US20060011698A1 - Tissue stapling method and tissue stapler - Google Patents

Abstract

A position information transmitting member for transmitting position information to a staple receiving portion is provided in a tissue stapler having a staple receiving portion which comprises the anvil of the stapler. Thereby, an operator can easily locate the position of and grasp the staple receiving portion located within a tissue to swiftly execute stapling. The tissue stapler includes a stapling portion provided with an endoscope inserting tube path, a stapling portion provided with a staple injecting portion arranged on a distal end side of the inserting portion, and a staple receiving member (anvil) arranged separately from the inserting portion, to be grasped by a treatment tool introduced via the inserting portion in a state when it is opposed to the stapling portion via a tissue, to bend a distal end portion of a staple pressed out from the staple injecting portion of the stapling portion which has penetrated through the tissue.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application is based upon and claims the benefit of priority from prior Japanese Patent Application No. 2004-207740, filed Jul. 14, 2004, the entire contents of which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to a tissue stapling method and a tissue stapler. A tissue stapler is used when, for example, the intraluminal organ of the esophagus, the stomach or the like is subjected to an anastomosis or a fixing treatment during surgery or the like.
• 2. Description of the Related Art
• Tissue staplers have been known in the related art. A tissue stapler is used in anastomosing end portions of the normal intraluminal organ after or before cutting off a morbid or diseased portion of the intraluminal organ of, for example, the large intestine, or the small intestine, or in anastomosing side portions of the stomach and the small intestines. Such a tissue stapler can considerably shorten an operation time period by stapling the tissue with a plurality of staples, arranged in a ring-like shape and simultaneously cutting off a substantially central portion of the tissue stapled along the ring-like shape.
• Such a tissue stapler is provided with a stapling portion arranged with a plurality of staples at a distal end of an inserting portion that is inserted into the intraluminal organ, and a distal end portion of the stapling portion is attachably and detachably integrated with an anvil which provides a tissue fixing portion. The anvil is able to staple the tissue by pressing a foot portion of the staple into contact with the staple projected from a stapling portion. Further, a control section is provided on a proximal side of the inserting portion of the tissue stapler.
• Recently, there has been proposed an inserting portion to be inserted into the intraluminal organ formed to provide flexibility in consideration of insertability into a deep portion of the intraluminal organ, or promoting insertability by arranging an observing optical system at a distal end thereof (refer to, for example, JP-A-2003-111763, U.S. Pat. No. 5,411,508).
• Further, when the intraluminal organs are anastomosed by using the tissue stapler with the promoted insertability of the inserting portion, the inserting portion and the anvil are inserted into the intraluminal organ orally or via the anum. Further, the intraluminal organs are anastomosed at an aimed position in the coelom of the intraluminal organ by confirming a distal end position of the inserting portion and a position of the anvil used in combination with the inserting portion and controlling the movement of at least one of them.
• Hence, in addition to anastomosis being assisted by a rigid scope and forceps, recently there has also been proposed a tissue stapler constituted to facilitate operability by opposedly arranging magnets at the anastomosing portion and the anvil to enable their positioning proximate to each other by a magnetic force (refer to, for example, U.S. Pat. No. 5,411,507).
• However, although observing optical systems are disclosed in the tissue staplers of JP-A-2003-111763 and U.S. Pat. No. 5,411,508, the apparatus parts, per se are disposed in the intraluminal organ and therefore, in order to execute anastomosis while attracting the organs disposed at positions remote from each other in the coelom, there is need for assistance by a rigid scope and forceps which are transabdominally inserted (introduced). Further, even on the premise of the transabdominal approach, the position of the distal end of the tissue stapler and the position of the anvil disposed in the intraluminal organ need to be confirmed by the rigid scope and grasped to be guided by the grasping forceps and therefore, there is a drawback that handling is awkward.
• Further, the tissue stapling system of U.S. Pat. No. 5,411,507 is not useful when the tissues to be anastomosed are not disposed proximate each other, necessitating assistance of a rigid scope and a grasping forceps which are transabodomnally inserted. This constitutes a substantial drawback.
• The invention has been made in view of the above-described observations and it is an object of the invention to provide a tissue stapler of improved handling operability.
BRIEF SUMMARY OF THE INVENTION
• In a staple receiving portion (anvil) of a tissue stapler, the invention features providing a position information transmitting member for transmitting position information.
• An embodiment of the tissue stapler includes an inserting portion provided with an endoscope inserting tube path, a stapling portion provided with a staple injecting portion arranged on a distal end side of the inserting portion, and a staple receiving member (anvil) arranged separately from the inserting portion. The staple receiving member is grasped by a treatment tool introduced via the inserting portion in a state where it is juxtaposed to the stapling portion. The staple receiving member is capable of folding (bending) a distal end portion of a staple member penetrating through the tissue, which staple member protrudes from the staple injecting portion of the stapling portion.
• According to the above-described constitution, by detecting the position information transmitted from the position information transmitting member at the staple receiving portion, an operator can obtain the position of the staple receiving member in the tissue. Therefore, the operator can grasp the staple receiving portion by operating a treatment tool inserted into the inserting portion based on the position information. Therefore, stapling can be finished conveniently and easily without depending on hunch, and in a swift manner.
BRIEF DESCRIPTION OF THE DRAWINGS
• These and other features, aspects and advantages of the apparatus and methods of the present invention will become better understood with regard to the following description, appended claims, and accompanying drawings, where:
• FIG. 1 is a perspective view showing a tissue stapler according to a first embodiment of the invention;
• FIG. 2 is a perspective view showing an anvil and a stapling portion ofFIG. 1;
• FIG. 3 is a perspective view showing a shaft member of the anvil ofFIG. 1;
• FIG. 4 is a perspective view showing a portion of an anvil grasping piece ofFIG. 1;
• FIG. 5 is a view showing a state of inserting the anvil and the stapling portion ofFIG. 1 into the tissue;
• FIG. 6 is a view showing a state of grasping the anvil by the anvil grasping piece via the tissue follows the state ofFIG. 5;
• FIG. 7 is a view showing a state of grasping the anvil by the anvil grasping piece via the tissue follows the state ofFIG. 6;
• FIG. 8 is a view showing a state of subjecting the tissue to the stapling and anastomosing treatment follows the state ofFIG. 7;
• FIG. 9 is a view showing a state of separating the stapled portion from a state of finishing to staple and the tissue anastomose ofFIG. 8;
• FIG. 10 is a view showing another example of an anvil grasping portion applied to the first embodiment;
• FIG. 11 is a view showing another example of the anvil grasping portion applied to the first embodiment;
• FIG. 12 is a view showing a state of grasping to fix the tissue ofFIG. 11;
• FIG. 13 is a view showing another example of the anvil grasping portion applied to the first embodiment;
• FIG. 14 is a view showing a grasping and fixing state ofFIG. 13;
• FIG. 15 is a perspective view showing a portion of a tissue stapler according to a second embodiment of the invention;
• FIG. 16 is a view showing a state of stapling the tissue according toFIG. 15;
• FIG. 17 is a view showing a state before stapling tissue by a stapling portion ofFIG. 15;
• FIG. 18 is a view showing a state of stapling the tissue ofFIG. 17;
• FIG. 19 is a view sectioning to show a portion of an anvil of a tissue stapler according to a third embodiment of the invention;
• FIG. 20 is a view showing a state of expanding an anvil arm of the anvil ofFIG. 19;
• FIG. 21 is a view showing an initial state of grasping to fix the tissue by an anvil grasping piece on a side of a stapling portion of the anvil ofFIG. 19;
• FIG. 22 is a view showing a state of grasping the anvil ofFIG. 21 by the anvil grasping piece;
• FIG. 23 is a view showing a state of grasping to fix the anvil ofFIG. 21 by the anvil grasping piece;
• FIG. 24 is a view showing a state of subjecting the tissue to the stapling and anastomosing treatment from the state ofFIG. 23;
• FIG. 25 is a view showing other example of an anvil used in a tissue stapler according to a third embodiment of the invention;
• FIG. 26 is a view showing a reference example of a tissue stapler according to the invention;
• FIG. 27 is a view showing a state of the tissue stapler ofFIG. 26 before stapling the tissue;
• FIG. 28 is a view showing a state of finishing to staple the tissue ofFIG. 27;
• FIG. 29 is a view showing another reference example of a tissue stapler according to the invention;
• FIG. 30 is a view showing a state of restraining a staple member ofFIG. 29; and
• FIG. 31 is a view that explains a procedure of stapling the tissue ofFIG. 29.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• An embodiment of the invention will be described below with reference to the accompanying drawings.
• FIG. 1 shows a tissue stapler according to the first embodiment of the invention. The tissue stapler includes ananvil12 which is a staple receiving member arranged separately from a staplermain body2.
• The staplermain body2 is provided with a staplingportion4 on a distal end side of an insertingportion3 and provided with a proximalside control section5 on a proximal side of the insertingportion3. The insertingportion3 is formed with an endoscope insertingtube path6 from the staplingportion4 to the hand-heldcontrol section5 substantially on an axial portion thereof (refer toFIG. 2) and the endoscope insertingtube path6 is inserted with anendoscope7. A treatment tool insertingtube path8 of theendoscope7 accommodating a treatment tool, for example, ananvil grasping piece11, and theanvil12 is detachably grasped by ananvil grasping portion9 at a distal end of theanvil grasping piece11. Theanvil grasping piece11 is arranged with a proximalside control section10 on a proximal side and the proximalside control section10 is operably located on a proximal side of the insertingportion3.
• The staplingportion4 is inserted with astaple container41 that is substantially hollow, and a distal end face of thestaple container41 is provided with a plurality ofstaple containing holes20 in double rows, in a ring-like shape (refer toFIG. 2). Thestaple containing holes20 are equipped withstaples21, each of which has a substantially horseshoe shape. As shown, the plurality ofstaple containing holes20 are arranged alternately on an inner peripheral side and on an outer peripheral side in the ring-like shape aligned in double rows.
• Further, thestaple container41 is provided with a cuttermember inserting hole22 in a ring-like shape in parallel with thestaple containing hole20 on an inner peripheral side of thestaple containing hole20. Further, a movingmember23 substantially in a cylindrical shape is movably inserted into thestaple container41 along the axis of the endoscope insertingtube path6. On end of the proximal side of the movingmember23 is provided with afemale screw portion24, and thescrew portion24 is screwed with ascrew member27. Thescrew member27 is connected to a motor unit15 (refer toFIG. 1), described later, via a cable28. When themotor unit15 is driven, a rotational force thereof is transmitted via the cable28 to adjust the position of the movingmember23 to move the movingmember23 in an axial direction.
• The other end of the movingmember23 is provided with a plurality ofstaple extruding members25 each substantially in a plate-like shape having a width and a thickness insertable into thestaple containing hole20 at positions corresponding to the respective staple containing holes20. When the movingmember23 is maximally moved rearward to the proximal side, a distal end of thestaple extruding member25 is disposed at a proximal side end of thestaple containing hole20. Further, in a state of maximally moving forward the movingmember23 to a distal end side, the movingmember23 is urged to move thestaple extruding member25 in the same direction to contact the staple21 to extrude the staple21 from a distal end face of thestaple containing hole20.
• Further, in an inner side of thestaple extruding member25, there is provided acutter member26 having a cylindrical shape entirely surrounding the endoscope insertingtube path6. A blade tip of thecutter member26 is contained in thestaple containing member41 of the staplingportion4 when the movingmember23 is positioned in the most proximal position, and is projected from an distal end face of the staplingportion4 when the movingmember23 is in the most distal position.
• Theanvil12 includes an anvilmain body42 and ashaft member16, and theshaft member16 is formed to have an outer diameter insertable into the endoscope insertingtube path6. Theshaft member16 is provided with a shaft30 (refer toFIG. 3) extending from the anvilmain body42, and a distal end side of theshaft30 is formed with a distal end graspedportion32 substantially in a spherical shape. Further, a proximal end side (rear end side) of the distal end graspedportion32 is formed with afitting groove33 over an entire periphery of theshaft16, and theanvil grasping portion9 detachably grasps at thefitting groove33.
• Further, theshaft30 is covered with ashaft cover member31 from a rear portion of thefitting groove33 to the anvilmain body42. Theshaft cover member31 is provided with atransparent portion35 at a vicinity of afitting groove33, and theshaft30 inside of thetransparent portion35 is provided with alight emitting member34 of, for example, an LED or the like constituting a position information transmitting member. Thelight emitting member34 is electrically connected to a power source member (not shown) provided in the anvilmain body42 via acable36 and emits light by being energized with a power source member (not shown).
• The anvilmain body42 is provided with a plurality ofrecess portions17 for underfolding (bending) staple feet arranged substantially in a ring-like shape in double rows at positions opposed to thestaple containing holes20 of the staplingportion4. Further, a cutter member receiving slit18 substantially in a ring-like shape is provided at a position opposed to thecutter member26 of the staplingportion4. Further, the anvilmain body42 is provided with atissue receiving portion19 for receiving a tissue to be cut off, surrounding a proximal end of theshaft member16. The anvilmain body42 is provided with a guidewire inserting hole39a(through hole) connecting a distal end side thereof and the tissue receiving portion19 (refer toFIG. 2).
• Further, the proximalside control section5 is extended with acable tube14 via ananti-folding member13, an end portion of thecable tube14 is electrically connected to themotor unit15. A motor (not shown) is accommodated in themotor unit15 and a rotational force of the motor is transmitted to the cable28. The cable28 is provided inside of acable tube path29 connecting thecable tube14 and the staplingportion4, and connected to thescrew member27 for transmitting the rotational force.
• Theanvil grasping piece11 is provided with theanvil grasping portion9 to grasp and release theanvil12 at the distal end thereof. As shownFIG. 4, theanvil grasping portion9 is provided with a pair of graspingarms38 substantially in a hollow shape openably and closably pivoted on ashaft37 provided at a distal end of the insertingportion3, and distal end portions of the graspingarms38 are provided with a graspinggroove39 which forms an opening in a closed state of the graspingarms38. When the graspingarms38 are closed, the graspinggroove39 is fitted with thefitting groove33 of theanvil12. The pair of graspingarms38 of theanvil grasping portion9 are connected to the proximalside control section10 arranged on the proximal side of the insertingportion3 by a link mechanism (not shown) and an operating wire (not shown). The graspingarms38 are operated to open and close via the operating wire and the link mechanism by an open-close operation of the proximalside control section10.
• In the above-described configuration, when a tissue, for example a large intestine, is partially cut off to be stapled, an operator initially inserts aguide wire45 to a deep portion of thelarge intestine46 per anum as shown inFIG. 5. Further, the operator inserts theanvil12 passed through the guidewire inserting hole39afrom the anus side end of theguide wire45 to a position beyond amorbid portion73 following the guide of theguide wire45. Next, the operator inserts the inserting portion of the staplermain body2 with theendoscope7 inserted in the endoscope inserting tube path, into thelarge intestine46 per anum. The endoscope, as a position detecting device, reaches near themorbid portion73 and stops at the anum side thereof in theintestine46.
• At this point, the operator confirms the positions of theanvil12 and the insertingportion3 of the staplermain body2 by a rigid scope47 inserted transabdominally. At this time, since thelight emitting member34 in theshaft30 and theendoscope7 inserted into the insertingportion3 are emitting light, the position of theanvil12 is determined by observing the light through enteron wall of thelarge intestine46. Thus the light of the anvil provides position information.
• Further, while the operator is grasping a vicinity of themorbid portion73 of thelarge intestine46 with a graspingforceps74 which is a guiding member inserted into the coelom transabodominally and moving the grasping portion to one side, the operator drags theanvil12 to a vicinity of the staplingportion4 of the insertingportion3 by the other graspingforceps48.
• Thus, a side face and another side face of thelarge intestine46 near each other as the intestine forms a loop, and theanvil12 and the staplingportion4 of the insertingportion3 come closer to each other. The operator detects light emitted from thelight emitting member34 of theanvil12 with theendoscope7 by reducing an emitted light amount of the rigid scope47 in a state of making theanvil12 and the staplingportion4 proximate to each other. When theshaft30 is grasped by theanvil grasping piece11 with the enteron wall using the light as a guide, the distal end graspedportion32 of theanvil12 is contained in the hollow portion of the graspingarms38 and the graspinggroove39 of the graspingarms38 are fitted together with thefitting groove33. Thereby, the distal end graspedportion32 is firmly grasped are held by the anvil grasping piece11 (refer toFIG. 6 andFIG. 7).
• Next, the operator drags theendoscope7 and theanvil grasping piece11 into the endoscope insertingtube path6, while grasping theanvil12 along with thelarge intestine46. This interposes the large intestine wall of two layers between theanvil12 and the staplingportion4 of the insertingportion3. At this point, the cable28 is rotated by driving themotor unit15. Then, the rotational force of the cable28 is transmitted to thescrew member27, thescrew member27 is driven to rotate and the movingmember23 is moved linearly in the direction of the distal end.
• As a result, the movingmember23 pushes thestaple extruding member25 in the distal direction, which extrudes the staple21 from thestaple containing hole20.
• Then, the distal end portion of the staple21 pierces through the intestine wall of two layers and press contacts with therecess portion17 of the anvilmain body42. Thereby, the foot of the staple is underfolded to an inner side along the shape of therecess portion17 to staple the large intestine wall. Further, thecutter member26 projects from the staplingportion4 responsive to the movingmember23 to cut the large intestine wall to form the anastomosed openingportion49. At this point, the blade tip is received in the cutter member receiving slit18. The tissue cut off by thecutter member26 is captured in thetissue receiving portion19.
• At a stage of finishing to staple and cut off the large intestine wall in this way, theanvil grasping piece11 is temporarily moved forward to form a gap between theanvil12 and the staplingportion4, then thelarge intestine46 stapled by thestaple21 is released, thereafter, the inserting portion is drawn out (refer toFIG. 8).
• Thus, thelarge intestine46 substantially formed in the loop shape has, the side faces of the enteron anastomosed, incorporating themorbid portion73 in the loop portion. The operator cuts off and staples each root portion of the loop by atissue staple remover43 inserted into the enteron transabdominally (refer toFIG. 9).
• Although an explanation has been given of a procedure of cutting off a large intestine portion, the operation is not limited thereto but can similarly be carried out to staple other tissue types. That is, the operator inserts theanvil12 constituting the staple receiving member provided with thelight emitting member34 constituting a position information transmitting member into the first tissue and inserts the insertingportion3 into the second tissue. According to the described embodiment, the insertingportion3 includes the staplingportion4, integrated with theanvil12, provided with the plurality of staple injecting portions substantially in the ring-like shape and theendoscope7 with theanvil grasping piece11 is inserted into the insertingportion3.
• Next, the operator determines the position of theanvil12, by detecting the position information from thelight emitting member34 of theanvil12, using at least one of, for example, theendoscope7 inserted into the insertingportion3 or theanvil grasping piece11 mounted to theendoscope7, or the rigid scope47 inserted transabdominally. Further, theanvil12 is grasped by theanvil grasping piece11 via the first and the second tissue, being guided by theanvil grasping piece11 or the grasping piece inserted transabdominally, for example, by the graspingforceps48 serving as a guiding member. Thereafter, the operator performs the stapling treatment by the staplingportion4 of the insertingportion3 and theanvil12.
• Further, although in the above-described stapling treatment procedure, an explanation has been given of a case in which the transabdominally inserted rigid scope47 and the graspingforceps48 are used as the position information detecting member for detecting the position information from theanvil12 and as the guiding member for guiding theanvil12 based on the detected position information, the procedure is not limited thereto. For example, the guiding members may be constituted by using theendoscope7 mounted to the insertingportion3 and theanvil grasping piece11.
• As described above, the tissue stapler is constituted such that theanvil12 is arranged with thelight emitting member34 and theanvil12 is grasped to be attached to the staplingportion4 by theanvil grasping piece11 of theendoscope7 inserted through the insertingportion3 by specifying the position of theanvil12 based on the position information from thelight emitting member34.
• Thus, high accuracy guiding can be obtained by detecting the position information of theanvil12 by the rigid scope47 inserted transabdominally and using the graspingforceps48, similarly inserted, and the anvil can firmly be grasped to be fixed swiftly and easily.
• For example, under the assistance of the graspingforceps48, by having theanvil12 located in the tissue such as a large intestine lumen approach to the staplingportion4 of the insertingportion3, the operator can identify theanvil12 transabdominally with the endoscope and easily execute an anastomosis operation.
• Further, the lumen of the large intestine or the like can be cut off and anastomosed without cutting the enteron wall and highly reliable and highly accurate cutting and anastomosing treatment can be carried out.
• Further, the structure of an anvil grasping portion of theanvil grasping piece11 mounted to theendoscope7 is not limited to a constitution described above. Rather, the structure is similarly effective even when constituted as shown byFIGS. 10, 11,12,13 and14. InFIG. 10 throughFIG. 14, the same portions as those ofFIG. 1 throughFIG. 9 are annotated with the same reference characters and the explanation thereof is omitted.
• According to the structure of the anvil grasping portion ofFIG. 10, ananvil grasping portion50 comprises anoperating wire51 connected to the proximalside control section10 and inserted into a distal end portion of asheath52, and a pair of graspingarms54 are arranged openably and closably at a distal end portion of theoperating wire51. The pair of graspingarms54 are arranged expandably in a state of being projected from the distal end portion of thesheath52, and distal end sides thereof are provided with graspinggrooves53 having an opening diameter portion capable of being fitted to thefitting groove33 of theshaft30 of theanvil12 andhollow portions55 for accommodating the distal end graspedportion32 of theanvil12.
