US20080243148A1

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Publication number: US20080243148A1
Application number: US12/057,604
Authority: US
Inventors: Takayasu Mikkaichi; Takayuki Suzuki; Kunihide Kaji; Junji Shiono; Kensuke Hayashi; Masatoshi Sato; Masayuki Iwasaka
Original assignee: Olympus Medical Systems Corp
Current assignee: Olympus Medical Systems Corp
Priority date: 2005-09-28
Filing date: 2008-03-28
Publication date: 2008-10-02
Also published as: JP4885868B2; WO2007037326A1; EP1938760A4; JPWO2007037326A1; EP1938760B1; EP1938760A1; US7875041B2; EP1938761B1; US7722631B2; US20070073321A1; US20070073320A1; US20070073322A1; US8758375B2; EP1938761A4; WO2007037335A1; EP1938761A1; US20090125039A1

Abstract

A suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, consisting of: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of the anchors inside, and is provided with a side hole through which the anchors are capable of passing; a pusher whose remote end abuts the anchor that is housed in the needle and is disposed in a manner to be capable of moving in the axial direction of the elongated member; and a push-out control portion that is provided in the needle or the pusher and changes the movement direction of the anchor that has been moved to a formation position of the side hole by the pusher from the length-wise direction of the needle to a direction heading toward the side hole.

Description

This application is a continuation application based on a PCT Patent Application No. PCT/JP2006/319299, filed on Sep. 28, 2006, whose priority is claimed on U.S. patent application Ser. No. 11/238,016 and 11/238,017 filed on Sep. 28, 2005. The contents of both the PCT Application and the U.S. Application are incorporated herein by reference.

TECHNICAL FIELD

The present invention relates to a suture instrument that uses an endoscope, for example, relating to a suture instrument that sutures a perforation that is formed in the wall of a hollow organ.

BACKGROUND ART

In the case of performing treatment in a body of a patient, the treatment can be performed by incising the body of the patient by surgical operation, or by oral endoscopic treatment or transanal endoscopic treatment. A method for suturing a perforation formed in an abdominal area by surgical operation is disclosed in FIGS. 6a to 6c ofPatent Document 1. According to this suturing method, a needle is thrust into the tissue around the perforation, and an anchor equipped with a suture thread is then extruded from the needle. After the needle is drawn out from the tissue, two suture threads across the perforation are knotted together to close the perforation.

The treatment using an endoscope is carried out by passing a forceps, high-frequency treatment instrument, incision instrument, suture tool or the like through a channel of the endoscope. When the medical treatment is carried out by using an endoscope inserted into a hollow organ through a natural opening of a living body such as the mouth, anus, or the like, for example, a hole is formed by removing the tissue from the abdominal cavity or incising the tissue in the abdominal cavity, and the medical treatment is then carried out by approaching the abdominal cavity through this hole from the inside of the hollow organ. After performing the medical treatment, the formed hole is sutured by a suture tool.

A method for suturing in a hollow organ is disclosed in FIGS. 6 to 9 ofPatent Document 2, for example. According to this suturing method, the tissue is drawn into an overtube, and a needle is then thrust through this tissue from the proximal side to the distal end side thereof. From the inside of the needle, an anchor equipped with a suture thread is pushed out to the distal end side of the tissue. After that, when the needle is pulled out, the suture thread penetrates through the tissue, and so the tissue is tightened up by this suture thread. There is also a method disclosed in FIG. 1, FIG. 4, FIGS. 5A to 5C ofPatent Document 3. According to this method, a flexible endoscope is inserted into the vicinity of a perforation via the mouth or the anus. The tissue around the perforation is aspirated by a tube of the flexible endoscope. When an O-ring provided at the outside of the tube is pushed out from the distal end of the tube, the aspirated tissue is clamped by the O-ring.

Here, it is preferable to be able to control the deployment of each anchor. For example, in a hard endoscope treatment tool, it is known to provide in the control portion on the hand side a plurality of notches that restrict the stroke of a pusher that pushes out anchors to a fixed amount. (For example, refer to Patent Document 4.)

Patent Document 1: U.S. Pat. No. 6,066,146

Patent Document 2: Japanese Unexamined Patent Application, First Publication No. 2004-601

Patent Document 3: U.S. Pat. No. 5,297,536

Patent Document 4: U.S. Pat. No. 5,507,754

DISCLOSURE OF THE INVENTIONProblem to be Solved by the InventionDisclosure of the Invention

The invention according to a first aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of the anchors inside, and is provided with a side hole through which the anchors are capable of passing; a pusher whose remote end abuts the anchor that is housed in the needle and is disposed in a manner to be capable of moving in the axial direction of the elongated member; and a push-out control portion that is provided in the needle or the pusher and changes the movement direction of the anchor that has been moved to a formation position of the side hole by the pusher from the length-wise direction of the needle to a direction heading toward the side hole.

The invention according to a second aspect of the present invention is the suture instrument according to the first aspect, wherein the push-out control portion is a plate spring that is provided in the needle and projects toward the side hole.

The invention according to a third aspect of the present invention is the suture instrument according to a first aspect, wherein the push-out control portion is a erecting hook that is attached to the needle in a manner to freely rotate and is capable of rising toward the side hole.

The invention according to a fourth aspect of the present invention is the suture instrument according to a first aspect, wherein the push-out control portion is a slanted face that is obliquely provided at the distal end of the pusher in a manner facing the side hole and abuts the base end portion of the anchor that is housed at the base end side among the two anchors, and at the distal end portion of the anchor that is housed at the base end side is formed a face that slants toward the side hole and abuts the base end portion of the anchor that is housed at the distal end side.

The invention according to a fifth aspect of the present invention is the suture instrument according to the first aspect, wherein the needle additionally has an opening portion at the sharp end portion, the push-out control portion consists of a projection that protrudes so as to press the distal end side first anchor toward the side hole, the distal end side first anchor has an outer shape to be pushed out from the side hole by being guided by the projection, and the base-end side second anchor has an outer shape that enables it to be pushed out from the opening portion without interference from the projection.

The invention according to a sixth aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, and is capable of housing a plurality of the anchors inside; and a side hole that is provided in the side portion of the needle along the lengthwise direction of the needle; wherein by compressing the anchors in a direction that intersects at right angles the lengthwise direction thereof, the anchors are housed in the needle in the state of the dimension in this direction decreasing and the dimension in the lengthwise direction being extended.

The invention according toclaim7 of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, and is capable of housing a plurality of the anchors inside; and a side hole that is provided in the side portion of the needle along the lengthwise direction of the needle and has an opening length that is shorter than the extended length of one anchor.

The invention according to an eighth aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, and is capable of housing a first anchor and a second anchor inside; a first pusher that pushes out the first anchor that is housed at the distal end side from the needle; and a second pusher that is provided to freely move forward or backward with respect to the first pusher and pushes out the second anchor from the needle.

The invention according to a ninth aspect of the present invention is the suture instrument according to the eighth aspect, wherein a housing portion that disposes the second anchor is provided in the first pusher, and the second pusher is passed in a manner to freely move forward or backward in the first pusher.

The invention according to a tenth aspect of the present invention is the suture instrument according to the eighth aspect, wherein the first pusher is passed in the second pusher and, by passing through a through hole that is formed in the second anchor, pushes out the first anchor.

The invention according to an eleventh aspect of the present invention is the suture instrument according to the tenth aspect, wherein the second pusher is passed in the lengthwise direction of the needle in a manner to be capable of being pushed and pulled therethrough, and the base end portion of the first pusher is engaged with the second pusher in a manner to be capable of screwing thereon.

The invention according to a twelfth aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of anchors inside, and has provided at the sharp tip an opening portion that is capable of pushing out the anchors; a pusher that pushes out the anchors from the needle through the opening portion; and a side hole that is provided in an extended manner from the opening portion of the needle and through which a suture thread that is attached to each of the anchors is passed, being formed in a shape that enables the anchors to be pushed out from the opening portion of the needle one at a time.

The invention according to a thirteenth aspect of the present invention is the suture instrument according to the twelfth aspect, wherein a portion of the side hole that passes the suture thread extending from a first anchor that is housed at the distal end side has a crooked shape so as to shift in the circumferential direction of the needle with respect to a portion that passes the suture thread extending from a second anchor that is housed at the base-end side, and the pusher has a distal end portion that engages in the circumferential direction with the second anchor.

The invention according to a fourteenth aspect of the present invention is the suture instrument according to the twelfth aspects wherein a portion of the side hole that passes the suture thread extending from a first anchor that is housed at the distal end side has a curved shape so as to shift in the circumferential direction of the needle with respect to a portion that passes the suture thread extending from a second anchor that is housed at the base-end side.

The invention according to a fifteenth aspect of the present invention is the suture instrument according to the twelfth aspect, wherein a narrowed portion in which the opening width is partially narrowed is formed in the side hole.

The invention according to a sixteenth aspect of the present invention is the suture instrument according to any one of the twelfth aspect to the fifteenth aspect, wherein the anchors have a projection that is inserted into the side hole.

The invention according to a seventeenth aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of anchors inside, and has provided at the sharp tip an opening portion that is capable of pushing out the anchors; and a pusher that pushes out the anchors from the needle through the opening portion; wherein the needle is manufactured to have resilience with a projection that reduces the inner diameter being formed therein, and the first anchor that is disposed at the distal end side has an outer diameter that is capable of passing the projection while the second anchor that is disposed at the base-end side has an outer diameter that interferes with the projection.

The invention according to an eighteenth aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of anchors inside, and has provided at the sharp tip an opening portion that is capable of pushing out the anchors; a pusher that pushes out the anchors from the needle through the opening portion; a first connecting portion that connects a first anchor that is disposed at the distal end side and a second anchor that is disposed at the base-end side and is breakable; and a second connecting portion that connects the second anchor and the pusher and is breakable.

The invention according to a nineteenth aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of anchors inside, and has obliquely provided at the sharp tip an opening portion that is capable of pushing out the anchors; and a pusher that pushes out the anchors from the needle through the opening portion; wherein the needle is capable of housing two anchors arranged in the radial direction along the slanting direction of the sharp tip.

The invention according to a twentieth aspect of the present invention is the suture instrument according to the nineteenth aspect, wherein the distal end portion of the pusher is capable of pushing each of the two anchors, and the base-end side of the sharp tip that slants protrudes.

The invention according to a twenty-first aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of anchors inside, and has obliquely provided at the sharp tip an opening portion that is capable of pushing out the anchors; and a pusher that pushes out the anchors from the needle through the opening portion; wherein the distal end portion of the pusher has recessed portions that are capable of housing each of the two anchors in the lengthwise direction of the needle, with the distal end side recessed portion being formed facing the opening direction of the opening portion, and the base-end side recessed portion formed facing the opposite side of the distal end side recessed portion.

The invention according to a twenty-second aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to be engaged to tissue, including: an elongated member that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; a needle that is provided at the remote end of the elongated member, has at the distal end a sharp tip that is capable of puncturing tissue, is capable of housing a plurality of anchors inside, and has provided at the sharp tip an opening portion that is capable of pushing out the anchors; and a pusher that pushes out the anchors from the needle; wherein a push-out control portion that is capable of engaging and disengaging with at least one of the anchors to cause the anchors to be pushed out one at a time from the opening portion is provided in the needle or the pusher.

The invention according to a twenty-third aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein the push-out control portion consists of projections that are formed facing the inner side of the needle, and recessed portions that are capable of engaging and disengaging with the projections are provided on the anchors.

The invention according to a twenty-fourth aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein the push-out control portion is mounted on the needle and has a projection that passes through the needle to protrude toward the inner side thereof, and a recessed portions that is capable of engaging and disengaging with the projection is provided on the anchors.

The invention according to a twenty-fifth aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein the push-out control portion consists of an elongated spring that has a projection that is biased to be capable of engaging and disengaging with a recessed portion that is formed on the anchors.

The invention according to a twenty-sixth aspect of the present invention is the suture instrument according to any one of the twenty-third aspect to the twenty-fifth aspect, wherein two of the anchors are housed in the needle, and the recessed portion is formed in only one of the anchors.

The invention according to a twenty-seventh aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein the push-out control portion is a spring that expands diameter in the radial direction when compressed in the lengthwise direction of the needle to release the engagement with the anchor.

The invention according to a twenty-eighth aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein an intermediate member that freely engages and disengages with the second anchor is provided at the distal end portion of the pusher as a push-out control portion, and a side hole is provided that biases the intermediate member so that the second anchor engages with the intermediate member at the base end side of the needle and releases the bias of the intermediate member so that the engagement of the intermediate member and the second anchor is released at the distal end side of the needle.

The invention according to a twenty-ninth aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein an intermediate member that freely engages and disengages with the second anchor is provided at the distal end portion of the pusher as a push-out control portion, and either one of the second anchor and the intermediate member is manufactured from a permanent magnet and the other is manufactured from a magnetic body.

The invention according to a thirtieth aspect of the present invention is the suture instrument according to the twenty-second aspect, wherein a hook is provided at the distal end portion of the pusher as a push-out control portion, is inserted and engaged with a recessed portion of an anchor that is housed in the base-end side, and when pulled out from the recessed portion, expands to be capable of pressing the base-end portion of the anchor.

EFFECT OF THE INVENTIONBRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a drawing that shows the schematic configuration of an endoscope and a suture instrument.

FIG. 2 is a cross-sectional view of the suture instrument and the distal end portion of the endoscope.

FIG. 3 is a perspective view of the suture instrument and the distal end portion of the endoscope.

FIG. 4 is a drawing that shows the constitution of a suture tool.

FIG. 5 is a cross-sectional view along the line A-A inFIG. 2.

FIG. 6 is a drawing that shows the step of inserting the endoscope into the stomach of a patient and observing an intended incision line from within the stomach.

FIG. 7 is a drawing that shows the step of performing a treatment in an abdominal cavity through a perforation.

FIG. 8 is a drawing that shows the position of thrusting the needle.

FIG. 9 is a drawing that describes the operation of pushing out the first anchor.

FIG. 10 is a drawing that shows the first anchor being pushed out after the needle has penetrated.

FIG. 11 is a drawing that shows the mounting of the suture tool.

FIG. 12 is a drawing that shows forceps tightening the suture tool.

FIG. 13 is a drawing that shows the step of tightening the suture tool with the outer sheath of the forceps.

FIG. 14 is a drawing that shows the mounting of the suture tool.

FIG. 15 is a drawing that shows the tightened suture tool.

FIG. 16 is a drawing that shows the tightened suture tool.

FIG. 17 is a drawing that shows the step of thrusting the needle obliquely at the inner circumferential face of the perforation.

FIG. 18 is a drawing that shows the anchor being pushed out after the needle has penetrated.

FIG. 19 is a drawing that shows the mounting of the suture tool.

FIG. 20 is a drawing that shows the membrane on the inner portion side of the stomach being resected in the area of the perforation.

FIG. 21 is a drawing that shows the step of thrusting the needle into the face that is exposed by resecting the membrane.

FIG. 22 is a drawing that shows the mounting of the suture tool.

FIG. 23 is a drawing that shows the tightened suture tool.

FIG. 24 is a drawing that shows the step of resecting the membrane and thrusting the needle into the surface that is made to swell by a local injection in that area.

FIG. 25 is a drawing that shows the mounting of the suture tool.

FIG. 26 is a drawing that shows the tightened suture tool.

FIG. 27 is a drawing that shows the membrane of the stomach resected.

FIG. 28 is a perspective view of the suture instrument, grasping forceps and the distal end portion of the endoscope.

FIG. 29 is a drawing that shows the step of elevating the area where the membrane is resected with the grasping forceps.

FIG. 30 is a drawing that shows the step of inserting the needle into the elevated membrane.

FIG. 31 is a drawing that shows the tightened suture tool.

FIG. 32 is a drawing that shows varieties of embodiments of elevating the membrane and placing the anchors.

FIG. 33 is a drawing that shows varieties of embodiments of elevating the membrane and placing the anchors.

FIG. 34 is a drawing that shows varieties of embodiments of elevating the membrane and placing the anchors.

FIG. 35 is a cross-sectional view of the distal end portion of the suture instrument that houses curved anchors.

FIG. 36 is a drawing that describes the operation of pushing out the first anchor from the needle.

FIG. 37 is a cross-sectional view of the distal end portion of the suture instrument that has a plate spring in the needle.

FIG. 38 is a drawing that describes the operation of pushing out the first anchor from the needle.

FIG. 39 is a cross-sectional view of the distal end portion of the suture instrument that has an erecting hook in the needle.

FIG. 40 is a cross-sectional view of the distal end portion of the suture instrument that is provided with a needle in which the routes for pushing out two anchors differ.

FIG. 41 is a cross-sectional view along the line B-B inFIG. 40.

FIG. 42 is a drawing that describes the operation of pushing out the first anchor.

FIG. 43 is a drawing that describes the operation of pushing out the second anchor.

FIG. 44 is a cross-sectional view of the distal end portion of the suture instrument in the case of the anchors being permanent magnets.

FIG. 45 is a drawing that describes the operation of pushing out the first anchor.

FIG. 46 is a cross-sectional view of the distal end portion of the suture instrument that has pushers corresponding to two anchors of different diameters.

FIG. 47 is a drawing that describes the operation of pushing out the first anchor.

FIG. 48 is a drawing that describes the operation of pushing out the second anchor.

FIG. 49 is a perspective view of the distal end portion of the suture instrument that houses two anchors in parallel.

FIG. 50 is a perspective view of the distal end portion of another embodiment of the suture instrument that houses two anchors in parallel.

FIG. 51 is a cross-sectional view that shows the constitution of the suture instrument that is provided with a pusher that passes through the second anchor to be capable of pushing out the first anchor.

FIG. 52 is a drawing that describes the operation of pushing out the first anchor.

FIG. 53 is a drawing that describes the operation of pushing out the second anchor.

FIG. 54 is a cross-sectional view of the distal end portion of the suture instrument in which the two anchors are connected to the pusher.

FIG. 55 is a cross-sectional view along the line C-C inFIG. 54.

FIG. 56 is a drawing that describes the operation of pushing out the first anchor and causing it to separate from the second anchor.

FIG. 57 is a drawing that describes the operation of pushing out the second anchor and causing it to separate from the pusher.

FIG. 58 is a drawing that shows the distal end portion of the suture instrument that has a projection in the needle that narrows the passage of the anchor.

FIG. 59 is a cross-sectional view of the distal end portion of the suture instrument that has a projection in the needle that narrows the passage of the anchor.

FIG. 60 is a drawing that describes the operation of pushing out the first anchor.

FIG. 61 is a drawing that describes the operation of pushing out the second anchor.

FIG. 62 is a perspective view of the distal end portion of the suture instrument that has a crank-shaped side hole.

FIG. 63 is a drawing that describes the linking structure between the second anchor and the pusher.

FIG. 64 is a drawing that describes the operation of pushing out the first anchor.

FIG. 65 is a drawing that describes the operation of rotating to push out the second anchor.

FIG. 66 is a drawing that describes the operation of pushing out the second anchor.

FIG. 67 is a cross-sectional view of the distal end portion of the suture instrument that houses two anchors of differing lengths.

FIG. 68 is a drawing that describes the operation of pushing out the first anchor.

FIG. 69 is a drawing that describes the operation of pushing out the second anchor.

FIG. 70 is a drawing that shows a pusher that has two recessed portions that each houses an anchor in different directions

FIG. 71 is a drawing that describes the operation of pushing out the first anchor.

FIG. 72 is a drawing that describes the operation of pushing out the second anchor.

FIG. 73 is a perspective view of the distal end portion of the suture instrument that has projections in the needle that are capable of engaging with the anchors.

FIG. 74 is a cross-sectional view along the line C-C inFIG. 73.

FIG. 75 is a cross-sectional view of the distal end portion of the suture instrument shown inFIG. 73.

FIG. 76 is a drawing that describes the operation of pushing out the first anchor.

FIG. 77 is a drawing that describes the operation of pushing out the second anchor.

FIG. 78 is a drawing that describes the embodiment of mounting a ring instead of projections.

FIG. 79 is a cross-sectional view of when the ring is mounted.

FIG. 80 is a drawing that describes the embodiment of attaching a wire spring instead of projections.

FIG. 81 is a drawing that shows the distal end portion of the suture instrument that has a narrowed portion of the side hole of the needle.

FIG. 82 is a drawing that describes the operation of pushing out the first anchor.

FIG. 83 is a drawing that shows the distal end portion of the suture instrument in which the side hole is formed in a cam shape.

FIG. 84 is a cross-sectional view of the distal end portion of the suture instrument that has a spring that holds the anchor.

FIG. 85 is a drawing that describes the operation of pushing out the first anchor

FIG. 86 is a drawing in which the second anchor is engaged by the spring when the first anchor has been pushed out.

FIG. 87 is a perspective view of the distal end portion of the suture instrument that is provided with a housing portion that houses the second anchor.

FIG. 88 is a perspective view that shows the second anchor and the housing portion.

FIG. 89 is a cross-sectional view along the line E-E inFIG. 88.

FIG. 90 is a cross-sectional view along the line F-F inFIG. 88.

FIG. 91 is a view that shows in cross section a portion of the distal end portion of the suture instrument that provides in the pusher a hook that engages with the second anchor.

FIG. 92 is a view in which the hook is released from the second anchor by pulling the pusher from the state ofFIG. 91.

FIG. 93 is a schematic view that shows the step of observing the outer portion side of the stomach.

FIG. 94 is a schematic view that shows the step of thrusting the tissue with the needle of the suture instrument.

FIG. 95 is a schematic view that shows the step of pushing out the anchor from the needle to the inner portion side of the stomach.

FIG. 96 is a schematic view of both anchors being placed on the outer portion side of the stomach.

FIG. 97 is a schematic view that shows the step of tightening the perforation with the suture tool.

FIG. 98 is a drawing that shows the step of inserting an endoscope in the stomach of a patient and observing the intended incision line from within the stomach.

FIG. 99 is a drawing that shows the step of thrusting the needle at the suture position.

FIG. 100 is a drawing that shows the step of thrusting the needle and pushing out an anchor to the side of the abdominal cavity.

FIG. 101 is a drawing that shows two suture tools mounted.

FIG. 102 is a drawing that shows the embodiment of two suture instruments respectively being passed through two channels.

FIG. 103 is a drawing that shows the step of making an incision along the intended incision line.

FIG. 104 is a drawing that shows the step of inserting the endoscope insertion part from a perforation into an abdominal cavity and performing a procedure.

FIG. 105 is a drawing in which forceps are passed through the endoscope in order to tighten the suture tool.

FIG. 106 is a drawing in which the suture thread of the suture tool is gripped by the forceps.

FIG. 107 is a drawing in which the suture tool is tightened by the outer sheath of the forceps.

FIG. 108 is a drawing in which the perforation is sutured by tightening two suture tools.

FIG. 109 is a drawing for describing the order of tightening a plurality of suture tools.

FIG. 110 is a drawing that describes the step of closing the perforation around the endoscope.

FIG. 111 is a drawing that describes the step of closing the perforation around the endoscope.

FIG. 112 is a drawing that describes the step of closing the perforation around the overtube.

FIG. 113 is a drawing that describes the step of closing the perforation around the overtube.

FIG. 114 is a drawing for describing a method of suturing down the wall of a hollow organ to reduce the diameter thereof.

FIG. 115 is a drawing that describes by the cross section along G-G inFIG. 114 the process of the hollow organ diameter becoming smaller by suturing down the wall of a hollow organ.

BRIEF DESCRIPTION OF THE REFERENCE NUMERALS

- 11,101,101A,101B,101C,101D,131,131A,131B,141,151,161,171,181,201,211,231,241 suture instrument
- 13 inner sheath (elongated member)
- 14,115,132,140,145,152,162,172,182,203,212,232,242 needle
- 15,104,137,154,164,174,184,204,252 side hole
- 16 suture tool
- 20,134,135,142A,142B,144,145,148A,148B pusher
- 21 distal end portion (push-out control portion)
- 25 suture thread
- 27,103,120,133,156A,156B,165A,165B,175,185A,185B,206A,206B,216A,216B,237A,237B,244A,244B,244C anchor
- 116,153,163,173,183,203,213,234,243 opening portion
- 32A,33A,33B slanted face
- 106 plate spring (push-out control portion)
- 110 erecting hook (push-out control portion)
- 117 projection (push-out control portion)
- 141A,141B,146A,146B lumen
- 176 recessed portion
- 177 engagement portion
- 209A projection portion (push-out control portion)
- 210A engagement portion (push-out control portion)
- 215 narrowed portion (push-out control portion)
- 239 spring (push-out control portion)
- 245 housing portion (push-out control portion)
- 261 recessed portion
- 262 hook (push-out control portion)

BEST MODE FOR CARRYING OUT THE INVENTION

Next, each embodiment of the present invention shall be described with reference to the drawings. Note that in the descriptions of each embodiment, the same reference numbers shall be given to identical portions. Also, descriptions of overlapping portions shall be omitted.

First Embodiment

InFIG. 1, an endoscope and a suture instrument used in this embodiment are shown. An endoscope1 (flexible endoscope) has anendoscope operation unit2 which is operated by an operator. Theendoscope operation unit2 is connected to a control device via auniversal cable3 and equipped with various switches4 andangle knobs5. At the distal end of theendoscope operation unit2, anendoscope insertion part6 that is flexible and long is extendedly formed. At the distal end of theendoscope insertion part6, anobservation device7 which obtains an image of the internal body, alighting unit8, and a distal end opening of achannel9 are provided. As theobservation device7, an image taking device having a CCD (Charge Coupled Device) or an optical fiber can be used. Thelighting unit8 has an optical fiber that conducts light from a light source. Thechannel9 opens at alateral part2aof theendoscope operation unit2 through theendoscope insertion part6. At an opening of thelateral part2a, acap10 is provided. In thecap10, an insertion hole is formed, and a treatment tool such as asuture instrument11 is inserted into thechannel9 through this insertion hole. That is, theendoscope1 or thechannel9 are used as tools for inserting a treatment tool such as thesuture instrument11 from a natural opening of a living body into a hollow organ.

As shown inFIGS. 1 to 3, in thesuture instrument11, a flexibleinner sheath13 is passed through the inside of a flexibleouter sheath12 so as to be able to freely move forward or backward. To the distal end (remote end when viewed from the hand side) of the inner sheath13 (elongated member), ahollow needle14 is fixed. Theneedle14 is blocked and the distal end thereof has a sharp end portion. Asuture tool16 is contained inside of theneedle14. Two anchors27 of thesuture tool16 are housed in theneedle14. Each of the lengths of theouter sheath12 and theinner sheath13 is longer than that of thechannel9 of theendoscope1. At a base end (proximal end viewed from the hand side) of theinner sheath13, anoperation unit17 is provided. Theoperation unit17 has ahandle19 which can freely slide with respect to amain body18 of the operation unit. To thehandle19, a base end (proximal end) of apusher20 is fixed. Thepusher20 extends through the inside of theinner sheath13 to the inside of theneedle14. Adistal end portion21 at the remote side of thepusher20 is pressed against thesuture tool16.

As shown inFIG. 4, thesuture tool16 has asuture thread25. Thesuture thread25 is folded approximately in two and aknot31 is formed in the vicinity of its turn-around point. Moreover, thesuture thread25 is bundled at both end portions thereof and passed through astopper26 that is substantially triangular. To each end portion of thesuture thread25, ananchor27 is fixed one by one. Theanchor27 has a cylindrical, elongated shape and thesuture thread25 is fixed at the approximately center portion in a longitudinal direction of theanchor27. Theanchors27 consist of afirst anchor27A which has a slantedface32A formed at one end portion and asecond anchor27B with

slanted faces

As shown inFIG. 3, the twoanchors27 of thesuture tool16 are sequentially held from the distal end side in an inner hole of theneedle14 in the order of thefirst anchor27A and thesecond anchor27B. Aside hole15 for releasing theanchors27 is provided in the side portion of theneedle14. Theside hole15 is provided at the distal end side of theneedle14, and extends in the length direction of theneedle14. The length thereof is approximately equal to the length of theanchor27. As shown inFIG. 5, a width L1 that perpendicularly intersects the length direction of theside hole15 is less then the diameter W of theanchor27. As shown inFIG. 2 andFIG. 3, aside hole35 with a decreased width is further provided in an extending manner from the base end side of theside hole15. Thesuture thread25 of thesecond anchor27B is passed through thisside hole35. Theslanted face32A of thefirst anchor27A is faced to the opposite side of the position of theside hole15. Thesecond anchor27B is positioned so that theslanted face33A at one end portion faces the slantedface32A of thefirst anchor27A, that is, faces theside hole15. At this time, theslanted face33B at the other end portion of thesecond anchor27B is faced to the opposite side of theside hole35. Thedistal end portion21 of thepusher20 is a push out control portion that slopes so as to make contact facing the slantedface33B having this orientation.

As shown inFIG. 2, thestopper26 is held at a more distal end than theneedle14 in theouter sheath12. The number of theanchors27 and the shape of thestopper26 are not limited to the embodiment shown in the figures.

Next, a suturing method of this embodiment will be explained mainly with reference toFIGS. 6 to 13.FIGS. 6 to 13 are pattern diagrams illustrating procedure and show the stomach as an example of a hollow organ.

As shown inFIG. 6, theendoscope insertion part6 is inserted from the mouth of a patient41 prepared with amouthpiece40, and the distal end of theendoscope insertion part6 is made to bend by theangle knob5. A needle-shaped knife, which is a high-frequency cutting tool, is passed through thechannel9 of theendoscope insertion part6, to form a perforation in the wall portion of thestomach43. As shown inFIG. 7, theendoscope insertion part6 is led through theperforation42 into theabdominal cavity44. Theforceps54 are passed through thechannel9, and the treatment of theabdominal cavity44 is performed by theforceps54.

After the treatment is completed, thesuture instrument11 is passed through thechannel9 in the place of theforceps54. The distal end portion of theendoscope insertion part6 is bent, and the distal end opening of thechannel9 is faced toward awall portion45 of thestomach43 in the vicinity of theperforation42 from the outside of the stomach43 (abdominal cavity44 side), and theneedle14 of thesuture instrument11 is projected from theouter sheath12. Thestopper26 falls to theabdominal cavity44 side. Thefirst anchor27A at this stage does not drop from theneedle14 because the opening width of theside hole15 of theneedle14 is narrow. As shown inFIG. 8, theneedle14 is thrust at apuncture position46 at a predetermined distance from the opening periphery of theperforation42. After theneedle14 has passed through thewall portion45 of thestomach43 in the order of amuscle layer47 and amembrane48, thepusher20 is moved forward (refer toFIG. 2).

The slanted portion of thedistal end portion21 of thepusher20 pushes the slantedface33B of thesecond anchor27B. Thesecond anchor27B advances, and pushes thefirst anchor27A, which makes surface contact via the slated faces32A and33B, toward the distal end of theneedle14. Here, the contact surfaces of the

anchors

27A,27B are slanted toward a direction intersecting the lengthwise direction of theneedle14, and slant toward the side of theside hole15. Moreover, the distal end portion of theneedle14 is blocked. Accordingly, as shown inFIG. 9, the movement direction of thefirst anchor27A is the direction from the length direction of theneedle14 to theside hole15. Thefirst anchor27A is released from theneedle14 while spreading the opening portion of theside hole15 in the direction shown by the arrows inFIG. 5. With the release of thefirst anchor27A, thesecond anchor27B moves to the vacated space. However, after the release of thefirst anchor27A, the opening width of theside hole15 reverts to the original size, so thesecond anchor27B does not drop from theneedle14.

As shown inFIG. 10, after thefirst anchor27A is pushed out, theneedle14 is drawn out from thewall portion45. Thefirst anchor27A remains on the inner portion of thestomach43, and because thesuture thread25 penetrates through thewall portion45, is drawn to the outside of thestomach43.

Thereafter, when theneedle14 is drawn out, as shown inFIG. 11, thesuture tool16 is mounted in the vicinity of theperforation42.

Next, as shown inFIG. 12, theendoscope insertion part6 is drawn back to the inside of thestomach43, and thesuture tool16 is tightened by theforceps60. Theforceps60 has anouter sheath61 having an external diameter larger than theanchor27, and aninner sheath62 passed through theouter sheath61 so as to freely move forward or backward. At the distal end of theinner sheath62, a supportingmember63 is provided, and a pair ofgrip segments64 is supported on the supportingmember63 so as to freely open or close. Theknot31 of thesuture thread25 of thesuture tool16 is gripped by thegrip segments64. When theouter sheath61 is moved forward, the distal end of theouter sheath61 presses against thestopper26. As shown inFIG. 13, when theouter sheath61 moves further forward, thestopper26 is pushed into thewall portion45. Since thestopper26 is constructed to be able to move in this direction, thestopper26 moves toward thewall portion45. Since the position of the pair of thegrip segments64 does not change, thestopper26 moves relatively forward with respect to thesuture thread25. As a result, the distance between thestopper26 and theanchor27 decreases, and thesuture thread25 is cinched.

After suturing of theperforation42 is completed, theouter sheath61 is moved backward, and thegrip segments64 are then opened. Thesuture thread25 leaves thegrip segments64. Although the end portion of thestopper26 can move in a direction in which the tissue is tightened up by thesuture thread25, it acts to tighten up thesuture thread25 in a direction for loosening thesuture thread25. As a result, thesuture thread25 maintains a sutured state without loosening, even if thesuture tool16 is placed inside of thestomach43.

In this embodiment, theendoscope1 and theoperation channel9 are used as tools for passing theneedle14. Theneedle14 that is inserted from a natural opening of a living body is thrust from the side of theabdominal cavity44 into thewall portion45, and since thesuture thread25 is tightened up so that the puncture positions46,49 are approximately matched, the muscle layers47 can be held together. In the embodiment, it is possible to tightly close theperforation42 by more reliably holding the muscle layers47 together. Therefore, the process of adhesion is fast, and recovery is quick.

FIGS. 14 to 16 show modified examples of this embodiment. As shown inFIG. 14, theneedle14 is passed from the puncture positions46,49 through themuscle layer47, and theanchors27 are placed between themuscle layer47 and themembrane48. Thesuture thread25 thus passes through only themuscle layer47 to be mounted on thewall portion45. As shown inFIG. 15, when thesuture thread25 is tightened, the puncture positions46,49 approach each other, the tissue is wound into the inside of thestomach43, and the outer surfaces of themuscle layer47 make close contact. As shown inFIG. 16, when the puncture positions46,49 are approximately matched, theperforation42 is closed. Since theanchors27 are placed between themuscle layer47 and themembrane48, in order to insert thesuture thread25, leaks in theabdominal cavity44 from the inside of thestomach43 along the holes that are formed in thewall portion45 are prevented. Also, since theanchors27 are not exposed to the inside of thestomach43, theanchors27 are protected from stomach acid. Moreover, since theanchors27 are not exposed to the inside of thestomach43, it is possible to maintain theanchors27 in an approximately germ-free state. In this case, recovery is promoted.

Second Embodiment

A second embodiment of the present invention shall be described with reference to the drawings. Note that descriptions of constituent elements and actions that are the same as those of the first embodiment shall be omitted.

As shown inFIG. 17, asuture instrument11 is passed through a channel of anendoscope insertion part6. Theneedle14 is thrust obliquely at apredetermined puncture position71 in themuscle layer47 that is exposed to the inner periphery face of theperforation42. As shown inFIG. 18, theneedle14 that is thrust from thepuncture position71 obliquely penetrates through the muscle layer, and when the distal end portion of theneedle14 is exposed on theabdominal cavity44 side, thefirst anchor27 is pushed out to theabdominal cavity44 side. Theneedle14 is then removed, and obliquely thrust at apredetermined puncture position72 in themuscle layer47 that is exposed to the inner periphery on the opposite side of theperforation42 shown inFIG. 17. It is preferable that thepuncture position71 and thepuncture position72 are at approximately identical positions in the thickness direction of thewall portion45. When theneedle14 has obliquely penetrated through themuscle layer47 from the inner periphery face of theperforation42 to theabdominal cavity44 side, thesecond anchor27 is pushed out to theabdominal cavity44 side. Thereafter, when theneedle14 is removed from thewall portion45, as shown inFIG. 19, thesecond anchor27 is placed on theabdominal cavity44 side similarly to thefirst anchor27. Thesuture thread25, after obliquely piercing themuscle layer47, is pulled into thestomach43 along the inside of theperforation42.

In this embodiment, after theneedle14 is obliquely thrust into themuscle layer47 that is exposed to the inner periphery of theperforation42, and theanchors27 are placed on theabdominal cavity44 side, the tissue is fastened together by thesuture thread25 so that puncture positions71,72 coincide. Therefore, it is possible to reliably hold the muscle layers47 together. Accordingly, the muscle layers47 are reliably adhered, and it is possible to quickly close theperforation42. Holes that allow passage of thesuture thread25 are not formed in the membrane.

Third Embodiment

A third embodiment of the present invention shall be described with reference to the drawings. Note that descriptions of constituent elements and actions that are the same as those of the first embodiment shall be omitted.

As shown inFIG. 20, atreatment tool80 such as a snare is passed through achannel9 of anendoscope insertion part6, and themembrane48 around theperforation42 is resected. After themembrane48 is resected, thesuture tool16 is mounted by thesuture instrument11. As shown inFIG. 21, theneedle14 is thrust at a predetermined position (puncture position31) in theinner surface47aof themuscle layer47 that is exposed by resection of themembrane48. When theneedle14 has penetrated through themuscle layer47 and protrudes on theabdominal cavity44 side, theanchor27 is pushed out. When theneedle14 is drawn out from themuscle layer47, thesuture thread25 passes through themuscle layer47, and theanchor27 is placed on theabdominal cavity44 side. Similarly, theneedle14 is thrust again at an approximately symmetrical position to sandwich theperforation42 therebetween. Apuncture position82 at this time is set at a location at which theinner surface47aof themuscle layer47 is exposed as a result of resection of themembrane48. Theneedle14 penetrates through themuscle layer47 from the inner surface side (inner portion side of the stomach43) to the outer surface side (outer portion side of the stomach43), and thesecond anchor27 is pushed out. As shown inFIG. 22, when theneedle14 is drawn out, thesuture tool16 is mounted so as to straddle theperforation42.

Thissuture tool16 is fastened similarly to the second embodiment. By pulling thesuture threads25, the inner periphery faces of theperforation42 are drawn in and made to stick together. Thesuture thread25 is drawn until the puncture positions81,82 approximately coincide. At this time, theend portions47bof themuscle layer47 are initially abutted together on the inner portion side of thestomach43, and with this as a starting point, the inner faces47aare pulled together. As shown inFIG. 23, the tissue is pushed out so that the inner periphery surfaces of theperforation42 face the outer portion side of thestomach43, and by resection of themembrane48, the exposed inner faces47aof themuscle layer47 are stuck together.

Fourth Embodiment

A fourth embodiment of the present invention shall be described with reference to the drawings. Note that descriptions of constituent elements and actions that are the same as those of the first embodiment shall be omitted.

As shown inFIG. 24, for example a treatment tool such as a snare is passed through thechannel9 of anendoscope insertion part6, and themembrane48 around theperforation42 is resected. After themembrane48 is resected, thesuture tool16 is mounted by thesuture instrument1. Theneedle14 is thrust at a portion that is made to swell by a local injection into themembrane48. When theneedle14 is thrust into the membrane, theanchor27 is pushed out. When theneedle14 is drawn out from the membrane, thesuture thread25 penetrates through the membrane, and theanchor27 is placed on theabdominal cavity44 side. Similarly, theneedle14 is thrust again at an approximately symmetrical position to sandwich theperforation42 therebetween. The puncture position at this time is a portion that is made to swell by a local injection. The membrane is penetrated with theneedle14, and thesecond anchor27 is pushed out. As shown inFIG. 25, when theneedle14 is drawn out, thesuture tool16 is mounted so as to straddle theperforation42.

Thissuture tool16 is fastened similarly to the second embodiment. By pulling thesuture threads25, the inner periphery faces of theperforation42 are drawn in and made to stick together as shown inFIG. 26.

Fifth Embodiment

A fifth embodiment of the present invention shall be described with reference to the drawings. Note that descriptions of constituent elements and actions that are the same as those of the first embodiment shall be omitted.

As shown inFIG. 27, for example a treatment tool such as a snare is passed through thechannel9 of anendoscope insertion part6, and themembrane48 is resected. After themembrane48 is resected, thesuture tool16 is mounted by thesuture instrument11. Also, as shown inFIG. 28, a graspingforceps80A is passed through aseparate channel9. As shown inFIG. 29, an end of themembrane48 that is resected is grasped by the graspingforceps80A. As shown inFIG. 30, after penetrating theneedle14 through themembrane48 that is raised by the graspingforceps80A, thefirst anchor27A is pushed out. When theneedle14 is drawn out from the membrane, thesuture thread25 penetrates through the membrane, and theanchor27 is placed on theabdominal cavity44 side. Similarly, theneedle14 is thrust again at an approximately symmetrical position to sandwich a membrane resected surface47ctherebetween. The membrane is penetrated with theneedle14, and thesecond anchor27B is pushed out. When theneedle14 is removed, thesuture tool16 is mounted so as to cover the membrane resected surface47c.

Thissuture tool16 is fastened similarly to the second embodiment. By pulling thesuture threads25, the membranes around the membrane resected surface47care drawn in and made to stick together as shown inFIG. 31.

Here, various modifications of the placement state of theanchors27 and method of inserting theanchors27 are possible as shown inFIG. 32 toFIG. 34. Also, the insertion method is not particularly limited. Note thatFIG. 32 shows a modification in which, by thrusting theneedle14 from the inner side to the outer side of the perforation, theanchors27 are placed on the outer side.FIG. 33 shows a modification in which the needle is thrust in tissue that is swollen on the inner side and the anchors are placed on the inner side.FIG. 34 shows a modification in which one of theanchors27 is placed by being passed from the outer side to the inner side, while theother anchor27 is placed by being passed from the inner side to the outer side.

Sixth Embodiment

As shown inFIG. 35, theneedle14 of thesuture tool101 is provided at the distal end of theinner sheath13 that is an elongated member (also in the embodiments below unless particularly stated). Theneedle14 has a hollow shape with a sharp distal end portion that is closed, and twoanchors103 of thesuture tool16 are housed therein, being arranged along the lengthwise direction. The end of asuture thread25 is passed through the center portion of eachanchor103. Theanchors103 smoothly curve from the center portion to both ends in the lengthwise direction to form an arch shape that becomes convex toward aside hole15. Theanchor103 is made of an elastically deformable material, and is biased in the flat direction when housed in the inner hole of theneedle14. Since theanchors103 in theneedle14 are compressed in a direction that perpendicularly intersects the lengthwise direction (vertical direction), the dimension in this direction decreases, and the dimension in the lengthwise direction is extended. The diameter of the inner hole of theneedle14 is less than the height of theanchors103 from the side portion to the center portion when restored to their original shape (natural shape) without the application of an external force. Note that theanchors103 may be formed by flexing a cylindrical member into an arch shape, or flexing a plate member into an arch shape.

Aside hole104 that is continuous with the inner hole is formed at the side portion of the distal end side of theneedle14. Theside hole104 extends in the lengthwise direction of theneedle14, and the length thereof is shorter than the length of theanchor103 that is biased in the flat direction in theneedle14. The opening width that perpendicularly intersects the lengthwise direction of theside hole104 is preferably greater than the width of theanchor103. However, in the case of widening the opening width by elastically deforming theneedle14, the opening width may be less than or equal to the width of theanchor103.

When pushing out afirst anchor103A from theneedle14, apusher20 pushes asecond anchor103B to the distal end. When thefirst anchor103A moves to the formation position of theside hole104, that is, directly under theside hole104, the bias of thefirst anchor103A in the flat direction is released, and so thefirst anchor103A reverts to its natural shape. Therefore, since the height from the end portion to the center portion of the anchor as shown inFIG. 36 exceeds the inner diameter of theneedle14, and the length of thefirst anchor103A becomes less than or equal to the length of theside hole104, theanchor103A is released from theneedle14 through theside hole104.

Also, when it is desired to more reliably push out thefirst anchor103A from theneedle14, thefirst anchor103B is pushed further to the distal end side by thepusher20. Thefirst anchor103A that is pushed by thesecond anchor103B flexes because the distal end portion of theneedle14 is blocked. Due to the compression of thefirst anchor103A in the lengthwise direction, the height from the end portion to the center portion of the anchor further increases, and thefirst anchor103A is pushed out from theneedle14 through theside hole104.

In thissuture tool101, since pushing out of theanchors103 is controlled by utilizing the elastic deformation of theanchors103, it is possible to reliably push out theanchors103 one at a time from theneedle14.

Note that in thissuture tool101, when theanchors103 have moved to the formation position of theside hole104, theanchors103 are released from theneedle14 by utilizing the elastic deformation of theanchors103 and the push-bending by thepusher20. However, theanchors103 may be released from theneedle14 using only the elastic deformation of theanchors103. Also, theanchors103 may be released by using only the push-bending by thepusher20 without using the elastic deformation of theanchors103. Thesecond anchor103B advances into the space that is vacated when thefirst anchor103A has been pushed out. Since thesecond anchor103B at this time is longer than theside hole104, it does not drop out from theside hole104. To push out thesecond anchor103B, by pushing with thepusher20, thesecond anchor103B is compressed in the direction of theside hole104 to be made the same as or less than the length of theside hole104. When thepusher20 is further advanced, thesecond anchor103B is pushed out from theside hole104.

Here,FIGS. 37 to 45 show modified examples of this embodiment.

In theneedle14 of asuture tool101A shown inFIG. 37, aplate spring106 is provided as a push-out control portion at the distal end side of theneedle14 in conjunction with the formation position of theside hole104. Theplate spring106 is disposed with a slope so that the distal end side protrudes toward theside hole104. The twoanchors107 of thesuture tool16 have a cylindrical, elongated shape, with thesuture thread25 extending from the center portion. In this initial state, the twoanchors107 are disposed more to the base end side than theplate spring106. As shown inFIG. 38, when thepusher20 moves forward, thefirst anchor107A is moved to the distal end side of theneedle14 via thesecond anchor107B. Thefirst anchor107A moves forward while pushing down theplate spring106, but when thefirst anchor107A runs onto theplate spring106, it is pushed toward theside hole104 by the restoring force of theplate spring106, and pushed out from theside hole104. Once theplate spring106 has been restored, it works to prevent thesecond anchor107B from jumping out. To push out thesecond anchor107B, thesecond anchor107B is similarly made to run onto theplate spring106 while pushing it down, and then pushed out. Thus in thissuture tool101A, the same effect as above is obtained by providing theplate spring106 in theneedle14 as a push-out control portion.

In asuture tool101B shown inFIG. 39, an erectinghook110 is provided at approximately the opposite side of the formation position of theside hole104 of theneedle14. The erectinghook10 is supported to freely rotate on apin112 that is attached to ahole111 that is provided in theneedle14. The distal end portion of the erectinghook110 is disposed facing the distal end side of theneedle14, and anoperation wire113 is attached here. Theoperation wire113 is drawn out to the hand side through the inside of theneedle14. When pushing out thefirst anchor107A, thefirst anchor107A is moved to the formation position of theside hole104, that is, onto the top of the erectinghook110, by pushing thesecond anchor107B toward the distal end with thepusher20. When the erectinghook110 is made to rise toward theside hole104 by pulling theoperation wire113, thefirst anchor107A is pushed by the erectinghook110 and pushed out from theneedle14. When thefirst anchor107A has been pushed out, theoperation wire113 is pushed to house the erectinghook110 in thehole111. In this state, even if thesecond anchor107B moves to the formation position of theside hole104, it does not move in the direction of theside hole104, and so thesecond anchor107B is not pushed out from theneedle14. By providing the erectinghook110 as a push-out control portion in theneedle14 in thissuture tool101B, the same effect as above is obtained.

A suture tool101C shown inFIG. 40 has ahollow needle115. Theneedle115 has anopening portion116 that slopes obliquely toward the distal end. Aprojection117 is protrudingly provided at the inner circumferential portion of the base end side of anopening portion116. As shown inFIG. 41, the projection amount of theprojection117 is less than the radius of theinner hole115A of theneedle115, and the base end side of theprojection117 is a smooth curve. Also, aside hole118 is formed at a position on the opposite side of theprojection117. Aside hole119 that passes thesuture thread25 is continuously provided at the base end side of theside hole118.

Elongated anchors of thesuture tool16 consists of afirst anchor120A that is housed at the distal end side of theneedle14 and asecond anchor120B that is housed at the base end side. The outer diameter of thefirst anchor120A is greater than the portion that is reduced by theprojection117, but thefirst anchor120A is capable of getting out from theside hole118. Thesecond anchor120B has aflank face121 that is cut to allow passage through theprojection117. The length of thesecond anchor120B is preferably longer than the length of theside hole118.

When pushing out thefirst anchor120A, thepusher20 is moved forward. Thefirst anchor120A is pushed toward the distal end via thesecond anchor120B. As shown inFIG. 42, thefirst anchor120A is guided by the curve of theprojection117 to be pushed out from theside hole118. In this state, thesecond anchor120B cannot leave to the outside from theside hole118. When pushing out thesecond anchor120B, thepusher20 is moved further forward. As shown inFIG. 43, thesecond anchor120B slips beyond theprojection117 due to theflank face121 and moves to the distal end, and is pushed out to outside of theneedle115 from theopening portion116.

In this suture tool101C, the same effect as above is obtained by making a difference between the route for pushing out thefirst anchor120A by providing theprojection117 as a push-out control portion in the distal end side of theneedle14, and a route for pushing out thesecond anchor120B.

In thesuture tool101D shown inFIG. 44, two

anchors

125A,125B are manufactured from permanent magnets. Thefirst anchor125A on the distal end side and thesecond anchor125B on the base end side are housed in theneedle14 so that the same magnetic poles face each other. In the example shown inFIG. 44, the S-poles face each other. When thepusher20 is moved forward, thefirst anchor125A is pushed out from theneedle14 as shown inFIG. 45 by utilizing the repulsion between the permanent magnets. Since the repulsion is utilized, thesecond anchor125B is not pushed out simultaneously. In thissuture tool101D, by using permanent magnets for the

anchors

125A and125B, the same effect as above is obtained. Note that the permanent magnets may only be formed at the end portions of the two

anchors

125A,125B that approach each other. Also, both end portions of the two

anchors

125A,125B may be permanent magnets.

Seventh Embodiment

As shown inFIG. 46, asuture tool131 has aneedle132 that serves as an elongated member. Theneedle132 has a hollow shape in which anopening portion132A is obliquely formed at the distal end. In the inner portion of theneedle132, two

anchors

133A,133B of thesuture tool16, afirst pusher134 that pushes out thefirst anchor133A, and asecond pusher135 that pushes out thesecond anchor133B are housed. Thefirst anchor133A is disposed at the distal end side and has an elongated shape with a larger diameter than thesecond anchor133B. Thesecond anchor133B has an elongated shaped that is housed in the cylindricalfirst pusher134. Aslit136 is formed in the side portion of the distal end side of thefirst pusher134, and thesuture thread25 is drawn out from here. Thesuture thread25 is further drawn out to the outside from aside hole137 of theneedle15. Theside hole137 passes thesuture thread25, but has an opening width that does not allow passage of the

anchors

133A,133B. Thesecond pusher135 is passed to freely move forward or backward in thefirst pusher134. The first and

second pushers

134,135 are drawn to the hand side, and are capable of moving forward or backward independently.

When pushing out thefirst anchor133A, thefirst pusher134 is moved forward. As shown inFIG. 47, thefirst anchor133A is pushed out from theopening portion132A at the distal end. At this time, thesecond anchor133B moves along with thefirst pusher134, but since it remains housed in thefirst pusher134, it is not released from theneedle132. When pushing out thesecond anchor133B, only thesecond pusher135 is moved forward. As shown inFIG. 48, thesecond anchor133B is pushed out from thefirst pusher134 and theneedle132.

In thissuture tool131, since a device that pushes out thefirst anchor133A and a device that pushes out thesecond anchor133B are separately provided, it is possible to reliably push out only thefirst anchor133A. Note that theneedle132 may be provided at the distal end of theinner sheath13.

FIGS. 49 to 50 show modified examples of this embodiment.

In thesuture tool131A shown inFIG. 49, two

lumens

141A,141B are formed in aneedle140. These

lumens

141A,141B are disposed in a direction that perpendicularly intersects the slope direction of the tip of theneedle140. Afirst anchor107A and afirst pusher142A are housed in thefirst lumen141A, and thesuture thread25 is drawn out from aside hole140A in the side portion. Asecond anchor107B and asecond pusher142B are housed in thesecond lumen141B, and thesuture thread25 is drawn out from aside hole140B in the side portion. When pushing out thefirst anchor107A, only thefirst pusher142A is moved forward. When pushing out thesecond anchor107B, only thesecond pusher142B is moved forward. In thissuture tool131A, the two

anchors

107A,107B are housed in different channels, and so by independently providing the

pushers

142A,142B in each channel, it is possible to reliably push out the

anchors

107A,107B one at a time.

In thesuture tool131B shown inFIG. 50, two

lumens

146A,146B are disposed in theneedle145, being arranged along the inclination direction of the tip of theneedle145. The cross-sectional shape of thefirst lumen146A is a semicircular shape, with an elongatedfirst anchor147A and afirst pusher148A being housed therein. The cross-sectional shape of thesecond lumen146B is a semicircular shape, with an elongatedsecond anchor147B and asecond pusher148B being housed therein. Thesuture threads25 of each

anchor

147A,147B are drawn out from side holes (not illustrated) formed in the side portion. When pushing out thefirst anchor147A, only thefirst pusher148A is moved forward. When pushing out thesecond anchor147B, only thesecond pusher148B is moved forward. In thissuture tool131B, by providing the two

pushers

148A,148B to be independently driven, it is possible to reliably push out the

anchors

147A,147B one at a time. Moreover, since the cross-sectional shape of the

lumens

146A,146B is a semicircular shape, it is possible to make effective use of the space in theneedle145.

Eighth Embodiment

As shown inFIG. 51, anopening portion132A is obliquely formed at the sharp tip of the distal end of aneedle132 of asuture tool141, and afirst anchor133A and a second anchor133C of thesuture tool16 are housed from the distal end side therein. The outer shape of the twoanchors133A,133C are approximately the same, but ahole143 that penetrates in the lengthwise direction is formed in the center portion of the second anchor133C. Thefirst pusher144 is passed through thishole143 so as to be able to freely move forward or backward. Moreover, further to the base end side than the second anchor133C, asecond pusher145 is provided in a cylindrical shape so as to cover the outer circumference of thefirst pusher144.

The hand side control unit of thesecond pusher145 is drawn out from the base of thesheath12, and a flange-shapedprojection145A is integrally provided in an extended manner at a position that is drawn out by a predetermined length from the base of thesheath12. A length Lp1 from theprojection145A to the sheath base end side corresponds to the stroke of thesecond pusher145. Amale thread147 is engraved on the outer circumference of the base end side of thesecond pusher145 beyond theprojection145A, and abase end portion148 of thefirst pusher144 is screwed onto thethread147. A distance Lp2 that thesecond pusher145 can be screwed into thebase end portion148 of thefirst pusher144 becomes the stroke of thefirst pusher144 with respect to thesecond pusher145. Note that the control unit at hand side of each

pusher

144,145 are not limited to the ones illustrated.

When pushing out thefirst anchor133A, thebase end portion148 of thefirst pusher144 is rotated without moving thesecond pusher145. Thefirst pusher144 moves forward with respect to thesecond pusher145. As shown inFIG. 52, thefirst anchor133A is pushed out by the distal end portion of thefirst pusher144 that penetrates the second anchor133C. Since thefirst pusher144 does not press the second anchor133C, the second anchor133C remains in theneedle132. When pushing out the second anchor133C, thesecond pusher145 is pushed out with respect to theneedle132. As shown inFIG. 53, theprojection145A of thesecond pusher145 is made to abut the base end portion of theneedle132. The second anchor133C is pushed out by thesecond pusher145.

In this embodiment, by providing thefirst pusher144 that can push out only thefirst anchor133A and thesecond pusher145 that can push out the second anchor133C on the same axis, it is possible to reliably push out only thefirst anchor133A while reducing the outer diameter. Also, although thesecond pusher145 is freely pushed and pulled, thefirst pusher144 has screw engagement with thesecond pusher145, and the operation for pushing out the

anchors

133A,133B are different with the two

pushers

144,145. Accordingly, it is easy to control the push out of the

anchors

133A,133B.

Ninth Embodiment

As shown inFIG. 54, aneedle152 of asuture instrument151 has anopening portion153 that is obliquely formed at the sharp tip of the distal end, with two

side holes

154,155 shifted approximately 90 degrees in the circumferential direction formed in the side portion. Two

elongated anchors

156A,156B arranged in the lengthwise direction are housed in theneedle152. The base portion of thefirst anchor156A on the distal end side is connected to the distal end portion of thesecond anchor156B by a first connectingportion157. The base portion of thesecond anchor156B is connected to apusher20 by a second connectingportion158. Each of the connecting

portions

157,158 is a push-out control portion that consists of a thin flat member and so can be broken by bending. The orientations of the first connectingportion157 and the second connectingportion158 are shifted approximately 90 degrees about the center axis. More preferably, the flat face of the first connectingportion157 faces theside hole154, and the flat face of the second connectingportion158 faces theside hole155.

When placing thefirst anchor156A, thepusher20 is moved forward to make thefirst anchor156A project out from the tip of theneedle152. Since as thefirst anchor156A is unified with thepusher20, abinding tool159 that binds thesuture tool16 is pulled back as a whole. As a result, thefirst anchor156A is pulled by thesuture thread25. As shown inFIG. 56, thefirst anchor156A is bent at the first connectingportion157, and the first connectingportion157 is broken, so that thefirst anchor156A separates from theneedle152 and thesecond anchor156B (and the pusher20). As stated above, when theside hole154 and the direction of easily bending the first connectingportion157 agree, it is possible to readily break off the first connectingportion157. Note that since thepusher20 and thesecond anchor156B are connected via the second connectingportion158, thesecond anchor156B does not detach.

When placing thesecond anchor156B, thepusher20 is moved further forward to cause thesecond anchor156B to project from the tip of theneedle152. Thebinding tool159 as a whole is pulled back again, causing thesecond anchor156B to be pulled by thesuture thread25. As shown inFIG. 57, thesecond anchor156B is bent at the second connectingportion158, and the second connectingportion158 breaks, so that thesecond anchor156B separates from thepusher20. As stated above, when theside hole155 and the direction of easily bending the second connectingportion158 agree, it is possible to readily break off the second connectingportion158.

In this embodiment, the two

anchors

156A,156B that are integrally provided with thepusher20 are detached in turn. Therefore, it is possible to reliably place only thefirst anchor156A.

Also, since the

anchors

156A,156B are formed as one piece, it is possible to lower the anchor manufacturing cost and thesuture instrument151 assembly cost compared to the other embodiments.

Tenth Embodiment

As shown inFIG. 58 andFIG. 59, anopening portion163 is obliquely formed at the sharp tip of the distal end of aneedle162 of asuture tool161, and aside hole164 is formed along the lengthwise direction of theneedle162 from the base end side of theopening portion163. Theside hole164 passes thesuture thread25, but cannot pass the

anchors

165A,165B. Aprojection166 for projection restriction (push-out control portions) is formed in an approximate ring shape so as to reduce the inner diameter. Theprojection166 forms a chamfered smooth curve. The twoelongated anchors165A,165bare housed in series to the base end side of theprojection166. The outer diameter of thefirst anchor165A is less than or equal to the inner circumference of theprojection166. The outer diameter of thesecond anchor165B is greater than thefirst anchor165A, and greater than the inner circumference of theprojection166.

When pushing out thefirst anchor165A, thepusher20 is moved forward. As shown inFIG. 60, thefirst anchor165A passes through theprojection166 to be pushed out from theopening portion163. Thesecond anchor165B is caught by theprojection166 and stopped. To push out thesecond anchor165B, thepusher20 is pushed further, to apply pressure to theprojection166 with thesecond anchor165B, and thereby spread out the distal end portion of theneedle162. As shown inFIG. 61, the space of the formation position of theprojection restriction projection166 expands, and thefirst anchor165A is pushed out from theopening portion163.

In this embodiment, theprojection166 is provided as a push-out control portion in theneedle162, and while thefirst anchor165A is pushed out as is, thesecond anchor165B cannot be pushed out without applying an even greater force. Therefore, it is possible to reliably push out the

anchors

165A,165B one at a time.

Eleventh Embodiment

As shown inFIG. 62, anopening portion173 is obliquely formed at the sharp tip of the distal end of aneedle172 of asuture tool171, and aside hole174 is formed from the base end side of theopening portion173. Theside hole174 has a crooked shape consisting of afirst portion174A on the distal end side of theside hole174 that extends along the lengthwise direction of theneedle172, asecond portion174B that extends in the circumferential direction, and athird portion174C that extends in the lengthwise direction. Two

elongated anchors

175A,175B of thesuture tool16 are inserted in order in theneedle172. Thefirst anchor175A is housed near thefirst portion174A of theside hole174, with thesuture thread25 being pulled out from thefirst portion174A. Thesecond anchor175B is housed near thethird portion174C of theside hole174, with thesuture thread25 being drawn out from thethird portion174C. As shown inFIG. 63, two recessedportions176 are formed in the base end portion of thesecond anchor175B.

Two projection-shapedengagement portions177 are formed in the distal end of thepusher20. Eachengagement portion177 has a shape that is capable of engaging with the recessedportion176 of thesecond anchor175B. Thereby, the second anchor175 and thepusher20 can be engaged in the rotation direction about the axial line.

To push out thefirst anchor175A, thepusher20 is pushed out. As shown inFIG. 64, with thesuture thread25 guided by thefirst portion174A of theside hole174, the first anchor175 is pushed out from theopening portion173. Since thesuture thread25 of thesecond anchor175B moves along thethird portion174C of theside hole174 through which it is passed, thesecond anchor175B is not pushed out from theneedle172. Note that thethird portion174C is of a length such that when thefirst anchor175A has been pushed out, thesuture thread25 of the second anchor remains in thethird portion174C. More preferably, by allowing for thesuture thread25 to move until the connecting portion with thesecond portion174B at the distal end of thethird portion174C, it is possible to quickly push out thesecond anchor175B with the subsequent operation.

To push out thesecond anchor175B, thepusher20 is rotated. Since thepusher20 and thesecond anchor175B are connected in the rotation direction by theengagement portions177, thesecond anchor175B rotates with thepusher20 as shown inFIG. 65, and thesuture thread25 thereof moves through thesecond portion174B of theside hole174 to thefirst portion174A. In this state, by further moving forward thepusher20, thesuture thread25 moves along thefirst portion174A as shown inFIG. 66, and thesecond anchor175B is pushed out from theneedle172. Since the engagement portion between thepusher20 and thesecond anchor175B does not engage in the pullback direction of thepusher20, thesecond anchor175B separates from the pusher to be released from theneedle172.

In this embodiment, the crank-shapedside hole174 is provided as a push-out control portion, thefirst anchor175A is disposed at the distal end side, thesecond anchor175B is disposed at the base end side, and by providing thepusher20 that engages with the second anchor175 in the rotation direction, it is possible to reliably push out only thefirst anchor175A.

Twelfth Embodiment

As shown inFIG. 67, anopening portion183 is obliquely formed at the sharp tip of the distal end of aneedle182 of asuture tool181, and aside hole184 extends in the lengthwise direction from the base end side of theopening portion183. In theneedle182, afirst anchor185A and asecond anchor185B that is longer than thefirst anchor185A of thesuture tool16 are disposed in a manner arranged in the radial direction of theneedle182. Thefirst anchor185A is disposed at the base end side of theopening portion183 of theneedle182, that is, on the side of theside hole184. A distal end portion186 (push-out control portion) of thepusher20 has a step, and anend portion186A on the side of theside hole184 projects toward the distal end. Thisdistal end portion186 of thepusher20 makes contact with both

anchors

185A,185B.

To push out thefirst anchor185A, thepusher20 is moved forward. The two

anchors

185A,185B are pushed simultaneously by thedistal end portion186 of thepusher20, but the length of thefirst anchor185A is short and is in the opening direction of theopening portion183. Accordingly, as shown inFIG. 68, the entire length of thefirst anchor185A projects to the outside of theneedle182 before thesecond anchor185B. As a result, thefirst anchor185A is pushed out first. At this time, thesecond anchor185B is hardly exposed from theneedle182, or completely unexposed. Moreover, since thesecond anchor185B is sandwiched between theneedle182 and theend portion186A of thepusher20, it does not fall out of theneedle182. To push out thesecond anchor185B, thepusher20 is moved further forward. As shown inFIG. 69, by projecting almost the entire length of thesecond anchor185B from theneedle182, it is released from thesuture tool181.

In this embodiment, since thedistal end portion186 of thepusher20 is provided as a push-out control portion, it is possible to push out the two

anchors

185A,185B with different lengths in sequence. Since thefirst anchor185A is shorter than thesecond anchor185B and is disposed so as to protrude first from theopening portion183, it is possible to reliably push out thefirst anchor185A before thesecond anchor185B.

Here, modification examples are shown inFIG. 70 toFIG. 72. A distal end portion190 (push-out control portion) of thepusher20 has an outer shape in which a cylindrical distal end side and base end side are each cut into a half-circle shape at one location. At the distal end side, the opening direction side of theopening portion183 that is sloped is cut away, and a recessedportion191 that houses one elongated anchor of thesuture tool16 is formed. A recessedportion192 at the base end side is formed by cutting away the side opposite the recessedportion191 of the distal end side. This recessedportion192 can also house one anchor.

As shown inFIG. 71, to push out afirst anchor107A, thepusher20 is moved forward until approximately the entire length of thefirst anchor107A projects from theopening portion183. Thereby, thefirst anchor107A that is disposed in the opening direction is released from theneedle182. At this time, since thesecond anchor107B is between the recessedportion192 of thepusher20 and theneedle182, it is not released from theneedle182. To push out thesecond anchor107B, as shown inFIG. 72, thepusher20 is moved forward until approximately the entire length of thesecond anchor107B projects from theneedle182.

By providing thedistal end portion190 of thepusher20 as a push-out control portion, it is possible to differentiate the timing at which the two

anchors

107A,107B project to be capable of separating, and so it is possible to reliably push out the

anchors

107A,107B one at a time.

Thirteenth Embodiment

As shown inFIG. 73 toFIG. 75, anopening portion203 is obliquely formed at the sharp tip of the distal end of aneedle202 of asuture tool201, and aside hole204 extends in the lengthwise direction from the base end side of theopening portion203. Two projections205 (push-out control portions) are formed in theneedle202 facing the inner side. It is preferable that theneedle202 be manufactured from a material that has resilience. Note that by providing theside hole204, the resilience is enhanced.

Afirst anchor206A and asecond anchor206B of thesuture tool16 have an elongated shape, and agroove207 is formed in an annular shape on the outer circumference of each. Thegrooves207 are of a size to be capable of engaging with theprojections205 of theneedle202. In the initial state, theprojections205 of theneedle202 are engaged with thegroove207 of thefirst anchor206A on the distal end side.

To push out thefirst anchor206A, thepusher20 is moved forward. Thefirst anchor206A proceeds past theprotrusions205, and so the engagement with theprotrusions205 is released. The amount of force required for releasing the engagement is the magnitude that can be input from the hand side. As shown inFIG. 76, when thepusher20 is moved forward as is, thefirst anchor206A is pushed out from theopening portion203 of the distal end. Thesecond anchor206B stops when the groove thereof engaged with theprojections205. For this reason, only thefirst anchor206A is pushed out. To push out thesecond anchor206B, thepusher20 is moved further forward. As shown inFIG. 77, thesecond anchor206B is thereby pushed out similarly to the case of thefirst anchor206A.

According to this embodiment, by providing theprojections205 on the side of theneedle202 as a push-out control portion and making thegroove207 of the

anchors

206A,206B engage, it is possible to reliably push out thefirst anchor206A only. Note that in order to change the operational feeling when pushing out thefirst anchor206A and when pushing out thesecond anchor206B, a difference in the force amount may be provided by pushing out the anchors without providing thegroove207 in thefirst anchor206A.

Here, modification examples are shown inFIG. 78 toFIG. 80.

As shown inFIG. 78 toFIG. 79, it is acceptable to form ahole208 in theneedle202 instead of the projections and mount a C-shaped ring209 (push-out control portion) with aprojection portion209A formed in the center thereof at thehole208. When theprojection portion209A of thering209 is mounted on theneedle202, it projects into theneedle202 via thehole208. Thisprojection portion209A accomplishes a similar function as theprojections205.

In theneedle202 shown inFIG. 80, a wire spring210 (push-out control portion) is provided to the base end side than theside hole204. Thewire spring210 extends toward the distal end, and anengagement portion210A is formed that is folded back to face the inside of theside hole204. Thisengagement portion210A accomplishes a similar function as theprojections205. This push-out control portion is not limited to a line shape provided it is elongated, and may be a plate shape or ribbon shape.

Fourteenth Embodiment

As shown inFIG. 81, anopening portion213 is obliquely formed at the sharp tip of the distal end of aneedle212 of asuture tool211, and aside hole214 is formed from the base end side of theopening portion213 along the lengthwise direction. In theside hole214, a narrowedportion215 is formed in which the opening length becomes smaller at the distal end side. The narrowedportion215 is constituted by a pair of projectedportions217 that form a smooth curve. Two

anchors

216A,216B of thesuture tool16 that are housed in the needle are each provided with aprojection217 on the outer circumference portion of the elongated shape. Theprojection217 is provided at a position that is shifted to the base end side from a location where thesuture thread25 is drawn out. The diameter of theprojection217 is larger than the opening length of the narrowedportion215 when an external force is not acting on the narrowedportion215 of theneedle212. Accordingly, theprojection217 is caught on the narrowedportion215, thereby preventing drop off of the

anchors

216A, and216B.

To push out thefirst anchor216A, thepusher20 is moved forward. Thereby, theprojection217 of thefirst anchor216A moves forward by spreading out the narrowedportion215, and is pushed out from theopening portion213 of the distal end. As shown inFIG. 82, after theprojection217 has passed, the narrowedportion215 reverts to its original shape, and so theprojection217 of thesecond anchor216B is caught and engaged. In this way, by providing the narrowedportion215 as a push-out control portion, it is possible to provide a difference in the force amount, and it is possible to reliably push out only thefirst anchor216A. To push out the second anchor, a force is newly added to spread open the narrowedportion215. Note that instead of spreading open the narrowedportion215 with theprojection217, it is possible to spread open the narrowedportion215 with thesuture thread25.

FIG. 83 shows a modified example. Theside hole220 has a cam configuration having afirst portion220A of the distal end side, passes through a connectingportion220B that smoothly curves, and links to asecond portion220C on the base end side. In the initial state, thesuture thread25 and theprojection217 of thefirst anchor216A are passed through thefirst portion220A, and thesuture thread25 and theprojection217 of thesecond anchor216B are passed through thesecond portion220C. The length of theportions220A to220C of theside hole220 is set so as to be capable of pushing out thefirst anchor216A while theprojection217 of thesecond anchor216B is in thesecond portion220C.

Thefirst anchor216A is pushed out if thepusher20 is moved forward. Since theprojection217 of the second anchor216 remains in thesecond portion220C of theside hole220, thesecond anchor216B is not pushed out simultaneously. To push out the second anchor216, theprojection217 thereof must be passed through the curved connectingportion220B of theside hole220, and so the work becomes heavy from the standpoint of the operator. When the connectingportion220B is passed, thesecond anchor216B once again moves forward with a small force, and is pushed out from theneedle212. In this way, by providing theside hole220 as a push-out control portion, a difference in the force amount is provided when pushing out the two

anchors

216A,216B, and it is possible to reliably control the push out of the two

anchors

216A,216B.

Fifteenth Embodiment

As shown inFIG. 84, aneedle232 of asuture instrument231 is fixed at the distal end of asheath233. Anopening portion234 is obliquely formed at the sharp tip of the distal end of theneedle232. The interior of theneedle232 contains, at the distal end side, afirst housing portion235 with a large diameter and, at the base end side, asecond housing portion236 with a small diameter. In the initial state, an elongatedfirst anchor237A of thesuture tool16 is housed in thefirst housing portion235, and an elongatedsecond anchor237B of thesuture tool16 is housed in thesecond housing portion236. Thefirst housing portion235 continues into thesecond housing portion236, with the distal end side being partitioned by anannular wall portion238 that projects the inner wall of theneedle232. Moreover, a coil-shapedspring239 is housed in thefirst housing portion235. The outer diameter of the distal end side of thespring239, in the state of an external force not acting thereon, is larger than the outer diameter of thefirst anchor237A and the inner diameter of thewall portion238. The base end portion of thespring239 is reduced in diameter, and engages with agroove240 that is cut in the outer circumference of the first anchor237. Thereby, the movement of thefirst anchor237A is regulated by the distal end portion of thespring239 abutting thewall portion238, and thus thefirst anchor237A remains in thefirst housing portion235. In the two

anchors

237A,237B, thegroove240 is formed in the base end of each, and the outer circumference of the distal end portion has a reduced diameter by beveling.

When thepusher20 is moved forward, thefirst anchor237A moves toward theopening portion234 of the distal end, and the distal end portion of thespring239 is thrust against thewall portion238. When thepusher20 is pushed further forward, since the distal end portion of thespring239 abuts thewall portion238 and does not move while the base end side of thespring239 advances with thefirst anchor237A, thespring239 is compressed and increases in diameter. As a result, as shown inFIG. 85, the base end portion of thespring239 expands in diameter to come off thegroove240 of thefirst anchor237A, and so thefirst anchor237A is pushed out from the distal end of theneedle232. As a result of thefirst anchor237A being pushed out, thesecond anchor237B advances into thefirst housing portion235. At this time, due to the beveled distal end of thesecond anchor237B, the base end portion of thespring239 expands in diameter. When thesecond anchor237B advances as is, the base end portion of thespring239 moves relatively along the outer circumference of thesecond anchor237B, and as shown inFIG. 86, engages with thegroove240 of thesecond anchor237B. Thereby, since the movement of thesecond anchor237B is restricted, the two

anchors

237A,237B are not pushed out simultaneously.

This embodiment has thespring239 as a push-out control portion and controls the movement of the

anchors

237A,237B by utilizing the expansion in the radial direction of thespring239 when compressed. Therefore, it is possible to reliably push out the

anchors

237A,237B one at a time. Thespring239 reverts to its original shape after the

anchors

237A,237B have been pushed out, and so can be repeatedly used.

Sixteenth Embodiment

As shown inFIG. 87 andFIG. 88, anopening portion243 is obliquely formed at the sharp tip of the distal end of aneedle242 of asuture tool241. An elongatedfirst anchor244A and asecond anchor244B of thesuture tool16, with thesecond anchor244B having a smaller diameter than thefirst anchor244A, are housed in theneedle242 in that order from the distal end side. Thesecond anchor244B is housed in a housing portion245 (intermediate member) that is provided at the distal end portion of thepusher20.

Thehousing portion245 is manufactured from a material that has resilience and is formed in a cylindrical shape with a bottom. Aslit246 is formed in acylindrical portion245A of thehousing portion245 in the lengthwise direction thereof. At the base end portion of thecylindrical portion245A, a pair ofengagement projections247 is provided sandwiching theslit246, with eachengagement projection247 extending to the outside in the radial direction. Moreover, on the inner side of thecylindrical portion245A of thehousing portion245, twoprojections248 are formed facing inward. Theseprojections248 engage with the recessedportions249 of thesecond anchor244B. As shown inFIG. 89, ahole250 is formed at abottom portion245B of thehousing portion245. Thehole250 passes thepusher20 to be able to freely move forward or backward, while aportion251 with a wide diameter at the distal end of thepusher20 is of a size that cannot be inserted.

As shown inFIG. 87, aside hole252 is formed in theneedle242 along the lengthwise direction thereof. A widenedportion252A is formed at the distal end of theside hole252. The width along the circumferential direction of the widenedportion252A is greater than the distance between the pair ofengagement projections247 of thehousing portion245. The width of the remainder of theside hole252 excluding the widenedportion252A is smaller than the length between the pair ofengagement projections247 in the natural state. As shown inFIG. 90, when theengagement projections247 are made to approach each other to the extent of making contact, they can be passed through theside hole252. At this time, theprojections248 of thehousing portion245 engaged with the recessedportions249 of thesecond anchor244B. In contrast, at the widenedportion252A of theside hole252, the pair ofengagement projections247 is restored to the original state so as to open as shown by the dashed lines. At this time, theprojections248 of thehousing portion245 move to the outside in the radial direction, and so their engagement with the recessedportions249 of thesecond anchor244B is released.

To push out thefirst anchor244A, thepusher20 is moved forward. Thefirst anchor244A is pushed out from theneedle242 via thesecond anchor244B, which is pushed by thepusher20, and thehousing portion245. Since theengagement projections247 of thehousing portion245 are biased so as to approach each other by theside hole252, theprojections248 maintain the state of engagement with the recessedportions249 of thesecond anchor244B, and so thehousing portion245 advances with thesecond anchor244B. For this reason, even when thefirst anchor244A is pushed out from theneedle242, thesecond anchor244B is not simultaneously pushed out.

When thepusher20 is further moved forward after pushing out thefirst anchor244A, theengagement projections247 enter the widenedportion252A of theside hole252. Since the force that had biased theengagement projections247 toward each other is removed, thecylindrical portion245A of thehousing portion245 opens, and the engagement between theengagement projections247 and the recessedportions249 of thesecond anchor244B is released. In this state, when thepusher20 is moved further forward, thesecond anchor244B is pushed by theportion251 at the distal end of thepusher20. In contrast, thehousing portion245, which is not engaged with either of thepusher20 and thesecond anchor244B, does not move since theside hole252 does not extend further to the distal end side. Accordingly, thesecond anchor244B is pushed out from theneedle242 accompanying the advance of thepusher20.

In this embodiment, by adjusting the engagement state between thehousing portion245 and thesecond anchor244B, and thepusher20, it is possible to ensure that thesecond anchor244B does not come out from thehousing portion245 when pushing out thefirst anchor244A. Accordingly, it is possible to control the pushing out of the two

anchors

244A,244B.

Also, after thefirst anchor244A has been pushed out, it is possible to draw back thesecond anchor244B by pulling thepusher20. For this reason, in the case of the puncturing performance of theneedle242 being affected by thesecond anchor244B being at the distal end portion of theneedle242, it is possible to improve the puncturing performance.

Here, a modification example of the present embodiment shall be shown.

Thesecond anchor244B may be made from a magnetic body, and thehousing portion245 may be made from a permanent magnet. In this case, thepusher20 is made from a non-magnetic body. Thesecond anchor244B and thehousing portion245 are thus engaged by the attraction due to the magnetism, and when a force is applied that overcomes this magnetism, thesecond anchor244B can be pushed out. Alternatively, thehousing portion245 may be made from a magnetic body, and thesecond anchor244B may be a permanent magnet.

As shown inFIG. 91, a recessedportion261 that extends in the lengthwise direction may be formed in the center of the base end portion of an elongatedsecond anchor244C. Ahook262 at the distal end of thepusher20 is pushed into this recessedportion261. When an external force is not applied to thishook262, it is wider than the diameter of the hole. In theneedle242 is provided awall portion263 that is capable of abutting the base end portion of thesecond anchor244C and allows thepusher20 to move forward and backward.

To push out thefirst anchor244A, since thesecond anchor244C is engaged by thehook262, thesecond anchor244C moves forward with thepusher20. After pushing out thefirst anchor244A, thepusher20 is made to retreat. Thesecond anchor244C that is engaged with thepusher20 is drawn back. When thesecond anchor244C abuts thewall portion263, it can move no longer back, but thepusher20 can be moved further back. As shown inFIG. 92, thehook262 of thepusher20 is pulled out from the recessedportion261 of thesecond anchor244C, and thus the engagement of both is released. When thehook262 reverts to its original shape, it becomes bigger than the recessedportion261. Accordingly, when thepusher20 is moved forward once again, thesecond anchor244C can be pushed out with thehook262.

Seventeenth Embodiment

In this embodiment, the case of using theendoscope1 and thesuture instrument11 the same as those in the first embodiment are described as another suturing method, but a suture instrument of another embodiment may also be used.

The suture method of this embodiment shall be described. As shown inFIG. 6, theendoscope insertion part6 is inserted until the vicinity of theperforation42, and performs observation of theperforation42 from within thestomach43. Next, as shown inFIG. 7, theendoscope insertion part6 is fed from theperforation42 into theabdominal cavity44, and observation of the perimeter of theperforation42 is made from theabdominal cavity44 side with an observation device (first observation device)7 of theendoscope insertion part6. After confirmation that other tissue is not in the area of the perforation42 (the position through with theneedle14 passes, the puncture position, or the position where theanchor27 is placed), theendoscope insertion part6 is drawn back into thestomach43. Next, thesuture instrument11 that is passed through thechannel9 is projected out. As shown inFIG. 93, the distal end portion of thesuture instrument11 is fed from theperforation42 into theabdominal cavity44. Then, the distal end portion of thesuture instrument11 is curved and made to face the exterior side of thestomach43 in theabdominal cavity44 and the perimeter of theperforation42.

As shown inFIG. 94, theneedle14 of thesuture instrument11 is projected from theouter sheath12, and theneedle14 passes through the tissue on the perimeter of theperforation42 from the side of theabdominal cavity44 into thestomach43. When projecting theneedle14 from theouter sheath12, it is preferable that thestopper26 enters thestomach43. As shown inFIG. 95, when theneedle14 has passed through the tissue, afirst anchor27 is pushed out to the inside of thestomach43 and made to remain there. As shown inFIG. 96, twoanchors27 are placed in thestomach43 so as to sandwich theperforation42, and then thesuture instrument11 is returned to inside of thestomach43 to be housed in thechannel9. Then, as shown inFIG. 97, theforceps60 are passed through thechannel9, and the tissue is fastened with thesuture tool16 using theforceps60, whereby theperforation42 is sutured. This fastening method is the same as that of the second embodiment.

In this embodiment, the interior side and exterior side of thestomach43 are observed in sequence by theobservation device7 of theendoscope1 to confirm that there is no other tissue around the perforation, theendoscope1 is then returned to the inside of thestomach43, and theneedle14 is passed through tissue from the exterior side of thestomach43. Accordingly, the inclusion of other tissue when performing suturing using theendoscope1 can be readily prevented.

Eighteenth Embodiment

In this embodiment, the case of using theendoscope1 and thesuture instrument11 the same as those in the first embodiment are described as another suturing method, referring mainly toFIG. 98 toFIG. 114, but a suture instrument of another embodiment may also be used. Note thatFIG. 98 toFIG. 114 are schematic views showing procedures, and a stomach is shown as an example of a hollow organ.

As shown inFIG. 98, theendoscope insertion part6 is inserted from the mouth (including a natural opening of a living body, anus, nose, ear and the like) of the patient41 prepared with amouthpiece40, and the distal end of theendoscope insertion part6 is made to bend with theangle knob5. An intendedincision line300 shown by virtual lines inFIG. 99 is confirmed with theobservation device7 from the interior side of the stomach43 (the interior side of the hollow organ), and the intendedincision line300 where the incision is to be made afterward is set at this intendedincision line300. When doing so, the intendedincision line300 may be marked with a high-frequency knife. As shown inFIG. 99, thesuture instrument11 is projected out, theneedle14 is pushed out from theouter sheath12, and thestopper26 is lowered into thestomach43. Theinner sheath13 of thesuture instrument11 is moved forward, and furthermore puncture

positions

301,302,303,304 are determined as suture positions when suturing with thesuture instrument11 based on the intendedincision line300. Thepuncture position301 and thepuncture position302 are symmetrical positions about the intendedincision line300, and a straight line through the two

puncture positions

301,302 approximately perpendicularly intersects the intendedincision line300. The same is true for the puncture positions303,304. At that time, marking of the intendedincision line300 may be performed with a high-frequency knife or the like.

Once the puncture positions301,302,303,304 have been determined, theneedle14 is thrust at theinitial puncture position301. As shown inFIG. 100, when theneedle14 has passed through the wall portion of thestomach43, thehandle19 on the hand side shown inFIG. 1 is pushed in to move thepusher20 forward. Thepusher20 pushes out thefirst anchor27 from the distal end of theneedle14 into the exterior side of the stomach43 (also referred to as the body cavity side or abdominal side of the hollow organ). Once thefirst anchor27 has been pushed out, thehandle19 is stopped, and theinner sheath13 is drawn in. Theneedle14 is then drawn out of the wall portion, so that only thesuture thread25 passes through the wall portion, and thefirst anchor27 remains on the side of theabdominal cavity44.

Next, theneedle14 is thrust at thepuncture position302 which is a symmetrical position to sandwich the intendedincision line300 shown inFIG. 99. Thesecond anchor27 is similarly pushed out to theabdominal cavity44. As shown inFIG. 8, aseparate suture tool16 is similarly mounted at thepuncture position303 and thepuncture position304. When mounting the twosuture tools16, it is acceptable to pull thesuture instrument11 out from theendoscope1 each time onesuture tool16 is mounted and then pass thesuture instrument11 that houses thenew suture tool16 through theendoscope1. Also, as shown inFIG. 102, it is also acceptable to pass thesuture instrument11 in advance in each of twochannels9, and so mount thesuture tools16 in sequence.

When thesuture tools16 are mounted, the intendedincision line300 is cut. As shown inFIG. 102, a treatment tool for cutting, for example a needle-shapedknife51 that is a high-frequency incision tool, is passed through thechannel9 of theendoscope insertion part6. A high-frequency is impressed on the distal end portion of the needle-shapedknife51, and when this needle-shapedknife51 is moved along the intendedincision line300, the wall portion is incised and theperforation42 is formed. As shown inFIG. 11, theendoscope insertion part6 is fed to anabdominal cavity53 via theperforation42. A treatment tool such asforceps54 is passed through thechannel9 to perform a medical procedure in theabdominal cavity53.

After completing the medical procedure in theabdominal cavity53, theendoscope insertion part6 is drawn back into thestomach43, and theperforation42 is sutured by fastening the twosuture tools16. At this time, for example,forceps60 such as those shown inFIG. 105 are used. Theforceps60 have anouter sheath61 that has a larger diameter than theanchor27, and theinner sheath62 is passed through the inside of a flexibleouter sheath61 so as to be able to freely move forward or backward. At the distal end of theinner sheath62, a supportingmember63 is provided, and a pair ofgrip segments64 is supported on the supportingmember63 so as to freely open or close. As shown inFIG. 106, after theknot31 of thesuture thread25 of thesuture tool16 is gripped by thegrip segments64, theouter sheath61 is moved forward and the distal end of theouter sheath61 presses against thestopper26. As shown inFIG. 107, when theouter sheath61 moves further forward, thestopper26 is pushed into the wall portion of thestomach43. Since thestopper26 is constructed to be able to move in this direction, thestopper26 moves toward thewall portion45. As a result, the distance between thestopper26 and theanchor27 decreases. Thereby, the tissue around theperforation42 is pulled together, and theperforation42 is sutured by thesuture thread25. When theperforation42 has been sutured by thesuture tool16, after theouter sheath61 is retracted, thegrip segments64 are opened to release thesuture thread25. The end portion of thestopper26 is capable of moving in the direction of fastening the tissue with thesuture thread25, but by working so as to tighten thesuture thread25 in the direction of loosening thesuture thread25, thesuture thread25 does not go slack even when thesuture tool16 is placed inside thestomach43.

By tightening the twosuture tools16 in order, theperforation42 is sutured as shown inFIG. 108. In the case of suturing theperforation42 with three ormore suture tools16 such as when making a large incision in thestomach43, thesuture tools16 may be tightened in order from one end of a row thereof. For example, in the example shown inFIG. 109, thesuture tools16 are tightened in the order ofsuture tool16a,suture tool16b,suture tool16c,suture tool16d, andsuture tool16e. Since the size of theperforation42 can gradually be made smaller by suturing theperforation42 from one end, the suturing becomes easy. Also, it is acceptable to initially tighten thesuture tool16 that is in the middle of the row ofsuture tools16, and next tighten thesuture tools16 that are positioned between themiddle suture tool16 that has been tightened and thesuture tools16 at the ends. In the example ofFIG. 109, thesuture tool16cis initially tightened, and next thesuture tool16band thesuture tool16dare tightened, and finally thesuture tool16aand thesuture tool16eare tightened. By always suturing the middle portion of the opening, shifting of the suturing position is minimized.

According to this embodiment, by mounting thesuture tool16 in a manner straddling the intendedincision line300 before making an incision in thestomach43, it is possible to prevent shifting of the suture position. In conventional methods, after making the incision, the needle is thrust in while confirming the suture position by sight. As a result, the suture position readily shifts, and careful attention has been required in order to prevent leaks from the perforation. However, since shifting of the suture position is prevented in the present embodiment, the procedure is easy. Also, since endoscope procedures are restricted to approaches from one direction, the field of vision has been limited, and the suture position has had to be selected in consideration of the tissue clearance and extension. But in the present embodiment, it is possible to reliably close the perforation by specifying the puncture positions301,302,303,304 before making an incision.

Here, there are times when theendoscope insertion part6 is fed from theperforation42 to theabdominal cavity53, and by excising a large tissue is brought out from theperforation42 to outside of the body through thestomach43. When theperforation42 is formed in accordance with the size of the tissue, the size of theperforation42 can at times be greater than the diameter of theendoscope insertion part6. In this case, when performing treatment in theabdominal cavity53, by supplying a gas from the distal end portion of theendoscope insertion part6 to swell the abdominal cavity, gas enters thestomach43 from theendoscope insertion part6 and the gap of theperforation42. In order to prevent the gas from flowing into thestomach43, thesuture tool16 may be lightly tightened to narrow the size of theperforation42 narrowed to the extent of the size of theendoscope insertion part6. As shown inFIG. 110, when theendoscope insertion part6 is fed from theperforation42 to theabdominal cavity53, thestopper26 is drawn out to theabdominal cavity53 by theforceps54 that are passed through theendoscope insertion part6. As shown inFIG. 111, when thestopper26 is pressed against the outer wall of thestomach43 and thesuture tool16 is lightly tightened, the gap of theperforation42 becomes smaller. Thereafter, when gas is supplied from the distal end portion of theendoscope insertion part6, theabdominal cavity44 swells. When the procedure is completed, theendoscope insertion part6 is drawn into thestomach43. Thestopper26 is then pulled into thestomach43 with theforceps54, and thesuture tool16 is tightened, whereby theperforation42 is sutured.

Also, as shown inFIG. 112, in the case of performing a procedure by passing theendoscope insertion part6 in anovertube70, the distal end of theovertube70 is projected from theperforation42 into theabdominal cavity53. As shown inFIG. 113, theforceps54 are fed from the side hole70A of theovertube70 on the interior side of thestomach43, and thesuture tool16 is lightly tightened to narrow theperforation42 to the extent of the outer diameter of theovertube70. Theendoscope insertion part6 is projected from the distal end of theovertube70, and theabdominal cavity53 is swelled with gas to perform the treatment. When the procedure is completed, theovertube70 is drawn back from theperforation42. Thereafter, when thesuture tool16 is tightened by theforceps54, theperforation42 is sutured.

Note that the present invention can be widely applied without being limited to the aforesaid embodiments.

For example, theendoscope1 may be inserted from the anus into the large intestine that is one example of a hollow organ. In this case, the perforation in the large intestine and the like is sutured.

In the first and second embodiments, theneedle14 is inserted approximately perpendicular with respect to themuscle layer47, but it may also be inserted at a predetermined angle. Thereby, thesuture thread25 passes through themuscle layer47 obliquely with respect to the axial line of theperforation42. In this case, the same effect is obtained.

Also, various application examples are conceivable such as suturing the diameter of ahollow organ400 as shown inFIG. 114, without being limited to perforation sutures and membrane sutures. In this case, as shown inFIG. 115, anchors27A,27B are placed at an interval in the inner circumferential direction of thehollow organ400, and by tightening them, the hollow organ wall is sutured so as to be folded over. By forming a plurality of such sutures along the axis direction of the hollow organ, it is possible to reduce the diameter of a hollow organ over a desired length.

In the case of theendoscope insertion part6 having twochannels9, asuture instrument11 may be passed through eachchannel9. In this case, theanchor27 of thesuture instrument tool16 is housed in therespective needle14 of eachsuture instrument11.

The number of anchors may be a plurality and is not limited to two.

In this suture instrument in accordance with the first aspect of the present invention, a plurality of anchors are moved in the lengthwise direction of the needle toward the distal end thereof by moving the pusher forward. The push-out control portion first causes the first anchor that has been moved to the formation position of the side hole to move toward the side hole, and causes this anchor to be pushed out from the side hole. The second anchor is moved to the formation position after the first anchor has been pushed out, and then pushed out from the side hole by the push-out control portion.

In this suture instrument in accordance with the second aspect of the present invention, the anchor that has been moved to the formation position of the side hole is pushed out from the side hole by being biased by the plate spring.

In this suture instrument in accordance with the third aspect of the present invention, when the anchor has moved to the formation position of the side hole, the anchor is pushed out from the side hole by raising the erecting hook.

In this suture instrument in accordance with the fourth aspect of the present invention, since the contact face of the pusher and the base end side anchor obliquely face the side hole, when the base end side anchor reaches the formation position of the side hole, the force of pushing the anchor is obliquely applied toward the side hole. As a result, the base-end side anchor is pushed out from the side hole. Since the abutting faces of the distal end side anchor and the base-end side anchor slant toward the side hole, the force of the pusher is obliquely transmitted to the distal end side anchor to be pushed out from the side hole.

In this suture instrument in accordance with the fifth aspect of the present invention, when the pusher is moved forward, the first anchor is moved toward the side hole by the projection and pushed out from the side hole. In contrast, the second anchor is pushed out from the distal end side opening portion without interference from the protrusion.

In this suture instrument in accordance with the sixth aspect of the present invention, the anchors are housed in the needle in the state of being deformed. When the anchors are moved to the formation position of the side hole by moving the pusher forward, the anchors revert to their original shape are released from the side hole.

In this suture instrument in accordance with the seventh aspect of the present invention, the anchors are curved by moving the pusher forward. When the length of the anchor along the lengthwise direction of the needle becomes shorter than the side hole, the anchor is pushed out from the side hole.

In this suture instrument in accordance with the eighth aspect of the present invention, by operating the first pusher and the second pusher in turn, the two anchors are pushed out from the needle in turn.

In this suture instrument in accordance with the ninth aspect of the present invention, the first pusher pushes out the first anchor while housing the second pusher. Thereafter, when the second pusher is moved forward with respect to the first pusher, the second pusher is pushed out from the first pusher and the needle.

In this suture instrument in accordance with the tenth aspect of the present invention, when the first pusher is moved forward with respect to the second pusher, the first pusher, by passing through the second anchor, pushes out the first anchor from the needle. The second pusher can push out the second anchor by moving forward the second anchor.

In this suture instrument in accordance with the eleventh aspect of the present invention, by screwing the first pusher onto the second pusher, the first anchor is pushed out. The second anchor is pushed out from the needle by pushing in the second pusher. By differentiating the operation methods when pushing out the two pushers, the anchors can be reliably pushed out one at a time.

This suture instrument in accordance with the twelfth aspect of the present invention has a side hole as a push-out control portion for pushing out the anchors one at a time. The pushing out of the anchors is controlled by the shape of the side hole.

Since the side hole of this suture instrument in accordance with the thirteenth aspect of the present invention has a crooked shape, it is necessary to rotate the second anchor in the circumferential direction to push it out. For this reason, a plurality of anchors being simultaneously pushed out does not occur.

Since this suture instrument in accordance with the fourteenth aspect of the present invention pushes out the second anchor along the curved shape of the side hole, the force required to push out the second anchor is greater than the force required to push out the first anchor. For this reason, a plurality of anchors being simultaneously pushed out does not occur.

Since the narrowed portion in this suture instrument in accordance with the fifteenth aspect of the present invention serves as resistance, a plurality of anchors being simultaneously pushed out does not occur.

In this suture instrument in accordance with the sixteenth aspect of the present invention, by guiding the anchor projection to the distal end side in accordance with the shape of the side hole, the simultaneous pushing out of the plurality of anchors is prevented.

In this suture instrument in accordance with the seventeenth aspect of the present invention, when the pusher is moved forward, the first anchor passes the projection and is smoothly pushed out, but the second anchor stops due to interference with the projection. Since it is necessary to apply an even greater force to push out the second anchor, a plurality of anchors being simultaneously pushed out does not occur.

In this suture instrument in accordance with the eighteenth aspect of the present invention, the first and second anchors are connected to the pusher. When placing the first anchor, the first connecting portion is broken. When placing the second anchor, the second connecting portion is broken after the first anchor has been placed.

In this suture instrument in accordance with the nineteenth aspect of the present invention, since the anchor at the base-end side of the slanting opening portion is protruded from the needle first, it is possible to place this anchor first. The anchor at the distal end side of the slanting opening portion is protruded from the needle with a delay in accordance with the slant of the opening portion. For this reason, the two anchors being simultaneously pushed out from the needle does not occur.

In this suture instrument in accordance with the twentieth aspect of the present invention, since the pusher protrudes the base-end side of the sharp tip that slants, it is possible to push out the anchor that is disposed at this position earlier than the other anchor.

In this suture instrument in accordance with the twenty-first aspect of the present invention, the anchor that is disposed in the distal end side recessed portion is pushed out from the needle first. At this time, since the base-end side anchor is sandwiched between the base-end side recessed portion of the pusher and the needle, it is not pushed out from the needle.

In this suture instrument in accordance with the twenty-second aspect of the present invention, the plurality of anchors is not pushed out simultaneously by engaging and disengaging the anchors and the push-out control portion.

In this suture instrument in accordance with the twenty-third aspect of the present invention, when pushing out the anchor that has the recessed portion, the recessed portion and the projections are engaged and disengaged by pushing the pusher.

In this suture instrument in accordance with the twenty-fourth aspect of the present invention, when the push-out control portion is mounted on the needle, the projection of the push-out control portion is disposed to be capable of engaging and disengaging with the recessed portion of the anchors.

In this suture instrument in accordance with the twenty-fifth aspect of the present invention, to push out the anchors that have the recessed portion, the pusher is pushed in to cause the recessed portion and the projection to engage and disengage by deforming the push-out control portion.

In this suture instrument in accordance with the twenty-sixth aspect of the present invention, since there is an anchor that engages with the push-out control portion and an anchor that does not engage with the push-out control portion, there is a difference in the operational feeling when pushing out these anchors, and so it is easy to push out the anchors one at a time.

In this suture device in accordance with the twenty-seventh aspect of the present invention, the spring serves as a stopper to prevent protrusion of the anchors. To push out an anchor with which the spring is engaged, the spring is compressed. Thereby, the diameter of the spring widens, and the engagement between the spring and the anchor is released, so that if the anchor is pushed it will protrude from the needle.

In this suture instrument in accordance with the twenty-eighth aspect of the present invention, to push out the first anchor, when the first anchor is pushed out, the second anchor moves forward together with the intermediate member, but since the intermediate member and the second anchor are engaged, the two anchors are not pushed out simultaneously.

In this suture instrument in accordance with the twenty-ninth aspect of the present invention, in order to push out the second anchor, since it is necessary to apply a force that overcomes the attraction between the permanent magnet and the magnetic body, it is possible to prevent the two anchors from being pushed out simultaneously.

In this suture instrument in accordance with the thirtieth aspect of the present invention, the distal end side anchor is pushed out in the state of the hook being inserted into the recessed portion of the base-end side of the pusher. The base-end side anchor is pushed out after releasing the engagement between the hook and the recessed portion.

By providing the placement and structure according to the present invention in the distal end side of the needle or the pusher, when operating the pusher at the hand side, it becomes possible to reliably push out a plurality of anchors that are housed in the needle in a predetermined order one at a time. Since a delicate operation at the hand side becomes unnecessary, the procedure is simplified and the procedure efficiency improves.

INDUSTRIAL APPLICABILITY

The suture method and suture instrument according to this invention may be preferably utilized for medical applications.