from each other. When theinsert section4 is drawn from the endoscope channel, the receivingmember22 slips off from the cut proximal end of theligating wire18. Therefore, as shown in FIG. 5, only the ligatingwire18 held in a tightly bound state by means of thestopper21 is retained in the body, and a surgical operation for tightly binding thelesion28 completes. The receivingmember22 having slipped off from the ligatingwire18 is naturally discharged to the outer of the body via the digestive tract.
• In this way, according to the[0061]medical ligating apparatus1, a manipulation for tightly binding thelesion28 by the ligatingwires18 and a manipulation of cutting and separating the ligatingwires18 can be carried out in series. Therefore, unlike the prior art, there is no need to replace the ligating apparatus with the scissors in the endoscope channel, and a surgical operation time can be reduced. Moreover, the ligatingwire18 can be cut at a portion close to thestopper21. Thus, the ligatingwire18 does not remain in the body cavity while being in an expanded state, and interference with another treatment device or an endoscope can be prevented.
• Such a simple structure is provided that the cutting means[0062]15 having the cuttingblade16 oriented in the longitudinal direction of the manipulatingdevice3 is mounted at the distal end of the cuttingsheath8, thus making it possible to reduce the manufacturing cost of the manipulating device and reduce the manipulating device in diameter. Further, even when the cutting performance of thecutting blade16 is degraded due to repeated use of the manipulatingdevice3, the cuttingsheath8 and cutting means15 can be easily replaced by removing them from the manipulatingdevice3.
• FIG. 6 and FIG. 7 show a second embodiment of the present invention. Like elements in the first embodiment are designated by like reference numerals. A duplicate description is omitted here. FIG. 6 and FIG. 7 are longitudinal side cross sections showing a distal end side of a medical ligating apparatus. An[0063]annular groove30 into which thecutting blade16 of the cuttingmember15 is to be inserted is provided on the proximal side face of theannular protrusion23 of the receivingmember22 according to the present embodiment.
• Therefore, while the[0064]slider12 is maintained, when thecutting manipulating section13 is manipulated, thereby advancing the cuttingsheath8, the cuttingsheath8 is advanced while it is guided to theinner sheath7. Then, thecutting blade16 of the cuttingmember15 is inserted into theannular groove30 of the receivingmember22. Therefore, the proximal end side of theligating wire18 inserted into the receivingmember22 is cut in the vicinity of the proximal end holes26a,26b, as shown in FIG. 7. At this time, thecutting blade16 is guided to theannular groove30, whereby the blade does not slip on the wire, and can cut the wire reliably. In addition, the cutting performance is improved more significantly.
• FIG. 8 shows a third embodiment of the present invention. Like elements in the first embodiment are designated by like reference numerals. A duplicate description is omitted here. FIG. 8 is a longitudinal side cross section showing a distal end side of a medical ligating apparatus. The cutting[0065]member31 of the present embodiment is provided at the inner of asheath7aso as to be advanced and retracted by means of the cuttingsheath8. The cuttingmember31 may be removable from the cuttingsheath8 so as to facilitate replacement.
• In addition, a receiving[0066]member32 is formed in a cylindrical shape that does not have an annular protrusion, and the distal end holes25a,25band the proximal end holes26a,26bare provided. An abutment face34 of acutting blade33 of a cuttingmember31 is provided on an internal wall of the receivingmember32.
• Therefore, when the[0067]cutting manipulating section13 is manipulated, thereby advancing the cuttingsheath8, the cuttingsheath8 is advanced while it is guided to thesheath7a. Then, thecutting blade33 of the cuttingmember31 abuts against the abutment face34 of the receivingmember32. Therefore, the proximal end side of theligating wire18 inserted into the receivingmember32 is cut in the vicinity of the proximal end holes26a,26b.
• As in the present embodiment, the cutting[0068]member31 is provided at the inner of thesheath7a, whereby any protrusion is eliminated at the outer of thesheath7a, and the cutting blade is not exposed. In this way, the outer sheath is eliminated, and thus, wiring can be directly provided to the endoscope channel. The outer sheath is eliminated, whereby theinsert section4 of themedical ligating apparatus1 is reduced in diameter, and wiring can be provided to a channel with its small internal diameter.
• FIG. 9 to FIG. 14 show a fourth embodiment of the present invention. Like elements in the first embodiment are designated by like reference numerals. A duplicate description is omitted here. FIG. 9 is a longitudinal side cross section showing a distal end side of a medical ligating apparatus. FIG. 10 is a plan view showing the same. FIG. 11 is a cross section taken along the line XI-XI. FIG. 12 is a sectional view taken along the line XII-XII. FIG. 13 is a sectional view taken along the like XIII-XIII. FIG. 14 is a longitudinal side cross section showing a distal end side of a medical ligating apparatus in a state in which a ligating wire is cut.[0069]
• A fixing[0070]member40 is provided at the proximal end side of theligating wire18. This fixingmember40 is preferably made of a plastic such as polypropylene, ABS, polyacetal, polycarbonate, or alternatively, a comparatively rigid material with excellent fluidity such as a liquid crystal polymer or polyphthal amide. This member may be made of a metal such as stainless or aluminum, is about 1 mm to 3 mm in external diameter, and is about 5 mm to 10 mm in length.
• The fixing[0071]member40 is composed of afirst member41 and asecond member42. Thefirst member41 is formed in a cylindrical shape. Alarge diameter section43 is provided at a proximal end of the first member, and a press-insection44 consisting of a short diameter section is provided at a distal end thereof. Anannular cutting member45 is engagingly fitted to the outer periphery at the distal end side of thelarge diameter section43 while itscutting blade46 is oriented to the distal end side. Wire guides47a,47bare provided at the top and bottom portions of the outer periphery of the proximal end side of thelarge diameter section43. Further, at the outer periphery of the distal end side of thelarge diameter section43,engagement claws48a,48bare provided at the right and left parts which are biased by 90 degrees in a peripheral direction relative to the wire guides47a,47b. In addition, at a coaxial section of thefirst member41, aninternal cavity49 is provided in an axial direction. Aprotrusion50 is provided at the substantially intermediate section in the axial direction of thisinternal cavity49. The height of thisprotrusion50 is between 0.1 mm to 0.3 mm.
• In the[0072]second member42, acolumnar section51 is provided at its distal end, and acylindrical section52 is provided integrally with thecolumnar section51 at its proximal end. At the center of thecolumnar section51, aninsert shaft53 to be inserted into theinternal cavity49 of thefirst member41 is protruded through the inner of thecylindrical section52. Further, a fixinginternal cavity54 into which a press-insection44 of thefirst member41 is to be pressed is provided at thecolumnar section51 so as to surround theinsert shaft53. The length of the fixinginternal cavity54 is between 1 mm to 3 mm.
• In addition, distal end holes[0073]55a,55binto the ligatingwires18 are inserted one by one are provided at the distal face of thesecond member42. Side holes56a,56bare provided at the top and bottom parts at the outer periphery of thecylindrical section52 of thesecond member42.Slits57a,57bare provided in the neighborhood of these holes. Further, at thecylindrical section52, engagement holes58a,58bto be engaged with theengagement claws48a,48bof thefirst member41 are provided at the right and left parts which are biased by 90 degrees in a peripheral direction relative to theslits57a,57b. In addition, anabutment face59 of thecutting blade46 is provided on an end face at the proximal end side of thecolumnar section51 of thesecond member42, and anabutment section60, on which the press-insection44 abuts, is provided in the vicinity of the distal end of the fixinginternal cavity54. A single-side clearance between an internal diameter of the fixinginternal cavity54 and an external diameter of the press-insection44 is defined so as to be smaller than an external diameter of theligating wire18.
• The[0074]insert shaft53 of thesecond member42 is inserted into theinternal cavity49 of thefirst member41, and a distal face of theinsert shaft53 abuts against theprotrusion50, whereby the insertion depth is restricted. Therefore, thecylindrical section52 of thesecond member42 is engaged with the outer of the cuttingmember45 so as to cover thecutting blade46.
• The[0075]ligating wire18 is inserted from the distal end holes55a,55binto the inner of thesecond member42, and is led out to the outer through the side holes56a,56b. Further, the ligatingwire18 is guided by theslits57a,57band wire guides47a,47b, and is led to the proximal end side of the fixingmember40. Connection between thefold section19 of theligating wire18 and both of the ends via the connectingpipe20 is similar to that in the first embodiment.
• Next, an operation of a fourth embodiment will be described.[0076]
• First, the manipulating[0077]wire9 is advanced, whereby theengagement member17 is protruded from a distal opening of thesheath7a. In this state, thefold section19 at the proximal end of theligating wire18 is hooked on a hook section of theengagement member17. When the manipulatingwire9 is retracted, thereby introducing theengagement member17 into the inner of thesheath7a, the convergingsection24 of the fixingmember40 is supported after being inserted into the distal opening of thesheath7a. In this state, thesheath7aincluding theligating wire18 is inserted through the endoscope channel, and is inserted into the body cavity. Then, the distal end of thesheath7ais guided to a target site in the body cavity. While thelesion28 such as polyp is observed by means of the endoscope, when thesheath7ais advanced, the ligatingwire18 is protruded from the distal opening of the channel. Then, the loop section of theligating wire18 is elastically restored, and is increased in diameter, as shown in FIG. 9.
• Next, while the[0078]lesion28 is observed by means of the endoscope, after the loop section of theligating wire18 is hooked on the root of thelesion28, when the manipulatingwire9 is retracted, the proximal end of theligating wire18 is introduced into the inner of thesheath7avia theengagement member17. Then, the ligatingwire18 is reduced in diameter, and thelesion28 is tightly bound.
• When the manipulating[0079]wire9 is further retracted, the distal face of thesecond member42 of the fixingmember40 abuts against thelesion28, and thelesion28 serves as a stopper. Thus, thefirst member41 is relatively advanced, and thesecond member42 is retracted. Therefore, theinsert shaft53 of thesecond member42 breaks theprotrusion50, and is inserted into theinternal cavity49 of thefirst member41.
• In addition, the press-in[0080]section44 of thefirst member41 is advanced in the direction of the fixinginternal cavity54 of thesecond member42. Thus, the intermediate section of theligating wire18 is fixed to be pinched between an internal face of the fixinginternal cavity54 and an external face of the press-insection44. Further, when the press-insection44 of thefirst member41 is advanced in the direction of the fixinginternal cavity54 of thesecond member42, thecutting blade46 of the cuttingmember45 provided at thefirst member41 abuts against anabutment face59 of thesecond member42. Therefore, when the intermediate section of theligating wire18 is cut, and a cut end is pinched and fixed between the internal face of the fixinginternal cavity54 and the external face of the press-insection44.
• In addition, when the distal end of the press-in[0081]section44 abuts against anabutment section60, theengagement claws48a,48bof thefirst member41 are engaged with the engagement holes58a,58b, and thefirst member41 is engaged with thesecond member42.
• The[0082]sheath7aand the fixingmember40 are separated from each other by disconnection of theligating wire18, and theligating device2 and manipulatingdevice3 are completely separated from each other. When thesheath7ais drawn from the endoscope channel, only the ligatingwire18 held in a tightly bound state by means of the fixingmember40 is retained in the body, and a surgical operation for tightly binding thelesion28 completes.
• In this way, according to the[0083]medical ligating apparatus1, a manipulation for cutting and separating the ligatingwires18 at the same time when thelesion28 is tightly bound by the ligatingwire18 can be carried out in series. Therefore, unlike the prior art, there is no need to replace the ligating apparatus with the scissors in the endoscope channel, and a surgical operation time can be reduced. Moreover, the cut end of theligating wire18 is housed at the inner of the fixingmember40, and thus, interference with another treatment device or an endoscope can be prevented more effectively. In addition, the cuttingmember45 is provided at themedical ligating device2 itself. Thus, a new cutting blade is always used without repeated use of thecutting blade46. As a result, the ligatingwire18 can be cut reliably.
• The cutting[0084]member45 is provided at the inner of the fixingmember40, whereby a protrusion is eliminated. Thus, the outer sheath becomes unnecessary, and the wire can be directly inserted through the endoscope channel. The outer sheath becomes unnecessary, whereby theinsert section4 of themedical ligating apparatus1 can be reduced in diameter, and the wire can be inserted through a channel with its small internal diameter.
• FIG. 16 to FIG. 18 show a fifth embodiment of the present invention. FIG. 16 is a longitudinal side cross section showing a distal end of the apparatus. FIG. 17 is an external view showing a distal end of a cutting sheath. FIG. 18 is a perspective view showing a state during ligation. Only differences from the first to third embodiments will be described here.[0085]
• As shown in FIG. 16, an external diameter of the[0086]stopper21 is substantially equal to that of theinner sheath7, and a distal face of theinner sheath7 can abut against a proximal face of thestopper21. A cuttingsheath8 is formed of a metallic meshed plastic (for example, polyethylene, PTFE, nylon or the like), or alternatively, a metallic multi-striped coil, and is excellent in rotation tracking properties.
• As shown in FIG. 17, a cutting[0087]member65 is connected at a distal end of the cuttingsheath8. The cuttingmember65 has acutout61. Acutting blade66 is provided at the distal edge and side face edge of thecutout61. Aclaw section62 is provided at the distal end side of thecutout61.
• Next, an operation of a fifth embodiment of the invention will be described.[0088]
• After the loop section of the[0089]ligating wire18 has been hooked on thelesion28, theslider12 is pulled toward the proximal side, and thelesion28 is ligated. Then, theslider12 is slightly pushed and advanced to the distal end side, and a portion of theligating wire18 at the proximal end side of thestopper21 is exposed to the distal end side of theinner sheath7, as shown in FIG. 18A.
• Next the[0090]cutting manipulating section13 is manipulated, whereby the cuttingsheath8 is advanced to be protruded to the distal end side more than theinner sheath7. In this state, by using a bending manipulation of the endoscope or the like, the ligatingwire18 exposed as shown in FIG. 18B is hooked on aclaw section62.
• Then, the[0091]cutting manipulating section13 is pulled to the proximal side or is rotated in the direction shown in FIG. 18B, whereby acutting blade66 provided at a cuttingmember65 cuts theligating wire18 at the proximal end side of thestopper21.
• According to the present embodiment, unlike the first to third embodiments, there is no need to provide a receiving member at the[0092]medical ligating device2, and the number of parts is reduced. Thus the manufacturing cost can be reduced. In addition, the ligatingwire18 does not pass through the distal end holes25a,25band proximal end holes26a,26bof the receiving member in a bent state, and extends straight between a proximal end of thestopper21 and theengagement member17. This makes it possible to push and advance thestopper21 to the distal end side with a gentle force when thelesion28 is ligated.
• FIG. 19 and FIG. 20 show a sixth embodiment of the present invention. FIG. 19 is a longitudinal side cross section showing a distal end of the apparatus. FIG. 20 is an external view of the apparatus in the direction indicated by the arrow XX in FIG. 19. Only differences from the first to third embodiments will be described here.[0093]
• An[0094]annular cutting member75 is provided at the proximal end side of thestopper21. The cuttingmember75 is formed of a metal member such as stainless. A convergingsection24 is provided at the proximal end side of the cuttingmember75, and is designed to enable engagement with a distal internal cavity of thesheath7a. An external diameter of the convergingsection24 is slightly larger than the distal internal diameter of thesheath7a. This external diameter is defined in a dimension such that the cuttingmember75, when engaged with the distal internal cavity of thesheath7a, does not slip off easily nor rotate relative to thesheath7a.
• In addition, the[0095]sheath7ais formed of a metallic meshed plastic (for example, polyethylene, PTFE, or nylon and the like), or alternatively, a metallic multi-stripe coil, and is excellent in rotation tracking properties.
• A[0096]distal end hole71 andproximal end hole72 through which two ligatingwires18 can be inserted are provided on a side face of the cuttingmember75. These holes communicate with an internal cavity of the cuttingmember75. After theligating wire18 has passed through the inner of thestopper21, the ligating wire enters a distal opening of the cuttingmember75. Then, the ligatingwire18 is exposed to the outer through thedistal end hole71. Further, the ligatingwire18 extends to theengagement member17 through theproximal end hole72, an internal cavity of the cuttingmember75, and an internal cavity of thesheath7a.
• It is desirable that a distance L between the distal end of the cutting[0097]member75 and thedistal end hole71 be short. The distance L is set to about 2 mm to 5 mm. In addition, acutting blade76 is provided at both edges of thedistal end hole71.
• Next, an operation of a sixth embodiment will be described.[0098]
• After the[0099]lesion28 has been ligated at the loop section of thelegating wire18, the proximal end side of thesheath7ais rotated. The cuttingmember75 and the distal end of thesheath7aare engaged with each other so as not to easily rotate therebetween. Thus, the cuttingmember75 rotates in unison with thesheath7a.
• The distal end side of the[0100]ligating wire18 is fixed to be ligated around thelesion28. Thus, when the cuttingmember75 rotates, thecutting blade76 abuts against a portion of theligating wire18 which is passing through thedistal end hole71, and cuts the portion of the wire. When the manipulatingdevice3 is removed from the endoscope, the cuttingmember75 is taken out of the body while it is fixed to the distal end of thesheath7a.
• The[0101]cutting blade76 may be provided at a distal edge of thedistal end hole71. In this case, thesheath7ais pulled to the proximal side, whereby theligating wire18 is cut by thecutting blade76. In this case, thesheath7aand convergingsection24 must be set so as not to be disengaged from each other in the range of a force required to cut the ligatingwire18.
• According to the present embodiment, the cutting[0102]member75 is provided in place of the receiving members according to the first to third embodiments. As a result, the cuttingsheath8 becomes unnecessary, the number of parts is reduced, and the manufacturing cost can be reduced. In addition, unlike the first to third embodiments, the medical ligating device is not retained in the body in such a state that another member remains at the proximal end side of the fixing member. Thus, interference with another treatment device or an endoscope can be prevented more efficiently immediately after the ligating device has been retained.
• As has been described above, a manipulation for tightly binding a lesion by a ligating member and a manipulation for cutting the ligating member can be carried out in series. In addition, there is no need to replace the ligating apparatus with the scissors in the endoscope channel, and a surgical operation time can be reduced. Moreover, the ligating member can be cut at a portion close to the fixing member. Thus, the cut end of the ligating member does not remain in the body cavity while it is extended, and interference with another treatment device or an endoscope can be prevented. In addition, the cutting blade extends in the longitudinal direction of the manipulating device. Thus, the manipulating device can be reduced in diameter. Further, means for cutting the ligating member is formed with a simple structure. Thus, the manufacturing cost can be reduced. Note that the ligating device is not limited to a loop-shaped one.[0103]
• Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.[0104]

Claims (16)

What is claimed is:

1. A medical ligating apparatus comprising:

a medical ligating device including a ligating member which has a flexible wire rod and ligates living tissues, and a fixing member which is movably provided at the ligating member and fixes the living tissues in a ligated state;

a manipulating device having a flexible sheath and a proximal manipulating section; and

wherein the manipulating device comprises cutting means for cutting the ligating member, the cutting means being provided on the manipulating device and being movably provided on the ligating member.

2. A medical ligating apparatus comprising:

a medical ligating device including a ligating member which has a flexible wire rod and ligates living tissues, and a fixing member which is movably provided at the ligating member and fixes the living tissues in a ligated state; and

a manipulating device having a flexible sheath and a proximal manipulating section,

wherein the manipulating device comprises cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member, and the cutting means is advanced and retracted or is rotated to cut the ligating member at a proximal end side of the fixing member.

3. A medical ligating apparatus comprising:

a medical ligating device including a ligating member which has a flexible wire rod and ligates living tissues, and a fixing member which is movably provided at the ligating member and fixes the living tissues in a ligated state; and

a manipulating device having a flexible sheath and a proximal manipulating section,

wherein the manipulating device comprises cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member, and the medical ligating device comprises a receiving member which is movably provided on the ligating member and receives the cutting means.

4. A medical ligating device comprising:

a ligating member which includes a flexible wire rod and ligates living tissues;

a fixing member which is movably provided on the ligating member and fixes the living tissues in a ligated state; and

cutting means for cutting the ligating member, the cutting means being movably provided on the ligating member.

5. A medical ligating apparatus comprising:

a medical ligating device according toclaim 4; and

a manipulating device having a flexible sheath and a proximal manipulating section.

6. A medical ligating device comprising:

a ligating member which includes a flexible wire rod and ligates living tissues;

a fixing member which is movably provided on the ligating member that fixes the living tissues in a ligated state; and

cutting means for cutting the ligating member, the cutting means being provided on the fixing member.

7. A medical ligating apparatus comprising:

a medical ligating device according toclaim 6; and

a manipulating device having a flexible sheath and a proximal manipulating section.

8. A ligating apparatus for ligating living tissues by a ligating device using a predetermined elongated material, comprising:

tracting and ligating means for tracting a proximal end of the ligating device and ligating the living tissues by a distal end of the ligating device; and

cutting means for cutting the proximal end of the ligating device, while the tracting and ligating means is ligating the living tissues in the distal end of the ligating device, the cutting means having a blade section which is movably operated in parallel to a tracting direction of the tracting and ligating means and which is oriented to a distal end side of the tracting direction.

9. A ligating apparatus according toclaim 8, further comprising a receiving member which has an abutment section against which the blade section abuts and disposes the ligating device between the abutment section and the blade section.

10. A ligating apparatus according toclaim 9, further comprising a sheath which has an external diameter capable of being inserted into the cutting means and is inserted into the cutting means, and a receiving member to be mounted on a distal end of the sheath.

11. A ligating apparatus according toclaim 9, further comprising:

a sheath which has an internal diameter large enough to allow the cutting means to be inserted; and

a receiving member to be mounted on a distal end of the sheath.

12. A ligating apparatus for ligating living tissues by a ligating device using a predetermined elongated material, comprising:

tracting and ligating means for tracting a proximal end of the ligating device and ligating the living tissues by a distal end of the ligating device; and

cutting means being movable back and forth and rotable in a tracking direction of the tracking and ligating means, having a blade section oriented to the proximal end of the ligating device, and configured to cut the proximal end portion from of the ligating device which has ligated the living tissues by assistance of the tracking and ligating means, leaving the distal end portion of the ligating device;

13. A ligating apparatus according toclaim 12, wherein the cutting means further comprises a blade section which has a ring-shaped cross section in a plane perpendicular to a tracking direction of the tracking means.

14. A ligating apparatus for ligating living tissues by a ligating device using a predetermined elongated material, comprising:

tracting and ligating means for tracting a proximal end of the ligating device and ligating the living tissues by using a distal end of the ligating device; and

cutting means being rotable in a tracking direction of the tracking and ligating means, having a blade section oriented to the proximal end of the ligating device, and configured to cut to cut the proximal end portion from of the ligating device which has ligated the living tissues by assistance of the tracking and ligating means, leaving the distal end portion of the ligating device;

15. A ligating apparatus for ligating living tissues, comprising:

a ligating device which includes a predetermined elongated material and ligates living tissues;

tracting and ligating means for tracting a proximal end of the ligating device and ligating the living tissues by a distal end of the ligating device; and

cutting means for cutting the proximal end of the ligating device, while the tracting and ligating means is ligating the living tissues in the distal end of the ligating device, the cutting means having a blade section that is movably operated in parallel to a tracting direction of the tracting and ligating means and that is oriented to a distal end side of the tracting direction.

16. A ligating apparatus for ligating living tissues by a ligating device using a predetermined elongated material, comprising:

tracting and ligating means for tracting a proximal end of the ligating device and ligate the living tissues;

a first stopper and a second stopper which oppose each other, with the ligating device sandwiched therebetween, and which are engaged with each other by virtue of a traction force when the traction and ligating means pulls the ligating device, and which lock the ligating device in a frictional manner, thereby maintaining a ligation state by the ligating device; and

cutting means for cutting the proximal end of the ligating device, while the tracting and ligating means is ligating the living tissues in the distal end of the ligating device, the cutting means being provided at least one of the first and second stoppers.

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