• Further, according to the structure of the anvil grasping portion ofFIG. 11 andFIG. 12, a distal end side of ashaft member57 of ananvil56 is provided with afitting groove58 and a distal graspingportion59 in this order, and a distal end side of the distalend grasping portion59 is provided with amagnet member60 serving also as a position information transmitting member. Further, a distal end portion of ananvil grasping portion61 used in combination with theanvil56 is provided with arecess portion62 in correspondence with thefitting groove58 of theshaft member57. Further, amagnet member63 also serving as a position information transmitting member in cooperation with themagnet member60 is accommodated in therecess portion62 in an axially movable direction. Themagnet member63 is connected with anoperating wire64 that can be moved forwardly and backwardly with the operation of the proximalside control section10.
• In the above-described constitution, theanvil56 is inserted into the lumen of, for example, the small intestine or the like, theanvil grasping piece61 is placed proximate to theanvil56, theoperating wire64 is extruded by operating the proximalside control section10, and themagnet member63 is projected from theanvil grasping portion61. Then, themagnet member63 and themagnet member60 of theanvil56 attract each other magnetically, to become positioned proximate to each other. At this point, by drawing theoperating wire64 by operating the proximalside control section10 again, theshaft member57 is drawn into an inner portion of theanvil grasping portion61, and the projectedportion62 is fitted to thefitting groove58 to become fixedly grasped thereby (refer toFIG. 12). The magnetic force between themagnet member60 and themagnet member63 increases the grasping strength and fixing of the anvil.
• According to a structure of an anvil grasping portion ofFIG. 13 andFIG. 14, theanvil grasping portion65 comprises anoperating wire68 connected to the proximalside operating portion10, inserted into an operatingtube67. The operatingtube67 is movably inserted into an insertingsheath66, to move axially therein. Further, a distal end of the operatingtube67 is provided with a pair of graspingarms71 that are capable of being opened and closed, when the arms project from the insertingsheath66. Distal ends of the graspingarms71 are provided with graspinggrooves69 having a diameter of an opening fitted to thefitting groove58 of the shaft member57 (refer toFIG. 11), andhollow portions70 for accommodating the distalend grasping portion59.
• Further, amagnet72 is provided at a distal end of theoperating wire68, in correspondence with themagnet60 of theshaft member57 of theanvil56, in a manner that enables it to be extracted and retracted from and to the distal end of the insertingsheath66 by being moved in the axial direction inside of the insertingsheath66 along with the operatingtube67.
• In the above-described embodiment, the operator first places theanvil holding portion65 proximate to theanvil56 inserted into the lumen, for example, the small intestine or the like extruding the operatingtube67 and theoperating wire68 by operating the proximalside control section10. Then, themagnet60 of theanvil56 and themagnet72 of the operating wire attract and approach each other is magnetically.
• Theoperating wire68 is then drawn into the operatingtube67, and the operatingtube67 is drawn into the insertingsheath66. Then, the graspingarms71 are closed through the above drawing operations, and the graspinggrooves69 become fitted to thefitting groove58 of theshaft member57 of theanvil56 and theanvil56 is fixedly grasped by theanvil grasping portion65.
• Further, although the embodiment has been explained for the case where the position information transmitting member utilizes thelight emitting member34 and the magnetic force of themagnet members60,63, the utility of the position information transmitting member is not limited to this precise embodiment. For example, the position information transmitting member may be formed to transmit an electromagnetic wave such as visible light or the like as position information. The position information transmitting member and a position detecting member for detecting the position information may be a device that converts electric energy into visible light or the like, for example, a semiconductor LED or organic EL, a semiconductor laser, a device that emits light by a chemical reaction using luminol, or a fluorescent substance emitting fluorescence light induced by light emitted from the endoscope.
• Luminescence of green color or blue color is particularly effective, since the luminescence of these colors is easy to detect in the coelom.
• Further, the emitted light energy is not limited to visible light, but may be, for example, radio wave, X-ray, gamma ray or the like having extremely shorter wavelengths, or infrared radiation having a longer wavelength. Further, the transmitted energy may be radiated as wave energy or as supersonic, acoustic energy, or the like. Detecting the position information can be effected, other than through detection of light by CCD or the like provided at a distal end of the endoscope. Thus, the method of detecting radio wave by an antenna, detecting a magnetic field by a Hall element or the like, detecting radioactive ray by a scintillator, detecting supersonic wave by a transducer or the like can be utilized.
• Although the first embodiment has been explained for the case in which theanvil grasping piece11 as a treatment tool is inserted into the insertingportion3 via theendoscope7, the first embodiment is not limited thereto. For example, theanvil grasping piece11 can be directly inserted into the endoscope insertingtube path6 of the insertingportion3.
• FIG. 15 andFIG. 16 show a main portion of a tissue stapler according to a second embodiment of the invention.FIG. 15 shows a grasping state andFIG. 16 shows a stapling state.FIG. 15 andFIG. 16 also show previously described portions identified by the same reference numerals.
• That is, a staplingportion76 is provided at the distal end portion of the insertingportion3 and is inserted with astaple container77 substantially in a ring-like shape. A distal end face of thestaple container77 is provided with a plurality ofstaple containing holes78 arranged in double rows in a ring-like shape. Thestaple containing holes78 are provided such that positions of the holes are alternate to each other on an outer side and an inner side. A proximal side end of thestaple container78 is provided with a staple slide slit79 in a ring-like shape in the form of following thestaple containing holes78 as shown byFIG. 17 andFIG. 18.
• Thestaple containing holes78 contain thestaples80 bend in a horseshoe-like shape. The proximal sides of thestaples80 are opposedly arranged withstaple extruding members84. Thestaple extruding member84 is provided with a projectedportion82 brought into contact with the staple80 and brought into contact with a projectedportion81 provided on a proximal side of thestaple containing hole78. Thestaple extruding member84 is also provided with a projectedportion83 projecting into the staple side slit79 on a proximal side of the projectedportion81. The projectedportion83 of thestaple extruding member84 is provided with an inclined face.
• Further, thestaple containing member77 is provided with a cuttermember inserting hole85 substantially in a ring-like shape on an inner peripheral side of thestaple containing hole78. Further, a proximal side of thestaple container77 is arranged with a rotatingmember86 substantially cylindrically shaped and having a plane at a distal end side thereof, the rotating member can rotate around the axis of the endoscope insertingtube path6. A distal end face of the rotatingmember86 is provided with astaple slider87 substantially in a plate-like shape. A distal end portion of thestaple slider87 is provided with an inclined face, and the inclined face is designed to contact with the inclined face of the projected portion83 (refer toFIG. 17). Further, an inner peripheral side of thestaple slider87 is provided with acutter member88 substantially in a shape of a thin plate. A blade tip of thecutter member88 is projected from thestaple containing member77 to a distal end side, being inserted through the cuttermember inserting hole85.
• A proximal side of the rotatingmember86 is substantially cylindrical in shape, and an inner wall side thereof is provided with a gear (not shown). Agear member89 is meshed with the gear (not shown). Adrive gear90 is brought in mesh with thegear member89. The drive gear is connected to themotor unit15 via acable91, and is driven to rotate by the driving force transmitted via thecable91 from themotor unit15.
• A distal end side of thestaple container77 is covered with acover member92. Thecover member92 is provided with a plurality ofstaple inserting holes93 in double rows substantially in a ring-like shape at positions opposed to the staple containing holes78. An inner peripheral portion of thestaple inserting holes93 is provided with acenter hole94, corresponding to thecutter inserting hole85. Further, in an interval between thecover member92 and thestaple container77, aspring member95 is engagingly provided to push thecover member92 to the distal direction relative to thestaple container77. Thecover member92 is not detached from thestaple container77 because a projection provided on an inner wall of the proximal side of thecover member92 abuts a projected member96 of thestaple container77.
• Further, ananvil98 projects with ashaft member100 substantially at a central portion thereof, which shaft member is to be fixedly grasped by ananvil grasping piece99 inserted through the endoscope insertingtube path6. Further, a surrounding portion of theshaft member100 is provided with a plurality ofrecess portions101 in double rows substantially in a ring-like shape at positions opposed to thestaple containing holes78 and the staple inserting holes93. Further, acutter receiving slit102 is provided at a position opposed to thecutter inserting hole85.
• Further, although not illustrated inFIG. 15 andFIG. 16, theanvil98 is provided with, for example, thelight emitting member34 as the position information transmitting member, similar to theshaft member100, position information being emitted via thelight emitting member34.
• In the above-described embodiment, when a lumen wall such as thestomach wall103 and thesmall intestine wall104 are to be stapled, the operator first positions thestomach wall103 and thesmall intestine wall104 between the staplingportion76 and theanvil98. This is done by grasping theshaft member100 of theanvil98 by operating theanvil grasping piece99 integrated to theendoscope7 inserted through the insertingportion3 based on position information from theanvil98. In this state, when the operator drags theanvil grasping piece99 into the endoscope insertingtube path6, thecover member92 is pressed to the proximal side against the biasing force of thespring member95. Thereby, the blade tip of thecutter member88 projects from a distal end face of thecover member92 through the cuttermember inserting hole85 and thecenter hole94 and is received in thecutter receiving slit102 while piercing through thestomach wall103 and thesmall intestine wall104. In this way, the staplingportion76, thestomach wall103, thesmall intestine wall104 and theanvil98 come into close contact with each other (refer toFIG. 16,FIG. 18).
• At this stage, the operator drives themotor unit15 of the insertingportion3, whereby the drive force of themotor unit15 rotates thecable91, to rotatemember86 via thedrive gear90 and thegear89. The rotatingmember86 moves thestaple slider87 in sliding contact with the inclined face of the projectedportion83 in the staple slide slit79 and causes thestaple extruding member84 and the staple80 to extrude to the distal end side. Then, the foot portion of the staple80 pierces thestomach wall103 and thesmall intestine wall104 by being inserted through thestaple inserting hole93, and contacts therecess portion101 of theanvil98 disposed at a position opposed thereto. The foot portion is bend to an inner side along therecess portion101 to staple thestomach wall103 and thesmall intestine wall104 together.
• At the same time, thestaple slider87 rotates thecutter member88 along thecutter inserting hole85 in accordance with rotation of the rotatingmember86 to cut off thestomach wall103 and thesmall intestine wall104 with the blade tip portion piercing through thestomach wall103 and thesmall intestine wall104.
• According to the second embodiment, by enabling cutting the tissue in the ring-like shape by using thecutter member88 substantially in a plate-like shape, the force exerted on constituent parts of thestaple extruding member84, thecutter member88 and the like and the tissue can be reduced. Therefore, injury to tissue such as debridement or the like can be prevented. Further, slender diameter formation of the drivingcable91 and simplification of the constitution can be achieved with a reduction in the drive force.
• FIG. 19 shows a main portion of a tissue stapler according to a third embodiment of the invention, portions previously described bearing the same reference notations and providing equivalent function.
• Thus, ananvil150 has an anvildistal end portion151 with a spherical face at one end face of an anvil main body152 (refer toFIG. 19 andFIG. 20), a proximal side of the anvilmain body152 constituting the other face which projects to face ashaft member158 having a distal end graspedportion159 substantially at a center portion thereof. Further, a surrounding portion of the anvilmain body152 is provided with anvil armaccommodating portions153 in a recess shape at a plurality of portions thereof, for example, at four portions thereof substantially in a cross-like shape. The anvil armaccommodating portions153 are provided withanvil arms155 constituting staple receivers able to be folded and expanded via pivotingshafts154 thereof.
• Theanvil arms155 are respectively attachedly engaged withwound spring members157 between the pivotingshafts154 and projectedportions156 to exert biasing forces in the expanding directions, and when theanvil arms155 expand around the pivoting shafts by the biasing forces of thewound spring members157, theanvil arms155 project from the anvilmain body152 in the peripheral directions. Further, theanvil arms155 can be rotated reversely against biasing forces of thewound spring members157 to be folded and accommodated in the anvil armaccommodating portions153. Thereby, the outer shape of theanvil150 becomes substantially similar to an outer shape dimension of the anvilmain body152 to be brought into a so-called small diameter formation.
• Theanvil arms155 are respectively provided with lockingportions163 in a recess shape on proximal sides thereof, and projectedportions164 formed radially at one end of anoperating wire165 are selectively locked by therespective locking portions163. A middle portion of theoperating wire165 is loosely inserted into a wire insertingtube path161 provided at theshaft member158 movably in the axial direction. A base end portion of theoperating wire165 is provided with an operatingportion162 and the operatingportion162 is projected to aslit160 provided at ashaft member158 to be able to be operated to move axially. Theoperating wire165 is subjected to a biasing force in a direction of the anvil main body via a spring member166. When the operatingportion162 is grasped by ananvil grasping piece170, the operatingportion162 is moved in the direction of the proximal side against a biasing force of the spring member166 and the plurality of projectedportions164 are respectively detached from the lockingportions163 of theanvil arms155.
• Further, although not illustrated in the drawing, theanvil150 is provided with, for example, the aforementionedlight emitting member34 as the position information transmitting means similar to the first embodiment, in correspondence with, for example, theshaft member158 so that position information is transmitted via thelight emitting member34.
• A distal end side of an insertingportion169 constituting the tissue stapler is provided with a staplingportion172. The staplingportion172 is provided with, for example,wide portions172aat four portions thereof substantially in a cross-like shape in correspondence with theanvil arms155 of theanvil150. Thewide portion172ahas a shape corresponding to the state of the expanding theanvil arm155, and is provided with, for example, thestaple containing hole20 and the cuttermember inserting hole22 similar to the first embodiment. Further, the staplingportion172 is provided with an endoscope insertingtube path178 similarly inserted with theendoscope7 inserted with theanvil grasping piece170.
• In the above-described embodiment, the operator inserts theanvil150, for example, orally into thesmall intestine168 with theanvil arms155 folded around the pivoting shafts to be contained in the anvil armaccommodating portions153. On the other hand, the operator inserts the insertingportion169 into thestomach167 constituting the other lumen, for example, orally, by cutting a portion of thestomach167 to approach the coelom from anopening portion171 thereof (refer toFIG. 21). At this point, the operator confirms the position of theanvil150 based on the position information from theanvil150 in thesmall intestine168, and cuts a corresponding portion of thesmall intestine168. The operator grasps theanvil shaft member158 by theanvil grasping piece170 along with the distalend grasping portion159 and an operatingportion162 of the operating wire165 (refer toFIG. 22).
• Next, the operator draws theanvil grasping piece170 into the inserting portion. Then, the operatingportion162 of theoperating wire165 is moved to the proximal side by theanvil grasping piece170 against the biasing force of the spring member166 and the projectedportions164 are detached from the lockingportions163 of theanvil arms155. Thereby, theanvil arms155 pivot and expand outwardly around the pivoting shafts due to the biasing forces of thewound spring members157, becoming detached from the anvil armaccommodating portions153. At the same time, when theanvil grasping piece170 is drawn into the insertingportion169, theanvil arms155 of theanvil150 contact thewide portions172aof the staplingportion172, the stomach wall and the small intestine wall being interposed therebetween.
• The operator then presses a staple (not illustrated inFIG. 23) from a staple inserting hole172cof the staplingportion172 by operating the control section10 (refer toFIG. 1) of the insertingportion169. As a result, a distal end portion of the extrudedstaple21 is pressed into a recess portion (not shown) of theanvil arm155, piercing and stapling the stomach wall and the small intestine wall (refer toFIG. 23). Thereafter, acutter member172eis displayed from a cutter member inserting hole172dof the staplingportion172, and a stapled inner peripheral side thereof is cut in a ring-like shape and ananastomosed hole173 is formed as shown inFIG. 24.
• The third embodiment enables easy insertion of theanvil150 into the lumen and enables realizing a large diameter stapling, which enhances the handling operability.
• Further according to the third embodiment, positional relationship between the staplingportion172 and theanvil150 can be precisely set during stapling. Further, by enabling adjusting the positional relationship between the staplingportion172 and theanvil150 by twisting theendoscope7 and theanvil grasping piece170, the staplingportion172 and theanvil150 can be grasped more conveniently, easily and accurately.
• Further, the structure of the anvil is not limited as described above, at it can also take the form shown by Fi.25. InFIG. 25, portions previously described with reference toFIG. 19 throughFIG. 24 bear the same reference numerals and a detailed explanation thereof will be omitted.
• InFIG. 25, a root end of theshaft member158 of the anvilmain body151 includes a projectingfitting portion158asubstantially hexagonally shaped. Further, the anvil structure includes a complementary recessfitting portion172balso hexagonally shaped and formed on a distal end side of the endoscope insertingtube path178 in the staplingportion172 of the insertingportion169. Theanvil150 is fixedly grasped to fit the recessfitting portion158aof the anvilmain body151 to the recessfitting portion172b. Thereby, the positional relationship between theanvil150 and the staplingportion172 is accurately set to fix and obtain further improved, excellent effects.
• Next, a fourth embodiment of a tissue stapler is now described by reference toFIG. 26, which shows a tissue stapler which includes an insertingportion112 to be inserted into substantially flexible tissue, a staplingportion111 provided on a distal end side of the inserting portion, an operatingportion113 provided on a proximal side of the inserting portion, and ananvil portion114 arranged on a distal end of the staplingportion111.
• An operating shaft115 extends on a proximal side of theanvil portion114. The operating shaft115 is arranged to move forward and rearward in an operating shaft insertingtube path116 to communicate the staplingportion111, the insertingportion112, and the operatingportion113 from a distal end to a proximal side thereof. The proximal side projects from the operatingportion13, and a graspingportion119 is provided at an end portion on the proximal side.
• Further, theanvil portion114 is provided with an endoscope insertingtube path121 opened to a distal end side thereof, and communicating to the proximal side and to the operating shaft115. Anendoscope131 is operably insertable through the endoscope insertingtube path121. The endoscope insertingtube path121 is provided withairtight valves117,118 on the distal end side and the proximal side to provide a predetermined interval therebetween. Further, the operating shaft115 is provided with a plurality of suction holes120 at a side wall portion, between theanvil portion114 and the staplingportion111, in a manner extending to a distal end side and an end portion on the proximal side, with asuction mouthpiece122 communicating with theendoscope inserting tube121. Thesuction mouthpiece122 is connected with a suction source (not shown) to provide suction inside the operating shaft via the suction source.
• The staplingportion111 is substantially cylindrical at a distal end side thereof and includes the operating shaft insertingtube path116 on a proximal side thereof. Further, the operating shaft insertingtube path116 is inserted with the operating shaft115.
• Further, the staplingportion111 includes astaple container123 with a tube member extending to theproximal operating portion113. A distal end of thestaple container123 is provided with a plurality ofstaple containing holes124 in double rows substantially in a ring-like shape to penetrate thestaple container123.Staples125 are respectively contained in the staple containing holes124.
• A proximal side of thestaple container123 has a cylindrical, movingmember126 that is movable forward and rearward, axially within the operating shaft insertingtube path116. A distal face of the movingmember126 is arranged withstaple extruding members127, each substantially in a shape of a thin plate, at positions opposed to the staple containing holes124. Further, at a wall face of a proximal side of the movingmember126, an extrudingmember129, communicating from a distal end to a proximal side of the insertingportion112, extends to the proximalside operating portion113. The extrudingmember129 is arranged movably in an insertingtube path128, outwardly mounted to the operating shaft115.
• Further, an end face on a proximal side of theanvil portion114 hasrecess portions130 at positions opposed to the staple containing holes124.
• The operatingportion113 projects to provide agrip member132 for grasping, a portion of a root of thegrip member132 being provided with ahandle member134 able to be operated to pivot centering on ashaft133. Thehandle member134 is coupled with anoperating ring144 via alink135. Theoperating ring144 is arranged to move forward and rearward coaxially within the operating shaft insertingtube path116 and is attached to the extrudingmember129.
• Further, inside the operatingportion113 there is a projectingportion137 of a rod-like shape, projecting from the proximal side to an inner side. The projectingportion137 is opposed to an elastically deformablecantilever spring member136 provided at a side portion of the operating shaft115 and is selectively elastically lockable by thecantilever spring member136. Further, aspring member138 is engagingly attached between the projectedportion137 of the operating shaft115 and thestaple container123.
• Further, the operatingportion113 is provided with aswitch hole139 which is juxtaposed to thecantilever spring member136, and theswitch hole139 is provided with apressable switch140. Theswitch140 which is juxtaposed to thecantilever spring member136 of the operating shaft115, presses thecantilever spring member136 by pressing the switch40 and releases the operatingportion113 from being locked by the projectingportion137. Thereby, the operating shaft115 is biased to move to a proximal side by a biasing force of thespring member138.
• The above-described embodiment describes a tissue stapler suitable for the so-to-called regurgitant esophagitis used for forming a valve structure at, for example, a stomach-esophagus bonding portion143 which staples the tissue at the cardia.
• Thus, the operator inserts the staplingportion111 of the insertingportion112 including theanvil portion114 orally to the stomach-esophagus bonding portion143 under a field of view of theendoscope131 inserted into the operating shaft115. Next, the operator extrudes the operating shaft115 projecting from the operatingportion113 against thespring member138. Then, theanvil portion114 is projected from the staplingportion111 to the distal end side and forms a space as shown by a section ofFIG. 26 between theanvil portion114 and the distal end face of the staplingportion111. At this point, thecantilever spring member136 is brought into contact with the projectedportion137 of the operating shaft115 and presses theswitch140 outside of the operatingportion113 by a distal end portion thereof. At this point, the operator adjusts the space at a pertinent position of the stomach-esophagus bonding portion143 by adjusting the position of theanvil portion114 by reversely rotating theendoscope131 inserted into thestomach141.
• Subsequently, the operator actuates the suction source (not shown) connected to thesuction mouthpiece122 provided at the graspingportion119 of the operating shaft115, to provide suction inside of the operating shaft115, and theesophagus142 is drawn into the space between theanvil portion114 and the stapling portion111 (refer toFIG. 27). Theswitch140 of the operating portion is then pressed, and the operating shaft115 is moved and pressed back in the direction of the proximal side by the biasing force of thespring member138. Theesophagus142 is pinched between theanvil portion114 and the staplingportion111.
• Next, thehandle134 is gripped and theoperating ring144 is moved in the direction of the distal end side. The extrudingmember129, the movingmember126 and thestaple extruding member127 then move in the direction of the distal end side. At this stage, thestaple extruding member127 projects the staple125 from thestaple containing hole127, whereby the distal end portion of the staple125 pierces through theesophagus142, and contacts therecess portion130 of theanvil portion114. The distal end is folded to bend to the inner side to staple the esophagus over an entire periphery thereof (refer toFIG. 28).
• The fourth embodiment enables stapling the esophagus-stomach bonding portion over the entire periphery, orally and in one motion. A desired valve can thereby be easily formed at the stomach-esophagus bonding portion and, therefore, a highly effective treatment against regurgitant esophagitis is obtained. Further, by executing stapling with position confirmation using the field of view of the endoscope, convenient, easy and positive treatment can be realized.
• FIG. 29 shows a tissue stapler according to a fifth embodiment, in which ananvil member176 provided at a distal end side projects within an operatingshaft member177 on a proximal side thereof. Theanvil member176 and the operatingshaft member177 are formed with an endoscope insertingtube path178 from a distal end side to reach a proximal side. A staplermain body179 is outwardly mounted to the operatingshaft177 to move axially forward and rearward, and astaple pressing member180 is inserted to an outer peripheral portion of the staplermain body179 to move forward and rearward. The endoscope insertingtube path178 is inserted with anendoscope181 and a proximal side thereof is provided with a proximal side operating portion, not illustrated.
• An outer peripheral wall of theanvil member176 is provided with a plurality ofslit portions182 in a long axis direction (distal and rear direction) with predetermined intervals therebetween (refer toFIG. 30). Further, a distal end side of the staplermain body179 is provided with a plurality of locking staple containing slitportions183 opposed to theslit portions182 at predetermined intervals therebetween. The locking staple containing slitportions183 are fixed to contain end portions of proximal sides of lockingstaple members184 at fixingpositions185 at distal end portions on the proximal sides.
• The lockingstaple members184, on the proximal distal ends thereof are formed with an angle of inclination to open to an outer side directions of the staplermain body179. The staple distal end portions thereof are arranged to be opened to the outer sides of a distal end portion of the staplermain body179 and a peripheral wall of the staplermain body179. Further, a distal end side of thestaple pressing member180 is provided with a plurality of restrainingprojections186 contained in theslit portions182 and the locking staple containingslit portion183 are able to move forward and rearward and are placed at predetermined intervals.
• Further, a distal end portion of the staplermain body179 is provided with a plurality ofstaple containing holes187 between the lockingstaple containing slits183 in correspondence with recess portions designed to bend staples, not illustrated, formed at a side face of theanvil member176 on the proximal side.
• In the above-described embodiment, the operator first brings theanvil member176 substantially into contact with the staplermain body179 by acting to draw the operatingshaft member177 and moves thestaple pressing member180 in the direction of the distal end side. Then, the restrainingprojections186 of thestaple pressing member180 press the lockingstaple members184 to be contained in theslit portions182 of theanvil member176.
• In this state, theendoscope181 is inserted through the endoscope insertingtube path178, the whole device being orally inserted to the esophagus-stomach stapling portion189 along theendoscope181. Successively, the operator forms a space between theanvil member176 and the distal end portion of the staplermain body179 as shown by a section inFIG. 29 by projecting the operatingshaft member177 while viewing theendoscope181 in the stomach. At this stage, when the operator draws back thestaple pressing member180 to the proximal side, the lockingstaple members184 are projected to the outer peripheral side of thestaple pressing member180.
• In this state, as the whole device is pressed to move forward orally, the lockingstaple members184 pierce the muscle layer of the esophagus188 (refer toFIG. 31), and subsequently, thestaple pressing member180 is pressed forward to the staplermain body179. Then, by bringing the restrainingprojection186 of thestaple pressing member180 into contact with the lockingstaple members184 to move to the distal end side, the lockingstaple members184 are contained in the locking staple containing slitportions183 again. Thereby, theesophagus188 is drawn into the space formed between theanvil member176 and the distal end of the staplermain body179. By drawing the operatingshaft member177 in this state, theesophagus188 is pinched between theanvil member176 and the distal end of the staplermain body179 and by the subsequent operation of a control section, not illustrated, the esophagus tissue is stapled substantially over an entire periphery thereof by staples (not shown) arranged in the staplermain body179.
• According to the fifth embodiment, the esophagus tissue is mechanically drawn by the lockingstaple member184 in a manner that enables forming the valve structure at the esophagus-stomach bonding portion by stapling the esophagus tissue over an entire periphery through all the layers including the muscle layer. Thus, a sturdier and longer lasting valve can be provided.
• The above-described embodiments describe the case where the tissue is stapled over the entire periphery. The embodiments are, however, not so limited. For example, the position to be stapled can also be the portion of the esophagus-stomach bonding portion, such as a third periphery of or a half periphery thereof. Thereby, for a patient with a comparatively insignificant condition, the valve structure can be formed over less than the entire periphery. This is done by reducing a number and the outer diameter of the locking staple members used for drawing down the stapled portion, the anvil and the esophagus tissue by correspondingly limiting the stapled portion. Thus, an outer diameter of the inserting portion of the tissue stapler can be reduced and the burden on the patient whose tissue is being stapled can be alleviated.
• While there has been shown and described what are considered to be preferred embodiments of the invention, it will, of course, be understood that various modifications and changes in form or detail could readily be made without departing from the spirit of the invention. It is therefore intended that the invention be not limited to the exact forms described and illustrated, but should be constructed to cover all modifications that may fall within the scope of the appended claims.

Claims (15)

1. A tissue stapler comprising:

an inserting portion provided with an endoscope inserting tube path;

a stapling portion provided with a staple injecting portion arranged at a distal end of the inserting portion;

a staple receiving member arranged separately from the inserting portion and structured for being grasped by and fixed to a treatment tool introduced through the inserting portion in a state of being opposed to the stapling portion via a body tissue, the staple receiving member being formed to bend a distal end portion of a stapling staple member pressed out from the staple injecting portion of the stapling portion and penetrating through the tissue; and

a position information transmitting member provided at the staple receiving member for transmitting position information.

2. The tissue stapler according toclaim 1, further comprising:

a position detecting member for detecting a position of the staple receiving member by receiving the position information from the position information transmitting member; and

a guiding member for guiding the staple receiving member based on detected information of the position detecting member.

3. The tissue stapler according toclaim 2, wherein the position detecting member is arranged to be detected by at least one of an endoscope introduced via the inserting portion and the treatment tool, and wherein the guiding member comprises the treatment tool introduced via the inserting portion or the endoscope.

4. The tissue stapler according toclaim 2, wherein at least one of the position detecting member and the guiding member includes an endoscope and the treatment tool introduced transabdominally.

5. The tissue stapler according toclaim 1, wherein the staple receiving member is structured to be grasped by and fixed to the treatment portion using a magnetic force.

6. The tissue stapler according toclaim 1, wherein the stapling portion includes a cutting member for cutting an inner peripheral portion of the staple injecting portion.

7. The tissue stapler according toclaim 1, wherein the staple receiving member includes a main body thereof provided with a grasped portion having a diameter smaller than that of the stapling portion, a plurality of arm portions coupled with the main body and structured to be able to be folded in an inactivated state, and to expand when grasped at the grasped portion, to positions juxtaposed to the stapling portion.

8. The tissue stapler according toclaim 1, wherein the stapling portion is provided with a plurality of the staple injecting portions arranged in a substantially ring shape.

9. A staple receiving member of a tissue stapler comprising:

a position information transmitting member for outputting electromagnetic waves for informing its position to another device.

10. The staple receiving member according to a tissue stapler according toclaim 9, wherein the position information transmitting member outputs light as the electromagnetic waves.

11. The staple receiving member of a tissue stapler according toclaim 9, further comprising:

a shaft member structured to be grasped by a treatment tool and including the position information transmitting member thereat.

12. The tissue stapler according toclaim 1, wherein the stapling portion comprises a grasping piece made of first and second pivotably arranged arms which are openable and closeable to grasp the staple receiving member.

13. The tissue stapler according toclaim 1, further comprising a rotating member for rotating a portion of the stapling portion relative to the staple receiving member.

14. The tissue stapler according toclaim 1, further comprising a suction arrangement for creating suction in an area between the stapling portion and the staple receiving member to draw the body tissue therebetween for being thereafter clamped and stapled.

15. The tissue stapler according toclaim 1, wherein the stapling portion comprises staples that are peripherally and spacedly arranged relative to one another and the staple members being oriented at an angle relative to the axial direction of the stapling portion.

Images