JP2005161050A - Endoscopic treatment tool - Google Patents

Abstract

An endoscopic treatment tool is provided that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body.
A needle 441 for puncturing a biological tissue is provided. The needle includes a collection member 440 to which a thread 442 for suturing the tissue is fixed and further capable of recovering the needle 441 punctured into the tissue. The recovery member has an outer peripheral portion and an inner hole in which a groove 600 is formed, and is further elongated, and a guide 462 that can guide the recovery member, and an elongated tubular member 681 that can be inserted into the guide. And at least one arm 458 provided at the distal end of the elongated tubular member, and the recovery member 440 includes the elongated tubular member 681 when the arm 458 and the groove 600 are in the guide 462. An endoscopic treatment tool that engages with the endoscope.
[Selection] Figure 6

Description

  The present invention relates to a treatment instrument that can be inserted into a body cavity together with an endoscope.

Medical instruments that can be used for surgery using a laparoscope have been developed. Some of such medical devices include a pair of posts that support a pair of clevises in order to form a large force necessary for grasping a large tissue (see, for example, Patent Document 1).
US Pat. No. 5,171,258

However, in this conventional medical instrument, the post and the clevis interfere with each other, so that the angle that can be formed between the clevis is limited to about 90 °.
On the other hand, when a body cavity is sutured using an endoscope, it is necessary to puncture a living tissue with a needle, and thus there is a treatment tool that can move the needle over a large angle while having a small structure. is necessary. Furthermore, in order to reliably puncture living tissue, it is necessary to transmit a large force to the needle.
Therefore, the conventional technique cannot form an endoscope treatment instrument that requires a large opening / closing angle and a large force transmission.
The present invention has been made based on the above-described circumstances, and an object of the present invention is to provide an endoscopic treatment tool having a structure that further increases the open / close angle and produces a greater force.

  According to one aspect of the present invention, there is provided a treatment instrument that is used together with an endoscope and is operated outside the body to perform a treatment in a body cavity. The treatment instrument includes a needle for puncturing a living tissue, the needle includes a recovery member to which a thread for suturing the tissue is fixed, and a recovery member capable of recovering the needle punctured into the tissue. The member has an outer peripheral portion formed with a groove and an inner hole, and is further elongated, a guide that can guide the recovery member, an elongated tubular member that can be inserted into the guide, and a distal end of the elongated tubular member At least one arm provided in the guide, wherein the recovery member engages the elongated tubular member when the arm and the groove are present in the guide.

  According to the other aspect of this invention, the treatment tool for performing a treatment in a body cavity by using with an endoscope and operating outside a body is provided. The treatment instrument includes a recovery member capable of recovering a needle punctured in a tissue, the recovery member has an outer peripheral portion formed with a protrusion, and is further elongated and has an inner hole. A guide that can guide the member, a tubular member that has a tip provided with a groove, and that can be inserted into the guide; and an elongated tubular member that can be inserted into the tubular member, the protrusion and the groove And the tubular member can be moved forward and backward integrally, and the elongated tubular member and the tubular member are separable from each other.

  According to still another aspect of the present invention, there is provided an endoscope treatment tool that is used together with an endoscope and is operated outside the body to perform a treatment in a body cavity. This treatment tool has a distal end portion inserted into a body cavity, and has a flexible structure that can be operated outside the body, a push rod coupled to the distal end portion of the transmission member, and the push rod coupled to the push rod. Each of the first and second connecting members has a base end portion rotatably connected to the push rod, and a tip end portion, and First and second arm members each having a proximal end portion rotatably connected to a distal end portion of the connection member, and a distal end portion; and a holding member that rotatably holds each distal end portion of the arm member; Each is formed integrally at the tip of the arm member, and can be opened and closed when the transmission member operates the first and second connecting members and the first and second arm members via the push rod. At least one of the first and second actuating members and the first and second actuating members A needle for puncturing a living tissue, a thread attached to the needle, and a recovery member capable of recovering the needle, and one of the first and second actuating members has a loop portion. The recovery member can pass through the loop.

  According to still another aspect of the present invention, there is provided a treatment instrument that is used together with an endoscope and is operated outside the body to perform a treatment in a body cavity. This treatment tool has a distal end portion inserted into a body cavity, and has a flexible structure that can be operated outside the body, a push rod coupled to the distal end portion of the transmission member, and the push rod coupled to the push rod. Each of the first and second connecting members has a base end portion rotatably connected to the push rod, and a tip end portion, and First and second arm members each having a proximal end portion rotatably connected to a distal end portion of the connection member, and a distal end portion; and a holding member that rotatably holds each distal end portion of the arm member; Each is formed integrally at the tip of the arm member, and can be opened and closed when the transmission member operates the first and second connecting members and the first and second arm members via the push rod. At least one of the first and second actuating members and the first and second actuating members An operation member having a needle for puncturing a living tissue, a thread attached to the needle, a recovery member capable of recovering the needle, a cylindrical outer peripheral portion having a groove, and a central axis The operation member can operate the recovery member via the groove when the operation member rotates about a central axis.

  According to still another aspect of the present invention, there is provided a treatment tool that is used with an endoscope and is operated outside the body to perform a treatment in a body cavity, and the treatment tool is used together with the endoscope in a body cavity. Drive means inserted into the body and operated outside the body, an arm member disposed in the body cavity and actuated by the drive means, an actuating member formed integrally with the arm member, and detachable from the actuating member A needle connecting member to be attached and a needle for puncturing a living tissue are provided. A thread for suturing the tissue is fixed to the needle, and the needle is detachably attached to the needle connecting member.

  According to still another aspect of the present invention, there is provided a treatment instrument that is used together with an endoscope and is operated outside the body to perform a treatment in a body cavity. This treatment tool has a distal end portion inserted into a body cavity, and has a flexible transmission member that can be operated outside the body, a push rod connected to the distal end portion of the transmission member, and a push rod that is freely rotatable. First and second connecting members each having a connected base end portion and a tip end portion, a base end portion rotatably connected to the tip end portion of the connection member, and a first end portion, A second arm member, a holding member that rotatably holds the respective distal end portions of the arm member, and a distal end portion of the arm member are integrally formed with the second arm member, and the transmission member is connected via a push rod. Provided on at least one of the first and second actuating members and the first and second actuating members that can be opened and closed when the first and second connecting members and the first and second arm members are actuated; A needle for puncturing tissue, a thread attached to the needle, and collecting the needle Recovery means and an engaging member for engaging the recovery means. The needle and the thread are fixed to the case in advance, and the needle can be attached to the first or second actuating member. The recovery means can be attached to the engaging member.

  According to still another aspect of the present invention, there is provided a treatment instrument that is used together with an endoscope and is operated outside the body to perform a treatment in a body cavity. The treatment instrument is inserted into the body cavity together with the endoscope and is operated outside the body, an arm member disposed in the body cavity and operated by the drive means, and a connection attached to the arm member It has a member and a needle for puncturing a living tissue having a fixing part that can be attached to and detached from the connecting member. A thread for suturing the tissue is fixed to the needle. The treatment instrument further includes an elastic member disposed in the vicinity of the fixing portion, and the connection member and the needle are fixed via the elastic member.

  According to still another aspect of the present invention, there is provided a treatment instrument that is used together with an endoscope and is operated outside the body to perform a treatment in a body cavity. This treatment tool has a distal end portion inserted into a body cavity, and has a flexible transmission member that can be operated outside the body, a push rod connected to the distal end portion of the transmission member, and a push rod that is freely rotatable. First and second connecting members each having a connected base end portion and a tip end portion, a base end portion rotatably connected to the tip end portion of the connection member, and a first end portion, A second arm member, a holding member that rotatably holds the respective distal end portions of the arm member, and a distal end portion of the arm member are integrally formed with the second arm member, and the transmission member is connected via a push rod. The first and second actuating members that can be opened and closed when the first connecting member and the first and second arm members are actuated, and at least one of the first and second actuating members, A needle for puncturing tissue and a thread attached to the needle are provided. The thread extends from a portion fixed to the needle in a direction different from that of the needle, and a notch through which the thread passes is formed at at least one end of the first and second actuating members.

  As is apparent from the above, according to the present invention, it is possible to provide an endoscopic treatment tool having a structure that further increases the opening / closing angle and produces a greater force.

[First Embodiment]
1 to 29 show an endoscopic suturing system according to a first embodiment of the present invention. In the system of each embodiment described below, an endoscopic suturing device is used, but instead, for example, a grasping forceps, a thread trimming forceps, an acupuncture forceps, a hot biopsy forceps, a rotating clip device, or the like The treatment tool may be used.

  As shown in FIG. 1, an endoscopic suturing system 1 according to this embodiment includes an endoscopic system 2, a suturing device 3, and a suture thread 4. The suture thread 4 is preferably formed in a monofilament shape or a stranded wire shape using a material such as nylon, polyester, silk, fluorine resin, or bioabsorbable. The endoscope system 2 includes an endoscope 12, an image processing device 14, a light source device 15, an observation monitor 13, and an aspirator 11, similarly to a commonly used electronic endoscope system. The endoscope 12 is connected to the light source device 15 via a universal cord, and the image signal sent from the CCD camera 10 (see FIG. 8A) at the tip is processed by the image processing device 14 and then displayed on the monitor 13. Is done. As best shown in FIG. 2, the endoscope 12 has one forceps channel 6, but may be of a type having two forceps channels instead.

  As shown in FIG. 8A, the endoscope 12 is provided with a CCD camera 10, light guides 8 and 9, a forceps channel 6, and a nozzle 11 for cleaning the lens of the CCD camera at the distal end. Has been. Note that a fiber endoscope with an eyepiece may be used instead of the electronic endoscope using the CCD. As shown in FIG. 8A, the suturing device 3 is detachably fixed to the distal end of the endoscope 12 by a fixing member 40. Instead, the suturing device 3 and the endoscope 12 are integrated. May be.

  As shown in FIGS. 3 to 7, the suturing device 3 includes a flexible tube 73 described later and a holding member 18 that is fixed to the distal end portion and holds a needle described later. The holding member 18 has a hole communicating with the two support plate portions 18a facing each other via the slit 31 (see FIG. 7), and the slit 31 between these support plate portions and the inner hole of the flexible tube 73. 19 (see FIG. 5) is formed. A push rod 20 is disposed in the hole 19 so as to be movable forward and backward in the axial direction.

  One end of first and second connecting members 22 and 23 is pivotally attached to the tip of the push rod 20 via a pin 21. The other ends of the first and second connection members 22 and 23 are pivotally attached to the base end portions of the first and second arm members 24 and 25 via pins 26 and 27, respectively. Further, the first actuating member 16 formed integrally with the first arm member 24 is rotatably connected to the support plate portion 18 a via the pin 28. Similarly, the second actuating member 17 connected to the second arm member 25 is rotatably connected to the support plate portion 18 a via the pin 29.

  As exemplified by the pin 28 in FIG. 7, the pins 28 and 29 each have an end portion formed by a small diameter portion 30. Thereby, the size of the slit 31 formed between the support plate portions 18 a of the holding member 18 is maintained slightly larger than the total thickness of the first operating member 16 and the second operating member 17. The first actuating member 16 and the second actuating member 17 can move within the slit 31 without generating large friction.

  As shown in FIG. 7, the push rod 20 is connected to an elongated and flexible transmission member 71. The holding member 18 is connected to coils 72 and 76 that form axial holes. The end surfaces of the coils 72 and 76 facing each other are connected by suitable means such as laser welding, brazing, soldering, or adhesion. The coil 76 is formed of a strand having a diameter smaller than that of the coil 72, whereby the suturing device 3 is formed such that its distal end side is more easily bent. These coils 72 and 76 are covered with a flexible tube 73 over almost the entire length and are held in close contact with the flexible tube 73. The tube 73 restricts the expansion and contraction of the coils 72 and 76 in the axial direction, thereby increasing the force for opening and closing the first operating member 16 and the second operating member 17.

  As shown in FIG. 2, the proximal ends of the tube 73 and the coil 72 are fixed to the operation portion main body 77 of the suture instrument operation portion 67. The proximal end of the transmission member 71 is inserted into the operation portion main body 77 and is connected to the pipe 74 in a state where the transmission member 71 is inserted into the pipe 74 slidable with respect to the operation portion main body 77. The pipe 74 is connected to the movable member 75 by a connecting member (not shown). Therefore, when the movable member 75 is moved back and forth with respect to the operation unit main body 77, the first operating member 16 and the second operating member 17 can be opened and closed via the transmission member 71.

  As shown in FIGS. 5 and 6, the first and second arm members 24 and 25 can pass between the pins 28 and 29 and can be opened to the angle shown in FIG. 6. By appropriately setting the lengths of the first and second arm members 24 and 25 and the lengths of the first and second connecting members 22 and 23, the angle between the first and second arm members 24 and 25 is set. Needless to say, can be further increased or decreased. It can be opened and closed substantially at an angle of 95 ° or more and less than 360 °.

  As shown in FIGS. 7 and 11, a stopper pin 32 is fixed to the push rod 20. 3, 4 and 7, the stopper pin 32 is guided in the slit 33 extending in the longitudinal direction formed in the holding member 18, and in the opening direction of the first and second actuating members 16, 17. The movement can be restricted.

  A curved needle 34 is fixed to the tip of the first operating member 16. Instead of this, the curved needle 34 may be detachable from the first actuating member 16. A needle hole 5 into which the suture thread 4 can be inserted is formed at the distal end side of the curved needle 34. Further, as shown in FIG. 8A, the curved needle 34 is thinned in order to improve the sticking to the living tissue.

  As shown in FIGS. 5 to 8A, the second actuating member 17 has bifurcated fixing arms 43 and 44, and fixing needles 41 and 42 are fixed to the tips of the fixing arms 43 and 44, respectively. . In this embodiment, the fixed needles 41 and 42 are integrally fixed to the fixed arms 43 and 44, but may be detachable. On the other hand, as shown in FIG. 7, a protective member 45 in which holes 46 and 47 are formed is fixed to the first operating member 16 with screws 48 and 49. As shown in FIGS. 5 and 6, the protective member 45 covers the needle tips of the fixed needles 41 and 42 when the first and second actuating members 16 and 17 are in the closed state. 41 and 42 are prevented from being caught. Further, the protective member 45 may have a structure in which a depression 254 is formed in the first operating member 218 as shown in a tenth embodiment (see FIG. 68) described later.

  As shown in FIGS. 5 and 11, a channel member 35 is fixed to the holding member 18 via an L-shaped support member 39. The channel member 35 includes a pipe 36 formed of a relatively hard material disposed at a tip portion, and a tube 37 formed of a relatively soft material that is press-fitted into the pipe and then tightened with a fixing thread 38. The fixing thread 38 is fixed to the tube 37 with an adhesive. The pipe 36 enters the recess 52 (see FIG. 11) of the support member 39 and is fixed to the support member 39 by appropriate means such as brazing, soldering, or bonding. As shown in FIGS. 11 and 13, the support member 39 is formed with two long holes 53 through which the screws 50 and 51 can pass, whereby the support member 39 adjusts the position with respect to the holding member 18. It is possible to fix to the holding member 18 with screws 50 and 51.

  10 and 11, a protective member 54 is fixed to the pipe 36 by suitable means such as brazing, soldering, or bonding. The protective member 54 covers the needle tip of the curved needle 34 when the first and second actuating members 16 and 17 are in a closed state, and prevents the curved needle 34 from being caught on a living tissue or the like.

  As shown in FIGS. 11 and 13, a thread guide 55 having an axial hole through which the suture 4 can pass is attached to the support member 39. This thread guide 55 is composed of a pipe 57 formed of a relatively hard material and a tube 58 formed of a relatively soft material, and the pipe 57 is appropriately inserted into the tube 58 by, for example, press-fitting or bonding. It is fixed by means. The pipe 57 is fixed to the support member 39 by suitable means such as brazing, soldering, or bonding.

  As shown in FIGS. 11 to 13, similarly to the thread guide 55, the thread guide 56 is fixed to the holding member 18 with screws 62 and 63. The thread guide 56 includes a pipe 59 formed of a relatively hard material, a tube 60 formed of a relatively soft material, and a plate-like support member 61. The support member 61 and the pipe 59 are It is fixed by suitable means such as brazing, soldering or adhesion.

  As shown in FIG. 2, the tube 37 communicates with a base 64 connected to the operation portion main body 77 on the hand side. A forceps plug 69 is attached to the proximal side of the base 64. Further, the tubes 58 and 60 communicate with holes 65 and 66 formed in the operation portion main body 77 on the respective hand sides.

  The suturing device 3 according to the present embodiment is fixed at several places to the insertion portion 7 of the endoscope 12 by another fixing member 70 as shown in FIG. 2 in addition to the above-described fixing member 40 (see FIG. 8A). Has been. By forming these fixing members 70 so as to be detachable, the suturing device 3 can be detachably attached to the insertion portion 7 of the endoscope 12. Of course, it is also possible to integrally form the suturing device 3 and the insertion portion 7 so that they cannot be removed.

  As shown in FIGS. 2, 14, and 15 </ b> A, a thread gripper 68 for gripping the suture 4 includes a hook 79 that can advance and retreat in a flexible tubular member 78 formed of a coil and the like, and a hook 79. And a thread gripper operating unit 80 for operation. The hook 79 can be accommodated in or protrude from the flexible tubular member 78 by causing the thread gripper operating portion 80 to move a grip 81 movably disposed through, for example, a pipe 83. . When the suture thread 4 is hooked on the hook 79, the suture thread 4 can slide on the hook 79. Further, the hook 79 can be locked so as not to come out of the flexible tubular member 78 by fitting a stopper 82 for preventing the forward movement of the grip 81 into the pipe 83, for example. Such a thread gripper 68 is formed to have an outer diameter that can pass through the channel 35.

  Further, a thread gripper 524 shown in FIG. 15B may be used. Similar to the thread gripper 68, the thread gripper 524 has a hook 525 that allows the suture 4 to slide. Further, a guide member 526 is formed so as to face the thread gripper 524. As shown in FIG. 15D, the suture thread 4 is hooked to the hook 525 by sandwiching the curved needle 34 by the guide member 526 and the hook 525. It is easy to catch with.

  FIG. 16 shows an insertion assisting tool 84 for inserting the insertion portion 7 including the suturing device 3 into the body.

  The insertion assisting tool 84 of the present embodiment has a flexible tubular member 85 whose tip is easily inserted into a body cavity, for example, a tapered shape, and is disposed on the proximal side of the flexible tubular member 85. Two valves 86 and 87 having circular holes 90 and 91 and a base 89 communicating with the axial hole of the flexible tubular member 85 are provided. The base 89 can be used to connect an aspirator (not shown) through a tube, for example, when a suction function or the like is required. The base 89 is preferably sealed with a lid (not shown) when not in use.

As shown in FIG. 19, instead of the above-described valves 86 and 87, it is also possible to use a valve 92 provided with a plurality of slits 94 around the hole 93 so that even an outer diameter larger than the hole 93 can pass through. is there.
Moreover, it may replace with the insertion assistance tool 84 and may use the insertion assistance tool 95 shown in FIG.20 and FIG.21. The insertion assisting tool 95 includes a flexible tubular member 96, a flexible hood member 97 disposed near the flexible tubular member 96, and a state in which the hood member is substantially sealed in the insertion portion 7 including the suturing device 3. And a fixing member 98 to be fixed to. This insertion assisting tool 95 is useful for maintaining airtightness in the body cavity. After inserting the insertion aid 95 into the body cavity, the endoscope 3 is pushed out in the direction indicated by the arrow in FIG. 21 so that the suture instrument 3 fixed to the endoscope is protruded from the flexible tubular member 96. Can do.

  42 and 43, a sealing means 144 may be provided on the proximal side of the suturing device 3 and the endoscope 12.

  The sealing means 144 includes an inner tube 140 having an inner diameter through which the endoscope 12 can pass, and an outer tube 141 having an inner diameter larger than that of the inner tube 140 and inserted through the inner tube. The outer diameter of the outer tube 141 is slightly larger than the inner diameter of the holes 90 and 91 of the valves 86 and 87. Tubes 37, 58, 60, 73 and the like are passed through a space formed between the inner tube 140 and the outer tube 141. A sealing member 142 fills the space between these tubes. Both ends of the inner tube 140 are sealed between the endoscope 12 and the tape 143. Thereby, the space between the insertion assisting tool 84, the suturing device 3 and the endoscope 12 is securely sealed, and air leakage when the body cavity is inflated by sending air into the body cavity is prevented.

Next, a suturing procedure using the suturing system will be described.
(1) The suturing device 3 and the endoscope 12 assembled in the state shown in FIG. 2 are inserted into the flexible tubular member 85 shown in FIG. 16 and arranged in the state shown in FIG. At this time, the suture thread 4 is inserted into the needle hole 5 of the curved needle 34, and each end portion is pulled out of the suture instrument 3 from the holes 65 and 66 of the operation portion main body 77 through the thread guides 55 and 56, respectively. