US20090125039A1 - Suture instrument - Google Patents

Abstract

A suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, including a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is approximately pointed in the direction of the proximal end of the base; a tip position changing mechanism that is provided for changing the tip position of the anchor holding instrument and causes the anchor holding instrument to move in a direction that intersects with the axial line of the lengthwise direction of the base; and a position operation device that operates the tip position changing mechanism at the hand side and operates the tip position of the anchor holding instrument.

Description

• This application is a continuation application based on a PCT Patent Application No. PCT/JP2006/319335, filed on Sep. 28, 2006, whose priority is claimed on U.S. patent application Ser. No. 11/238,016 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 inserts a suture tool through the mouth or anus and sutures a perforation. For example, it relates 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 of U.S. Pat. No. 6,066,146. 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.
• Here, a method for suturing in a hollow organ is disclosed in FIGS. 6 to 9 of Japanese Unexamined Patent Application, First Publication No. 2004-601, 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 of U.S. Pat. No. 5,297,536. 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.
• Patent Document 1: U.S. Pat. No. 6,066,146
DISCLOSURE OF THE INVENTIONProblem to be Solved by the InventionDisclosure of the Invention
• A first aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, the suture instrument being provided with a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is approximately pointed in the direction of the proximal end of the base; a tip position changing mechanism that is provided for changing the tip position of the anchor holding instrument and causes the anchor holding instrument to move in a direction that intersects with the axial line in the lengthwise direction of the base; and a position operation device that operates the tip position changing mechanism at the hand side and operates the tip position of the anchor holding instrument.
• A second aspect of the present invention is the suture instrument in accordance with the first aspect, wherein the tip position changing mechanism changes the position by causing the anchor holding instrument to move to a position that is offset from the axial line in the lengthwise direction of the base.
• A third aspect of the present invention is the suture instrument in accordance with the first aspect, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.
• A fourth aspect of the present invention is the suture instrument in accordance with any one of the first aspect to the third aspect, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.
• A fifth aspect of the present invention is the suture instrument in accordance with any one of the first aspect to the third aspect, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.
• A sixth aspect of the present invention is the suture instrument in accordance with any one of the first aspect to the fifth aspect, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward or backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.
• A seventh aspect of the present invention is a suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, including a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility; an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is disposed at the remote end side of the base; a deflection mechanism that is provided for deflecting the tip position of the anchor holding instrument and causes the tip of the anchor holding instrument to deflect from the remote end of the base toward the direction that faces the proximal end; and a position operation device that operates the deflection mechanism at the hand side and operates the tip position of the anchor holding instrument.
• An eighth aspect of the present instrument is the suture instrument in accordance with the seventh aspect, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.
• A ninth aspect of the present invention is the suture instrument in accordance with the seventh aspect or the eighth aspect, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.
• A tenth aspect of the present invention is the suture instrument in accordance with the seventh aspect or the eighth aspect, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.
• An eleventh aspect of the present invention is the suture instrument in accordance with any one of the seventh aspect to the tenth aspect, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward or backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.
EFFECT OF THE INVENTIONBrief Description of Drawings
• FIG. 1 is a view that shows a schematic constitution of an endoscope and a suture instrument.
• FIG. 2 is a cross-sectional view of a suture instrument and the distal end portion of an endoscope.
• FIG. 3 is a perspective view of a suture instrument and the distal end portion of an endoscope.
• FIG. 4 is a view that shows the constitution of a suture tool.
• FIG. 5 is a schematic view that shows a step of inserting an endoscope into the stomach of a patient to observe a perforation from within the stomach.
• FIG. 6 is a schematic view showing a step of observing the outer side of the stomach.
• FIG. 7 is a schematic view showing a step of puncturing the tissue with a needle of a suture instrument.
• FIG. 8 is a schematic view showing a step of pushing an anchor out from a needle to the outer side of the stomach.
• FIG. 9 is a schematic view in which two anchors are placed outer side of the stomach.
• FIG. 10 is a schematic view showing a step of tightening up a perforation by a suture tool.
• FIG. 11 is a schematic view that describes the operation for grasping a suture tool with a forceps.
• FIG. 12 is a view in which a perforation is sutured by a forceps and a suture tool.
• FIG. 13 is a schematic view showing a rod which is an example of an excluding device.
• FIG. 14 is a schematic view showing a balloon catheter which is an example of an excluding device.
• FIG. 15 is a schematic view showing a balloon catheter in which a balloon is inflated.
• FIG. 16 is a schematic view showing a forceps which is an example of an excluding device.
• FIG. 17 is a schematic view showing one example of a combination of an endoscope with a suture instrument.
• FIG. 18 is a schematic view showing one example of a combination of an endoscope with a suture instrument.
• FIG. 19 is a schematic view showing one example of a combination of an endoscope using an overtube with a suture instrument.
• FIG. 20 is a schematic view showing one example of a combination of an endoscope with an observation device.
• FIG. 21 is a schematic view showing one example of a combination of an endoscope with a suture instrument.
• FIG. 22 is a schematic view showing one example of a combination of an endoscope using an overtube with a suture instrument.
• FIG. 23 is a schematic view showing a step of observing the outer side of the stomach.
• FIG. 24 is a schematic view showing a step of puncturing the tissue from the outer side of the stomach with a needle of a suture instrument.
• FIG. 25 is a schematic view showing a step of pushing out an anchor from a needle to the inner side of the stomach.
• FIG. 26 is a schematic view in which two anchors are placed on the outer side of the stomach.
• FIG. 27 is a schematic view showing a step of tightening up a perforation with a suture tool.
• FIG. 28 is a schematic view describing the operation of grasping a suture tool by a forceps.
• FIG. 29 is a view in which a perforation is sutured by a forceps and a suture tool.
• FIG. 30 is a schematic view showing a step of observing the outer side of the stomach.
• FIG. 31 is a schematic view showing a step of puncturing the tissue with a needle of a suture instrument.
• FIG. 32 is a schematic view showing a step of pushing out an anchor from a needle to the inner side of the stomach.
• FIG. 33 is a schematic view in which two anchors are placed on the outer side of the stomach.
• FIG. 34 is a schematic view showing a step of tightening up a perforation with a suture tool.
• FIG. 35 is a schematic view describing a method of thrusting a needle from the inner side of the stomach after observing the inner side and the outer side of the stomach by an endoscope.
• FIG. 36 is a schematic view showing one example of a combination of an endoscope with a suture instrument.
• FIG. 37 is an enlarged view of the constitution of the distal end portion of the suture instrument.
• FIG. 38 is a view from arrow A inFIG. 37 that shows the constitution of the distal end portion of the suture instrument.
• FIG. 39 is a view that describes the constitution of the operation unit of the suture instrument that is passed through the endoscope.
• FIG. 40 is a view that shows the state of the pair of forceps pieces of the suture instrument being opened and describes a procedure.
• FIG. 41 is a view of piercing through the tissue from the outer side to the inner side with a needle and pushing out and ejecting a first anchor.
• FIG. 42 is a view of piercing through the tissue on the opposite side centered on the perforation with the needle and pushing out and ejecting a second anchor.
• FIG. 43 is an enlarged view of the distal end portion of the suture instrument that is provided with a needle that freely rotates.
• FIG. 44 is a view that describes the constitution of the operation unit of the suture instrument that is passed through the endoscope.
• FIG. 45 is a view that shows the state of opening the needle and describes a procedure piercing the needle through tissue.
• FIG. 46 is a view that describes the operation of bringing the pusher toward the needle that has been pierced through the tissue and pulling out an anchor.
• FIG. 47 is a view that describes the operation of attracting and pulling an anchor onto the pusher.
• FIG. 48 is a view of pulling away and releasing the anchor from the pusher.
• FIG. 49 is an enlarged view of the distal end portion of a suture instrument in which the needle is curved in an approximate U-shape.
• FIG. 50 is a view of pulling out and deploying the needle from the second lumen.
• FIG. 51 is a view of protruding the needle to the outer side from the perforation in the state of being housed in the second lumen.
• FIG. 52 is a view of pulling out the needle from the second lumen and deploying it to the tissue.
• FIG. 53 is an enlarged view of the distal end portion of the suture instrument that has a curving portion that changes the direction of the needle.
• FIG. 54 is a view of the curving portion being curved.
• FIG. 55 is an enlarged view of the distal end portion of the suture instrument that has a balloon at the distal end portion of the sheath.
• FIG. 56 is a view that shows the sheath being curved by swelling the balloon.
• FIG. 57 is a cross-sectional view along line B-B inFIG. 56.
• FIG. 58 is a view that shows the sheath being curved by swelling the balloon and an outside organ being excluded.
• FIG. 59 is an enlarged view of the distal end portion of the suture instrument that has an erecting hook, with the distal end portion of the sheath curved approximately 90 degrees.
• FIG. 60 is a view that describes the constitution of an operation unit of the suture instrument that is passed through the endoscope.
• FIG. 61 is a view that describes the operation of catching the tissue around a perforation by the erecting hook.
• FIG. 62 is a view of pulling the suture instrument and drawing in the tissue that is caught by the erecting hook, and piercing the needle through the tissue.
• FIG. 63 is a view showing a cross-section of the distal end portion of the suture instrument that does not have a needle.
• FIG. 64 is a perspective view of the distal end portion of the suture instrument shown inFIG. 63.
• FIG. 65 is a view that shows a high-frequency knife as an example of a treatment tool to be used together with the suture instrument.
• FIG. 66 is a view that explains a procedure, and is a view of forming a small incision hole with a high-frequency knife.
• FIG. 67 is a view ofFIG. 66 seen from the side.
• FIG. 68 is a view that describes a procedure of curving an outer sheath of the suture instrument to pass through a small incision hole.
• FIG. 69 is a view of pushing out and ejecting an anchor to the inside of the stomach.
• FIG. 70 is a view for explaining the order of tightening a plurality of suture tools.
BRIEF DESCRIPTION OF THE REFERENCE NUMERALS
• • 13 inner sheath (base, anchor holding instrument)
  • 16 suture tool
  • 17,121,145,190 operation unit (position operation device)
  • 27,141, anchor
  • 42 perforation
  • 101,131,151,161,171,181 suture instrument
  • 102,152,162 sheath (base)
  • 103 treatment portion (tip position changing mechanism)
  • 112,139,163,183,193 needle (anchor holding instrument)
  • 112A,139A,163A sharp tip
  • 106 second forceps piece (opening-closing member)
  • 134 lumen
  • 140 operating wire (tip position changing mechanism)
  • 153,184 first lumen
  • 154 second lumen
  • 163A tip
  • 164 curving portion (deflection mechanism)
  • 168 curving control member (shape-memory alloy)
  • 173 balloon
  • 182 sheath (position operation device)
  • 188 erecting hook
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 withvarious 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, an endoscope observation device (a first observation device, hereinafter simply referred to as an observation device)7 which obtains an image of the internal body, alighting unit8, and a distal end opening of achannel9 are provided. As theobservation device7, an imaging device having a CCD (Charge Coupled Device), an optical fiber, and the like 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 or an observation device is inserted into thechannel9 through this insertion hole.
• As shown inFIGS. 1 to 3, in thesuture instrument11, aninner sheath13 which is a flexible base is passed through the inside of a flexibleouter sheath12 so as to be able to freely move forward or backward. At the remote end separated from the hand side (that is, the distal end) of theinner sheath13, ahollow needle14 having a sharp tip is fixed. Aslit15 extends in the lengthwise direction of theneedle14 from the distal end thereof. Asuture tool16 is contained inside of theouter sheath12 and theneedle14. Each of the lengths of theouter sheath12 and theinner sheath13 is longer than that of thechannel9 of theendoscope1. At the proximal end on a hand side of the inner sheath13 (hereinbelow, the base end), 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 of apusher20 is fixed. Thepusher20 extends through the inside of theinner sheath13 to the inside of theneedle14. Adistal end portion21 of thepusher20 is pressed against ananchor27 of 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. Theanchor27 has a cylindrical shape and thesuture thread25 is fixed at the approximately center portion in a longitudinal direction of theanchor27. Thestopper26 includes a long, thin plate member in which ahole28 is formed at the center portion in a longitudinal direction thereof through which thesuture thread25 is passed. Bothend portions29 in a longitudinal direction of thestopper26 are diagonally folded back to hold thesuture thread25 therebetween. Bothend portions29 in a longitudinal direction of thestopper26 are cut to formtriangular sections30. Bothend portions29 of thestopper26 are diagonally folded back so that thesections30 intersect with each other to hold thesuture thread25 therebetween. As a result, thesuture thread25 is prevented from passing through a space formed betweenend portions29. When theknot31 of thesuture thread25 is pulled in a direction away from thestopper26, bothend portions29 of thestopper26 are slightly opened. Accordingly, thestopper26 allows thesuture thread25 to move in this direction. On the other hand, when end portions of thesuture thread25 at the side of theanchors27 are pulled, thesuture thread25 is ready to move in a direction shown by an arrow inFIG. 4. However, bothend portions29 of thestopper26 close and secure thesuture thread25 at this time, and thereby thesuture thread25 does not move.
• As shown inFIG. 3, thesuture tool16 sequentially houses twoanchors27 in an inner hole of theneedle14 that functions as an anchor holding instrument. Thesuture thread25 is drawn out from theslit15 of theneedle14. As shown inFIG. 2, thestopper26 is held at a more distal end portion 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. 5 to 12.FIGS. 5 to 12 are pattern diagrams illustrating procedure and show the stomach as an example of a hollow organ.
• As shown inFIG. 5, theendoscope insertion part6 is inserted from the mouth (including a natural opening of a living body, such as the anus, nose, or ear) of a patient41 prepared with amouthpiece40. When the tip of theendoscope insertion part6 is bent by theangle knob5, aperforation42 can be checked by theobservation device7 from the inside of the stomach43 (the inside of the hollow organ). As shown inFIG. 6, an observation device (second observation device)50 is passed through thechannel9 of theendoscope1. Theobservation device50 is, for example, a catheter having a camera at the tip thereof. Theobservation device50 may be a long and narrow fiberscope.
• The distal end of theobservation device50 is inserted into anabdominal cavity44 from theperforation42, and the distal end of theobservation device50 is bent back by a wire or the like which is not shown in the figures. By using theobservation device50, an area around theperforation42 to be punctured with the needle14 (referred also to as a puncture position or a position through which theneedle14 passes) is observed from anabdominal cavity44 side (which is also the side at which theanchor27 is placed), that is, from the outer side of the stomach43 (referred also as a body cavity side of the hollow organ or the abdominal cavity side) to check that other tissues such as the small intestine, the liver, or the like do not exist at the position through which theneedle14 is passed in order to prevent these tissues from being punctured or sutured together.
• As shown inFIG. 7, thesuture instrument11 is projected to puncture the tissue around theperforation42 with theneedle14 while observing thestomach43 from theabdominal cavity44 side by theobservation device50. When the tissue is punctured, theneedle14 is projected from theouter sheath12 as shown inFIG. 3. In the process of projecting theneedle14, thestopper26 which is contained at the more distal end portion than theneedle14 is extruded from theouter sheath12 into thestomach43. When theneedle14 is moved forward with theouter sheath12 fixed, theneedle14 punctures the tissue. When thehandle19 provided at an operator-side as shown inFIG. 1 is pushed in, thepusher20 moves forward, and thefirst anchor27 is pushed out from the tip of theneedle14 into theabdominal cavity44, as shown inFIG. 8. When thefirst anchor27 is pushed out and released, thepusher20 is stopped, and theneedle14 is drawn out from the tissue. Thefirst anchor27 remains on theabdominal cavity44 side. Thesuture thread25 penetrates through the tissue. Note that thestopper26 exists inside of thestomach43.
• Moreover, theneedle14 is thrust again at an approximately symmetrical position with respect to the position at which theneedle14 is previously thrust centered about theperforation42. In the same manner as when using thefirst anchor27, when theneedle14 penetrates through the tissue, thepusher20 is moved forward. Thesecond anchor27 is pushed out into theabdominal cavity44. As shown inFIG. 9, when theneedle14 is drawn back, thesecond anchor27 remains on theabdominal cavity44 side, thesuture thread25 penetrates through the tissue, and thesecond anchor27 is released to the side of theabdominal cavity44 so as to sandwich theperforation42 therebetween.
• Next, as shown inFIG. 10, after theobservation device50 is drawn back to the inside of thestomach43, thesuture thread25 is pulled so that theanchor27 and thestopper26 tighten up the tissue, and thereby theperforation42 is sutured. When thesuture thread25 is pulled, aforceps60 shown inFIG. 11, for example, is used. Theforceps60 is passed through thechannel9 in the place of theobservation device50. 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 tip of theinner sheath62, a supportingmember63 is provided, and a pair ofgrip segments64 is supported on the supportingmember63 so as to freely open or close.
• After theknot31 of thesuture thread25 of thesuture tool16 is gripped by thegrip segments64, theouter sheath61 is moved forward to press the tip of theouter sheath61 against thestopper26. As shown inFIG. 12, when theouter sheath61 moves further forward, thestopper26 is pushed into the wall of thestomach43. Since thestopper26 is constructed to be able to move in this direction, thestopper26 moves toward the wall. 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. This pulls together the tissue around theperforation42, and theperforation42 is sutured by thesuture thread25. After suturing theperforation42 by thesuture tool16, theouter sheath61 is moved backward, and thegrip segments64 are then opened to release thesuture thread25. Although the tip 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 is not loosened, even if thesuture tool16 is placed inside of thestomach43.
• When a hollow organ such as the small intestine large intestine or another organ such as the spleen or the liver (hereinafter, merely referred to as tissue) exists around the perforation42 (the position through which theneedle14 is passed), the other tissue is excluded from thestomach43 by inserting an excluding device. The excluding device used in this case is exemplified inFIGS. 13 to 16. An excluding device shown inFIG. 13 is arod70 of which a tip portion can be bent. When therod70 is bent, the other hollow organ is excluded to form a space through which theneedle14 is passed. An excluding device shown inFIGS. 14 and 15 is aballoon catheter71. When aballoon73 provided at the tip portion of acatheter72 is inflated by supplying a fluid from the operator-side to exclude the other hollow organ, the space through which theneedle14 is passed is formed. An excluding device shown inFIG. 16 is aforceps74. When the other hollow organ is grasped by theforceps74 to draw it away from thestomach43, the space through which theneedle14 is passed is formed. At the tip portions of these excluding devices, an optical fiber or an observation device having a CCD may be provided. When the observation device is provided, it becomes possible to exclude other tissues while observing the state of theabdominal cavity44.
• In this embodiment, theperforation42 is observed from the inside of thestomach43 by theobservation device7 of theendoscope1 at first, and theperforation42 is then observed from theabdominal cavity44 side by theobservation device50. After that, thesuture instrument11 is made to penetrate through the tissue around theperforation42 to mount thesuture tool16, and theperforation42 is sutured by using thissuture tool16. Accordingly, it is possible to suture theperforation42 after respectively checking from the inside (the side from which theneedle14 is thrust) and the outside (the side through which theneedle14 penetrates or at which theanchor27 is placed) of thestomach43 that another tissue does not exist around theperforation42. According to a suturing method using an endoscope of the prior art, it is impossible to check the opposite side. According to the endoscopic suturing method in this embodiment, it is possible to easily and reliably check for the existence of other tissues, as a result of which procedure can be carried out with rapidity.
• Modified examples of this embodiment are shown inFIGS. 17 to 22.
• As shown inFIG. 17, twoexternal sheaths80 are provided at the periphery of theendoscope insertion part6. Asuture instrument11 is passed through eachexternal sheath80 so as to freely move forward or backward. Theanchors27 are individually contained in the respective needles14. It is possible to thrust twoneedles14 into the tissue at the same time or in an arbitrary order. As another example, oneexternal sheath80 may be used, and twoanchors27 may be contained in oneneedle14. Moreover,FIG. 18 shows an example in which thesuture instruments11 are individually passed through twochannels9 of theendoscope insertion part6.
• As shown inFIG. 19, theendoscope insertion part6 is inserted into anovertube81. At the inner periphery of theovertube81, alumen82 is provided, and thesuture instrument11 is passed through thelumen82. At the inner periphery of theovertube81, twolumens82 may be provided, and thesuture instruments11 may be individually passed through each of thelumens82.
• As shown inFIG. 20, achannel84 may be provided at the periphery of theendoscope insertion part6, and theobservation device50 may be passed through thischannel84. Moreover, theobservation device50 may be directly provided at the periphery of theendoscope insertion part6 without using thechannel84.
• As shown inFIG. 21, anexternal channel85 may be provided parallel to theendoscope insertion part6, and thesuture instrument11 may/be passed through thechannel85. The tip portion of thischannel85 can be bent. When observing theperforation42 from theabdominal cavity44 side as shown inFIG. 6, theendoscope insertion part6 is passed through theperforation42 and moved into theabdominal cavity44, and the tip portion of theendoscope insertion part6 is then bent to observe by theobservation device7 provided at the tip portion thereof.
• As shown inFIG. 22, thesuture instrument11 may be passed through thelumen82 formed inside of theovertube81. In this case, the area around theperforation42 is observed from theabdominal cavity44 side by using theobservation device7 of theendoscope insertion part6.
Second Embodiment
• In this embodiment, thesame endoscope1 andsuture instrument11 as in the first embodiment are used. Descriptions that overlap with the first embodiment will be omitted.
• A suturing method of this embodiment will be explained. As shown inFIG. 5, theendoscope insertion part6 is inserted into the vicinity of theperforation42 to observe theperforation42 from the inside of thestomach43. Next, as shown inFIG. 23, theendoscope insertion part6 is moved from theperforation42 into theabdominal cavity44, and an area around theperforation42 is then observed from theabdominal cavity44 side by the observation device (first observation device)7 of theendoscope insertion part6. After confirming that other hollow organs do not exist in the area around theperforation42, theneedle14 of thesuture instrument11 is projected from theendoscope insertion part6 as shown inFIG. 24, and theneedle14 is thrust from theabdominal cavity44 side into thestomach43. Since the safety of the inside of thestomach43 is confirmed first, the inside of thestomach43 may not be checked when thrusting theneedle14. The inside of thestomach43, however, may be punctured while observing the inside of the stomach43 (the side at which theanchor27 is placed) by using another observation device. In this case, it is possible to puncture at the puncture position while observing from both the inner side of thestomach43 and theabdominal cavity44 side.
• As shown inFIG. 25, thefirst anchor27 is extruded into thestomach43 from the tip of theneedle14. As shown inFIG. 26, after placing twoanchors27 so as to sandwich theperforation42 therebetween, thesuture instrument11 is contained inside of thechannel9. After that, theendoscope1 is drawn back to the inside of thestomach43.
• As shown inFIGS. 27 and 28, theforceps60 is passed through thechannel9 of theendoscope1 drawn back to the inside of thestomach43. Theforceps60 grasps theknot31 of thesuture thread25 existing in theabdominal cavity44 side, and draws thesuture thread25 and thestopper26 into the inside of thestomach43 through theperforation42. As shown inFIG. 29, when thestopper26 is pressed against the tissue by theouter sheath61, thesuture tool16 tightens up the tissue, and thereby theperforation42 is sutured.
• In this embodiment, after observation of the inner side of thestomach43 by using theendoscope1, theendoscope1 is moved to the outer side of thestomach43 to check by theobservation device7 from theabdominal cavity44 side that other tissues do not exist in the area around theperforation42. After that, theneedle14 is thrust into the tissue from the outer side to mount thesuture tool16 and suture theperforation42 while maintaining theendoscope1 passing through theperforation42. Accordingly, other tissues can be easily prevented from being sutured together when suturing by using theendoscope1.
Third Embodiment
• In this embodiment, thesame endoscope1 andsuture instrument11 as in the first embodiment are used. Descriptions that overlap with the first embodiment will be omitted.
• A suturing method of this embodiment will be explained. As shown inFIG. 5, theendoscope insertion part6 is inserted in the vicinity of theperforation42 to observe theperforation42 from the inside of thestomach43. Next, as shown inFIG. 23, theendoscope insertion part6 is moved from theperforation42 into theabdominal cavity44, and an area around theperforation42 is then observed from theabdominal cavity44 side by the observation device (first observation device)7 of theendoscope insertion part6. After checking that other tissues do not exist in the area around the perforation42 (the position through which theneedle14 is passed, the puncture position, or the position at which theanchor27 is placed), theendoscope insertion part6 is drawn back to the inside of thestomach43. Next, thesuture instrument11 which is passed through thechannel9 is projected. As shown inFIG. 30, the tip portion of thesuture instrument11 is moved from theperforation42 to theabdominal cavity44. The tip portion of thesuture instrument11 is then bent to face the outer side of thestomach43 and an area around theperforation42 in theabdominal cavity44.
• As shown inFIG. 31, thesuture instrument11 projects theneedle14 from theouter sheath12, and theneedle14 penetrates the tissue around theperforation42 from theabdominal cavity44 side into the inside of thestomach43. It is preferable that thestopper26 be made to enter the inside of thestomach43 when theneedle14 is projected from theouter sheath12. As shown inFIG. 32, after theneedle14 penetrates the tissue, thefirst anchor27 is pushed out and ejected to the inner side of thestomach43. As shown inFIG. 33, after placement of twoanchors27 inside thestomach43 so as to sandwich theperforation42 therebetween, thesuture instrument11 is drawn back to the inside of thestomach43, and contained in thechannel9. As shown inFIG. 34, theforceps60 is then passed through thechannel9, and the tissue is tightened up by thesuture tool16 using theforceps60 to suture theperforation42. The suturing method is the same as in the second embodiment.
• In this embodiment, after the inner side and the outer side of thestomach43 are sequentially observed by theobservation device7 of theendoscope1 to check that other tissues do not exist in an area around theperforation42, theendoscope1 is drawn back to the inside of thestomach43, and the tissue is punctured with theneedle14 from the outer side of thestomach43. Accordingly, other tissues can be easily prevented from being sutured together when suturing by using theendoscope1.
• Next, modified examples of this embodiment will be explained. As shown inFIG. 23, after observing the outer side of thestomach43 by using theobservation device7 of theendoscope insertion part6, theendoscope insertion part6 is drawn back to the inside of thestomach43. After that, thesuture instrument11 is projected from theendoscope insertion part6 present in thestomach43, and theneedle14 is thrust from the inner side to the outer side of thestomach43, as shown inFIG. 35. After placement of theanchor27 at the outer side of thestomach43, thesuture tool16 is tightened up to suture theperforation42, as shown inFIGS. 11 and 12. In this case, other tissues can be easily prevented from being sutured together when suturing by using theendoscope1.
• As shown inFIG. 36, achannel91 may be provided at the periphery of theendoscope insertion part6, and thesuture instrument11 may be passed through thischannel91. Moreover, thesuture instrument11 may be directly provided parallel to the periphery of theendoscope insertion part6. The tip portion of thesuture instrument11 is constructed so as to be able to be independently bent.
Fourth Embodiment
• In this embodiment, a preferred suture instrument for the suturing method of the third embodiment is described.
• As shown inFIG. 37 andFIG. 38, atreatment portion103 that is a tip position changing mechanism is fixed at the tip which is the remote end of asheath102 that is a flexible base in asuture instrument101. Thetreatment portion103 has asupport member104 that is fixed to thesheath102, and afirst forceps piece105 integrally extends from the tip of thesupport member104. Moreover, a second forceps piece106 (opening-closing member) is supported to thesupport member104 so as to freely rotate by apin107. A portion of thesecond forceps piece106 that is more to the base end side than thepin107 is pulled into thesupport member104 and connected to alink mechanism108. Thelink mechanism108 is connected to aforceps wire109 that is passed through thesheath102 so as to be able to freely move forward or backward. When theforceps wire109 is moved forward or backward, thesecond forceps piece106 rotates with respect to thesupport member104, and so it is possible to open and close the pair offorceps pieces105,106. Theoperation unit17 that performs the opening-closing operation (refer toFIG. 1) is fixed to the base end of thesheath102. Note that thefirst forceps piece105 may be constituted to perform the opening-closing operation.
• Slits110,111 are formed in the pair offorceps pieces105,106, respectively, along the lengthwise direction thereof. Ahollow needle112 is disposed in theslit111 of thesecond forceps piece106. Atip112A on the distal end side of theneedle112 that functions as an anchor holding instrument is disposed at the distal end portion of thesecond forceps piece106, and is supported to rotate freely at thesecond forceps piece106 by apin113. The base end side of theneedle112 is disposed at the base end side of theslit111 and is asharp tip112B. In the state shown inFIG. 37 andFIG. 38, theentire needle112 is housed in theslit111 of thesecond forceps piece106 in the closed state. Theneedle112 is approximately parallel with the lengthwise direction of thesheath102, and thesharp tip112A faces the base end side, that is, the proximal end side, of thesheath102.
• Two anchors27 of thesuture tool16 are housed inside of theneedle112. Aslit112C extends to a predetermined length in theneedle112 from thesharp tip112B to thetip112A, and thesuture thread25 is drawn out from thisslit112C.
• Apusher sheath115 is connected to the side of thetip112A of theneedle112. Thepusher sheath115 passes through therespective slits110,111 of the pair offorceps pieces105,106 and extends along thesheath102 to be drawn out to the hand side. Thepusher20 that pushes out theanchors27 of thesuture tool16 is passed in thepusher sheath115 so as to be able to freely move forward or backward.
• As shown inFIG. 39, a position operating device (operation unit121) that operates the tip position changing mechanism is used by being pulled out from theendoscope1. Theoperation unit121 has anoperation unit body122 at which the base end portion of thesheath102 is fixed. Aring122A for placing a finger is provided on theoperation unit body122, and aslider123 that is able to freely move forward or backward in the lengthwise direction of thesheath102 is attached further to the distal end side than thering122A. Theforceps wire109 is fixed to theslider123, and when theslider123 is made to move forward or backward with respect to theoperation unit body122, the pair offorceps pieces105,106 can be opened and closed. Moreover, in theoperation unit body122, apusher sheath115 is passed to be able to freely move forward or backward. Thepusher sheath115 is drawn out from a position that is separated from theslider123 by theoperation unit body122 branching into two lines. Apusher sheath knob124 is provided so as to be easily grasped by an operator at the end portion of thepusher sheath115 that is drawn out from theoperation unit body122. Thepusher20 is further drawn out from thepusher sheath knob124. Apusher knob125 is provided so as to be easily grasped by an operator at the end portion of thepusher20.
• When suturing a perforation, as shown inFIG. 5, theendoscope insertion part6 is inserted until the vicinity of theperforation42, and performs observation of theperforation42 from within thestomach43. Next, as shown inFIG. 23, 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 an area around the perforation42 (the position through with theneedle112 passes, the puncture position, or the position where theanchor27 is placed), theendoscope insertion part6 is drawn back into thestomach43.
• Thetreatment portion103 is protruded through theperforation42 to the outer side of the organ that is the suture object (for example, the stomach43) with the pair offorceps pieces105,106 closed. By pushing in theslider123 of theoperation unit121, thesecond forceps piece106 opens with respect to thefirst forceps piece105. Thesecond forceps piece106 that include theneedle112 moves in a direction intersecting with the axial line of thesheath102. Moreover, by gripping thepusher sheath knob124, thepusher sheath115 is pushed out. As shown inFIG. 40, theneedle112 that is pushed by thepusher sheath115 rotates about thepin113 to come out from theslit111 of thesecond forceps piece106, and thesharp tip112B of theneedle112 faces the proximal side of thesheath102, that is, the outer surface of the tissue around theperforation42, at a position that is offset with respect to the axial line of thesheath102.
• When theentire suture instrument101 is moved backward out after aligning with the position where thesharp tip112B of theneedle112 is to be thrust in, theneedle112 penetrates thestomach43 from the outer side to the inner side. By grasping thepusher knob125, as shown inFIG. 41, to push in thepusher20, afirst anchor27 is pushed out from theneedle112. Thereafter, when theentire suture instrument101 is moved forward, theneedle112 is removed from the tissue. Thesuture thread25 penetrates through the tissue, and thefirst anchor27 remains in thestomach43.
• Next, thesuture instrument101 is rotated about its axial line, and theneedle112 is moved to the opposite side of the location where thesuture thread25 was passed centered about theperforation42. Once again, when thesuture instrument101 is moved backward, theneedle112 penetrates thestomach43 from the outer side to the inner side. As shown inFIG. 42, thepusher20 is pushed further in, and asecond anchor27 is pushed out from theneedle14. When theneedle11 is drawn out from the tissue, by grasping thepusher sheath knob124, thepusher sheath115 is retracted, and theneedle112 is housed in theslit111 of thesecond forceps piece106. Moreover by pulling theslider123, the pair offorceps pieces105,106 is closed.
• When thesuture instrument101 is pulled out of theperforation42 into thestomach43, theperforation42 is closed by tightening thesuture tool16 with theforceps60 similarly toFIG. 28 andFIG. 29.
• According to this embodiment, in a suture method that passes theneedle112 from the outer side to the inner side of the tissue, it is possible to reliably pierce theneedle112. Since it is possible to place thesuture tool16 just by the opening-closing operation and the extending and retracting of thepusher sheath115 and thepusher20, the operation is simple. Note that the pair offorceps pieces105,106 can be used for holding tissue.
Fifth Embodiment
• In this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
• As shown inFIG. 43, asuture instrument131 has alumen134 in asheath132 that is a flexible base. Anattraction surface132A is provided so as to close the distal end of thelumen134. Anattraction instrument136 is passed in thelumen134 so as to move freely forward or backward. Thedistal end portion136A of theattraction instrument136 is made from a magnetic material.
• At the distal end of thesheath132, asupport portion137 extends approximately along the lengthwise direction so as to avoid the opening of thelumen134. At the distal end of thesupport portion137, ahollow needle139 is supported so at to rotate freely by apin138. Theneedle139 extends in an elongated manner from the end portion of the distal end side that is supported by thepin138, and the other end portion at the base end side becomes asharp tip139A. In the initial state, theneedle139 is approximately parallel to thesheath132, and thesharp tip139A is aimed at the base end side of thesheath132, that is, the proximal end side.
• Anoperation wire140 that constitutes the tip position changing mechanism is fixed to thesharp tip139A of theneedle139. Theoperation wire140 passes through the distal end of thesupport portion137 to be drawn out to the hand side. When theoperation wire140 is pulled, theneedle139 rotates about thepin138, and rises as shown by the virtual lines. Theoperation wire140 has a predetermined hardness, and so by pushing in theoperation wire140, theneedle139 is housed so as to approximately follow thesupport portion137, that is, to become approximately parallel to the lengthwise direction of thesheath132. Note that by providing a groove in thesupport portion137, theoperation wire140 passes along the groove, and so dropping out of theoperation wire140 is prevented.
• Anchors141 of thesuture tool16 are housed in theneedle139. In thesuture tool16, besides the twoanchors141 being manufactured from permanent magnets, it is the same as thesuture tool16. Theanchors141 are housed in theneedle139 so that the same magnetic poles face each other. InFIG. 43, the S-poles face each other.
• As shown inFIG. 44, anoperation unit145 that is a position operating device of thesuture instrument131 has anoperation unit body146 at which thesheath132 is fixed. Aring146A for placing a finger is provided on theoperation unit body146, and aslider147 that is able to freely move forward or backward in the lengthwise direction of thesheath132 is attached. Theoperation wire140 is attached to theslider147, and when theslider147 is made to move forward or backward, theneedle136 can be housed and deployed. Moreover, theoperation unit body146 branches into two lines, and theattraction instrument136 is drawn out to a position that is separated from theslider147. Aknob148 that can be easily grasped by the operator is formed at the end portion of theattraction instrument136.
• The procedure when suturing theperforation42 with thissuture tool131 involves sequentially observing the inner side and outer side of thestomach43 similarly to the third embodiment. When piercing theneedle139, the treatment portion133 is protruded from theperforation42 to the outer side. When theoperation wire140 is pulled by operating theslider147 of theoperation unit145, theneedle139 deploys by inclining in the direction intersecting with the axial line of thesheath132 centered on thepin138. As shown inFIG. 45, thesharp tip139A of theneedle139 is directed toward the tissue, that is, the proximal end side of thesheath132. When theentire suture instrument131 is moved backward, theneedle139 penetrates thestomach43 from the outer side to the inner side. By grasping theknob148 that is pulled out from theoperation unit145 to push in theattraction instrument136, as shown inFIG. 46, theattraction instrument136 is moved toward theneedle139 from the inner side of thestomach43. An attraction works between thedistal end portion136A of theattraction instrument136 and thefirst anchor141, whereby theanchor141 is drawn toward theattraction surface132A, and as shown inFIG. 47, thefirst anchor141 is taken out from theneedle139. After thefirst anchor141 has been suctioned onto theattraction surface132A, as shown inFIG. 48, by moving theattraction instrument136 backward in thelumen134, it is possible to cause thefirst anchor141 to separate from theattraction surface132A.
• After removing theneedle139 from the tissue by moving theentire suture instrument131 forward, it is rotated about its axial line, to move theneedle139 to the opposite side centered about theperforation42. Similarly, by moving thesuture instrument131 backward, theneedle139 penetrates thestomach43 from the outer side to the inner side. By bringing theattraction instrument136 closer, thesecond anchor141 is pulled out. By moving forward theentire suture tool131, theneedle139 is removed from the tissue, and after theneedle139 is aligned with thesupport portion137, thesuture tool131 is removed from theendoscope1. Then, theperforation42 is closed by tightening thesuture tool16 with theforceps60 similarly toFIG. 28 andFIG. 29.
• According to this embodiment, in a suture method that passes theneedle139 from the outer side to the inner side of the tissue, it is possible to reliably pierce theneedle139. Since only a rotation operation of theneedle139 and forward-backward movement of theattraction instrument136 are required, the operation is simple.
Sixth Embodiment
• In this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
• As shown inFIG. 49, twolumens153,154 are formed approximately parallel in the lengthwise direction in thesheath152 that is a flexible base. Thefirst lumen153 has anopening153A at the distal end, and aneedle155 is passed therethrough so as to move freely forward or backward. Thesecond lumen154 has adistal end opening154A which is formed further to the base end side than the distal end opening153A of thefirst lumen153.
• Theneedle155 is hollow and long, and is made from a shape-memory alloy. Asharp tip155A of theneedle155 protrudes from the distal end opening153A of thefirst lumen153, and after being elastically deformed in an approximate U-shape, is inserted from the distal end opening154A to thesecond lumen154 so as to be capable of being freely taken out and put in. That is, thesharp tip155A is disposed approximately parallel with thesheath152 and disposed facing the proximal end of thesheath152. Theneedle155 is an anchor housing tool in which two anchors27 (not illustrated inFIG. 49) of thesuture tool16 are housed at thesharp end portion155A. Theanchors27 can be pushed out by thepusher20 that is passed through theneedle155. Note that theneedle155 is curved in a loop shape and stores a shape so that thesharp tip portion155A faces the base end side. As shown inFIG. 50, when pulled out from thesecond lumen154, thecurved needle155 deploys in the direction of intersecting the axial line of thesheath152. An external width WD1 of theneedle155 at this time is greater than an external width WD2 of thesheath152. Note that in this embodiment, the curved portion of theneedle155 is a tip position changing mechanism, and the end portion at the hand side of theneedle155 is a position operation device.
• The procedure when suturing theperforation42 with thissuture tool151 involves sequentially observing the inner side and outer side of thestomach43 similarly to the third embodiment. As shown inFIG. 51, when piercing theneedle155, thesuture instrument151 is protruded to the outer side from theperforation42 until the formation position of the distal end opening154A of thesecond lumen154. When theneedle155 is pushed with respect to thesheath152, thesharp tip155A of theneedle155 comes out from thesecond lumen154. As shown inFIG. 52, theneedle155 deploys due to the self-restoring force, and thesharp tip155A moves from a position that is approximately parallel to thesheath152 to a position that is offset from the axial line of thesheath152 to be directed at tissue around theperforation42. By moving theentire suture instrument151 backward, theneedle155 penetrates thestomach43 from the outer side to the inner side. When oneanchor27 is pushed out and released by thepusher20, thesuture instrument151 is moved forward to remove theneedle155 from the tissue, and then similarly passed through tissue on the opposite side of theperforation42. When asecond anchor27 is pushed out and released by thepusher20, theneedle155 is removed from the tissue and then thesuture instrument151 is withdrawn. Then, theperforation42 is closed by tightening thesuture tool16 with theforceps60 similarly toFIG. 28 andFIG. 29.
• According to this embodiment, theneedle155 that is made to have a shape memory is curved to be housed in thesecond lumen154, whereby thesuture instrument151 can be readily passed through theendoscope1 and theperforation42. When deploying theneedle155, it only needs to be moved forward, so the operation is easy.
• Note that instead of theanchors27 and thepusher20, it is possible to use theanchors141 and theattraction instrument136 of the fourth embodiment.
Seventh Embodiment
• In this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
• As shown inFIG. 53, in asuture instrument161, ahollow needle163 that is an anchor holding instrument is passed through asheath162 that is a flexible base. Theneedle163 has flexibility, and after a curvingportion164 that is a deflection mechanism is provided at a portion protruding from thesheath162, asharp tip163A that is to be passed through tissue is provided. The curvingportion164 has a constitution in which a plurality of curvingpieces165 is connected in the lengthwise direction. Each curvingpiece165 consists of a hollow member, and each base end portion and distal end portion thereof is attached by apin167 to another adjacentcurving piece165 so as to rotate freely. Thepins167 that mutually link eachcurving piece165 are all disposed approximately in parallel. Moreover, a curvingcontrol member168 that consists of a shape-memory alloy is extended between eachcurving piece165. Each curvingcontrol member168 is disposed at the same position in the circumferential direction viewed from the center line of theneedle163, and each is wound in a coil shape in the initial state. That is, in the initial state, theneedle163 is disposed approximately parallel with the axial line of thesheath162, and thesharp tip163A faces the remote end direction of thesheath162. The curvingcontrol member168 can be restored to an approximately straight shape by passing electricity, heat generation, or body temperature. For this reason, the position operation device of thissuture instrument161 is thecurving control member168 itself in the case of restoring to the original shape by a device that passes electricity through or generates heat in the curvingcontrol member168, or by body heat.
• The procedure when suturing theperforation42 with thissuture instrument161 involves sequentially observing the inner side and outer side of thestomach43 similarly to the third embodiment.
• In the state of contracting the curvingcontrol members168 into a coil shape, that is, in the state of theneedle163 being disposed so as to be approximately parallel to thesheath162, theneedle163 is passed through theperforation42. When the curvingportion164 is projected to the outer side from theperforation42, electrical current is supplied to the curvingcontrol members168 or the curvingcontrol members168 are heated. When eachcurving control members168 is extended by reverting to the original shape, as shown inFIG. 54, the adjacent curvingpieces165 and theneedle163 are pushed in a certain direction. As a result, the curvingportion164 curves substantially in a U-shape, and thesharp tip163A of theneedle163 is directed from the remote end direction of thesheath162 to the proximal end side, that is, the tissue.
• By extending and retracting movement of theneedle163, theneedle163 penetrates thestomach43 from the outer side to the inner side, and thefirst anchor27 is pushed out from theneedle163 by thepusher20. When thesuture thread25 is passed through at two locations that sandwich theperforation42 and theanchors27 are pushed out and released into the inner side of thestomach43, thesuture instrument161 is withdrawn from theendoscope1. Then, theperforation42 is closed by tightening thesuture tool16 with theforceps60 similarly toFIG. 28 andFIG. 29.
• According to this embodiment, by using a shape-memory alloy in a portion of the curvingportion164 of theneedle163 to perform curving in the body, when withdrawing thesuture instrument161, it is possible to perform handling with theneedle163 in a straight line, and so the operation is easy.
• Here, the curvingcontrol members168 that consist of a shape-memory metal are not limited to a shape that winds a coil in a coil shape. Also, the curvingcontrol members168 may be a plate-shaped member that curves by being supplied electrical current or the like. It is possible to use the plate-shapedcurving control members168 together with the curvingpieces165 or in place of the curvingpieces165.
Eighth Embodiment
• In this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
• As shown inFIG. 55, in a suture instrument171 aneedle14 is passed in asheath172 that is a flexible base so as to be able to move backward or forward. Aballoon173 that is a deflection mechanism is integrally formed at the distal end portion of thesheath172. Theballoon173 is provided at only a portion of the outer circumferential surface, and does not continue over the entire circumference. Therefore, it is offset from the center line of theneedle14 that passes through the center of thesheath172.
• Accordingly, in the state of the sharp tip of theneedle14 being protruded to the outer side from the perforation427 a fluid supply device (position operation device) is attached to the end portion of a lumen that is not illustrated, and so when a fluid is supplied, theballoon173 swells as shown inFIG. 56 andFIG. 57, and thesheath172 curves by being pressed by theballoon173. Since theballoon173 is disposed so that thesheath172 curves in an approximate U-shape, the sharp tip of theneedle14 is directed from the distal direction of thesheath172 toward the proximal end side, that is toward the tissue, and so it is possible to pierce through the tissue from the outer side to the inner side. Here, as shown inFIG. 58, anoutside organ175 that is in the area of the tissue that is the suture object is excluded by the swelling of theballoon173.
• In this embodiment, since it is possible to curve theneedle14 in an approximate U-shape by swelling theballoon173, it becomes possible to pierce through the tissue from the outer side to the inner side with a simple operation. Moreover, since theballoon173 excludes theoutside organ175, it is possible to simply perform suturing even at locations that are in the proximity of theoutside organ175.
Ninth Embodiment
• In this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
• As shown inFIG. 59, in a suture instrument181 aneedle183 is passed in asheath182 that is a flexible base so as to be able to move backward or forward. Twolumens184,185 are formed approximately parallel in thesheath182. Since a curvingportion182A that functions as a deflection mechanism is formed at the distal end that is a remote end of thesheath182, afirst lumen184 forms anopening184A at the side portion by being curved approximately 90 degrees. Ahollow needle183 that is an anchor holding instrument is passed through thefirst lumen184 so as to freely move forward or backward. It is preferable to manufacture theneedle183 with a super-resilient alloy, so that even when passing through a lumen that is positioned at the curvingportion182A, a permanent deformation is not produced.
• Thesecond lumen185 is curved by approximately 90 degrees by the curvingportion182A, and at further to the base end side than thefirst lumen185, anopening185A is formed at the same side portion in the circumferential direction. Anoperation wire186 is passed through thesecond lumen185 so as to be able to freely move forward or backward. Theoperation wire186 is fixed to the distal end portion of an erectinghook188 that is supported in thesheath182 so as to freely rotate by apin187 further to the base end side than theopening185A. The erectingbook188 can be housed in a recessedportion189 that is formed in thesheath182 so that the distal end portion thereof faces the hand side. Thereby, when theoperation wire186 is pulled, the erectinghook188 deploys to the outer side as shown by the virtual lines.
• As shown inFIG. 60, anoperation unit190 that is the position operation device of thesuture instrument181 is constituted to include abase end portion182B of thesheath182. When thebase end portion182 is grasped and moved forward or backward, it is possible to move theentire suture instrument181 forward and backward. Theneedle183 and theoperation wire186 are separately pulled out from thebase end portion182B. Anoperation unit body191 is fixed to theneedle183. A ring19A for placing a finger is provided on theoperation unit body191, and aslider192 that is able to freely move forward and backward in the lengthwise direction is attached. Apusher20 is fixed to theslider192. Aknob193 that can be easily grasped by the operator is formed at the end portion of theoperation wire182.
• As shown inFIG. 61, when suturing theperforation42, in the state of theneedle183 being disposed at the base end side of thefirst lumen184, that is, the sharp tip of theneedle183 being housed approximately parallel in thesheath182, it is protruded to the outer side of theperforation42. When the erectinghook188 is sent to the outer side through theperforation42, by pulling theoperation wire186 the erectinghook188 is deployed. When the tissue around theperforation42 is caught on the distal end of the erectinghook188 and theentire suture instrument181 is moved backward, the tissue that is caught on the erectinghook188 is drawn in toward theendoscope1. As shown inFIG. 62, since orientation of theopening184A of thefirst lumen184 and the tissue that is drawn in intersect, when theneedle183 is moved forward, the sharp tip thereof is deflected approximately 90 degrees from the remote direction of thesheath182 to the direction heading toward the proximal end, and so it is possible to pierce through the tissue that is caught on the erectinghook188.
• When theneedle183 is pierced through and thefirst anchor27 has been pushed out and released, after theneedle183 is removed theentire suture instrument181 is moved forward. The engagement between the erectinghook188 and the tissue is thus released. Theneedle183 is then pieced through the tissue on the opposite side viewed from theperforation42 while similarly drawing in the tissue with the erectinghook188 and thesecond anchor27 is pushed out. After thesuture instrument181 has been removed from theendoscope1, theperforation42 is closed by tightening thesuture tool16 with theforceps60 similarly toFIG. 28 andFIG. 29.
• According to this embodiment, since theneedle183 is pierced through the tissue after it has been drawn in with the erectinghook188, it is possible to place thesuture tool16 with a simple operation. Moreover, by drawing in the tissue with the erectinghook188, it is possible to observe with theendoscope1 the position and piercing process when thrusting theneedle183 without curved deformation of theneedle183 by approximately 180 degrees as in other embodiments. Instead of hooking the tissue on the erectinghook188, the tissue may also be sandwiched between the erectinghook188 and thesheath182.
• Here, since the curvingportion182A at the distal end of thesheath182 may be an angle that allows theneedle183 to pierce through the tissue in cooperation with the erectinghook188, and may be greater than 0 degrees and equal to or less than 90 degrees, compared to the case of curving by approximately 180 degrees, the operation of moving thepusher20 forward and backward and pushing out of theanchors27 can be reasonably performed with a light force.
Ninth Embodiment
• In this embodiment, a preferred suture instrument for the suture method in the third embodiment is described.
• As shown inFIG. 63 andFIG. 64, in asuture instrument201, aninner sheath13 that functions as an anchor holding instrument that is a flexible base is passed inside of a flexibleouter sheath12 so as to freely move forward and backward. In theinner sheath13, aslit15 that opens at the distal end is provided along the lengthwise direction of the side portion. In the interior of theinner sheath13, twoanchors27 of thesuture tool16 are housed in line. Thepusher20 is made to abut the baseend side anchor27. Note that as the operation unit of this suture instrument210, it is possible to use the same one as theoperation unit17 shown inFIG. 1.
• In thissuture instrument201, a treatment instrument such as a high-frequency knife and the like is used for passing thesuture thread25 of thesuture tool16.FIG. 65 shows a high-frequency knife that is an example of a treatment instrument. The high-frequency knife211 has along sheath212 having flexibility, and anoperation unit213 is provided at the base end of thesheath212. Aslider215 that is able to move forward and backward with respect to theoperation unit body214 and aring214A for placing a finger are provided in the operation unit23. The end portion of along electrode216 is fixed to theslider215. Theelectrode216 is electrically connected to anelectrode cable217 via aterminal215A that is provided in theslider215. Theelectrode cable217 is connected to a high-frequency power supply not illustrated. Theelectrode216 passes through thesheath212 so as to be capable of freely moving forward and backward, and extends to the distal end of thesheath212. When theslider215 is moved backward, theelectrode216 is housed in thesheath212. When theslider215 is moved forward, the distal end portion of theelectrode216 protrudes from thesheath212.
• As shown inFIG. 66, when suturing theperforation42, the high-frequency knife211 is passed through thechannel9 of theendoscope1, and asmall incision hole220 is formed from the inner side to the outer side in tissue around theperforation42. Specifically, when the predetermined position where the small incision hole is to be formed is confirmed, theslider215 is moved forward to cause theelectrode216 to protrude from thesheath212. By supplying a high-frequency current from the high-frequency power supply, the distal end of theelectrode216 is pressed against the predetermined position to form thesmall incision hole220. When thesmall incision hole220 is formed at two locations sandwiching theperforation42, the supply of high-frequency current is stopped. After housing theelectrode216 in thesheath212, the high-frequency knife211 is removed from the endoscope.
• Next, thesuture thread25 is passed through thesmall incision hole220 and then anchors27 are placed one at a time. Thesuture instrument201 is passed through theendoscope1, and theinner sheath13 is protruded from theouter sheath12. At this time, theinner sheath13 abuts thestopper26 with a wide area, and pushes out thestopper26 from theouter sheath12 into thestomach43.
• As shown inFIG. 68, theouter sheath12 of thesuture instrument201 is protruded into theabdominal cavity44 through theperforation42. The distal end portion of theouter sheath12 is curved, and theouter sheath13 is directed from a direction toward the remote end of thesuture instrument201 to a direction toward the proximal end, that is, to the tissue. Moreover, by moving theinner sheath12 forward, it passes through thesmall incision hole220 from the outer side to the inner side. Since theinner sheath13 protrudes from theabdominal cavity44 into thestomach43, when thepusher20 is moved forward as shown inFIG. 69, thefirst anchor27 is pushed out and released in thestomach43. Then, theinner sheath13 is drawn out from thesmall incision hole220. Thesuture tread25 passes through thesmall incision hole220. Moreover, theinner sheath13 is similarly passed through thesmall incision hole220 on the opposite side. When the second anchor is released into the inside of thestomach43, thesuture instrument201 is pulled back, causing thesuture thread25 to pass through thesmall incision hole220. Thesuture instrument201 is pulled back into thestomach43, and when thesuture tool16 is tightened similarly to the previous embodiments, theperforation42 is sutured.
• Since thissuture instrument201 is of a constitution that does not have a needle, a wide contact surface with thestopper26 is provided, and so thestopper26 can easily and reliably be pushed out from theouter sheath12.
• This invention can be widely applied without being limited to the above-mentioned embodiments.
• For example, in each suture instrument from the fourth embodiment to the eight embodiment, it is possible to use an anchor holding instrument such as shown in the ninth embodiment in place of a needle, with the anchors being released after passing the anchor holding instrument through a small incision hole that is formed with another treatment tool.
• For example, theendoscope1 may be inserted from the anus into the large intestine which is an example of a hollow organ. In this case, a perforation formed in the large intestine is sutured. Although theperforation42 is described as being already formed, the procedure of the above-mentioned embodiment may be carried out after forming theperforation42 by using theendoscope1. In this case, theendoscope1 is inserted from a natural opening into the inside of thestomach43, and a predetermined incision portion is checked by theobservation device7 provided at the tip of theendoscope insertion part6. After that, the predetermined incision portion is incised after passing a high-frequency knife or the like through thechannel9 of theendoscope1 to form theperforation42.
• When thestomach43 is widely incised and theperforation42 is sutured by using at least threesuture tools16,suture tools16 plurally lined up are preferably sequentially tightened up from one end thereof. In an example shown inFIG. 70, asuture tool16a, asuture tool16b, asuture tool16c, asuture tool16d, and asuture tool16eare tightened up in this order, for example. Since theperforation42 is sutured from one end thereof, and the size of theperforation42 can be gradually diminished, suturing can be easily carried out. Alternatively, thesuture tool16 at the center of thesuture tools16 lined up may be tightened up first, followed by tightening thesuture tools16 at the center positions between thesuture tool16 tightened up at the center position and thesuture tools16 at the ends thereof. In the example shown inFIG. 70, thesuture tool16cis tightened up first, thesuture tool16band thesuture tool16dare then tightened up, and thesuture tool16aand thesuture tool16eare finally tightened up. Since the center position of the opening is always sutured, the degree of slippage of suture positions can be diminished.
• In the suture instrument in accordance with the first aspect of the present invention, when the anchor holding instrument is passed through a perforation and placed on the outer side, by driving the tip position changing mechanism with the position operation device, the anchor holding instrument is moved in a direction that intersects with the axial line in the lengthwise direction of the base. When the base is pulled back in this state, since the anchor holding instrument passes through the tissue around the perforation from the outer side to the inner side, when the anchors are pushed out from the tip of the anchor holding instrument, it is possible to eject the anchors in the state of the suture thread passing through the tissue.
• In the suture instrument in accordance with the second aspect of the present invention, by offsetting the anchor holding instrument with respect to the axial line of the base, it is possible to point the tip of the anchor holding instrument toward the tissue around the
• In the suture instrument in accordance with the third aspect of the present invention, by inclining the anchor holding instrument, it is possible to point the tip of the anchor holding instrument toward the tissue around the perforation.
• In the suture instrument in accordance with the fourth aspect of the present invention, since it is possible to pierce the tissue with the anchor holding instrument, there is no need to form a hole in the tissue in advance with another treatment tool or the like.
• In this suture instrument in accordance with the fifth aspect of the present invention, when having pierced through the tissue with the anchor holding instrument, it is possible to push out and eject the anchors as is.
• In this suture instrument in accordance with the sixth aspect of the present invention, when the attraction instrument is brought near an anchor, the anchor is ejected from the anchor holding instrument.
• In this suture instrument in accordance with the seventh aspect of the present invention, when the anchor holding instrument is passed through a perforation and placed on the outer side, by driving the deflection mechanism with the position operation device, the orientation of the anchor holding instrument is made to point to the proximal end side of the base. When the base is pulled back in this state, since the anchor holding instrument passes through the tissue around the perforation from the outer side to the inner side, when the anchors are pushed out from the tip of the anchor holding instrument, the
• In this suture instrument in accordance with the eighth aspect of the present invention, by inclining the anchor holding instrument, it is possible to point the distal end of the anchor holding instrument to the tissue around the perforation.
• In this suture instrument in accordance with the ninth aspect of the present invention, since it is possible to pierce through the tissue with the anchor holding instrument, there is no need to form a hole in the tissue in advance with another treatment tool or the like. instrument consists of a hollow needle, and the anchors are disposed in the needle.
• In this suture instrument in accordance with the tenth aspect of the present invention, when having pierced through the tissue with the anchor holding instrument, it is possible to push out and eject the anchors as is.
• In this suture instrument in accordance with the eleventh aspect of the present invention, when the attraction instrument is brought near an anchor, the anchor is ejected from the anchor holding instrument.
• In accordance with the present invention, since it is possible to deploy the anchor holding instrument to make it point toward tissue around a perforation in the state of the base being passed through the perforation, if the anchor holding instrument is moved toward the tissue in this state, it is possible to make it pass from the outer side to the inner side of the tissue. Accordingly, it is possible to eject the anchors from the outer side to the inner side of the tissue with a simple operation.
INDUSTRIAL APPLICABILITY
• The suture method and suture instrument according to this invention may be preferably utilized for medical applications.

Claims (11)

1. A suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, comprising:

a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility;

an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is approximately pointed in the direction of the proximal end of the base;

a tip position changing mechanism that is provided for changing the tip position of the anchor holding instrument and causes the anchor holding instrument to move in a direction that intersects with the axial line of the lengthwise direction of the base; and

a position operation device that operates the tip position changing mechanism at the hand side and operates the tip position of the anchor holding instrument.

2. The suture instrument according toclaim 1, wherein the tip position changing mechanism changes the position by causing the anchor holding instrument to move to a position that is offset from the axial line in the lengthwise direction of the base.

3. The suture instrument according toclaim 1, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.

4. The suture instrument according to any one ofclaims 1 to3, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.

5. The suture instrument according to any one ofclaims 1 to3, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.

6. The suture instrument according to any one ofclaims 1 to5, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward and backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.

7. A suture instrument that is inserted into a body and ejects an elongated anchor to which a suture thread that sutures a perforation is connected and which is placed on tissue, comprising:

a base that extends from a proximal end on a hand side to a remote end that is introduced to tissue and has flexibility;

an anchor holding instrument that is disposed at the remote end of the base, is capable of housing a plurality of the anchors inside, and whose distal end that ejects the anchors is disposed at the remote end side of the base;

a deflection mechanism that is provided for deflecting the tip position of the anchor holding instrument and causes the tip of the anchor holding instrument to deflect from the remote end of the base toward the direction that faces the proximal end; and

a position operation device that operates the deflection mechanism at the hand side and operates the tip position of the anchor holding instrument.

8. The suture instrument according toclaim 7, wherein the tip position changing mechanism changes the position by inclining the anchor holding instrument with respect to the axial line in the lengthwise direction of the base.

9. The suture instrument according toclaim 7 or8, wherein the anchor holding instrument is a needle that has at the distal end a sharp tip.

10. The suture instrument according toclaim 7 or8, wherein the distal end of the anchor holding instrument consists of a hollow needle, and the anchors are disposed in the needle.

11. The suture instrument according to any one ofclaims 7 to10, further provided with an attraction instrument that attracts the anchors with a magnetic force, wherein the attraction instrument is disposed along the base so as to move freely forward and backward, and the anchors and the attraction instrument are both made from a magnetic body, and one of them is a magnet.

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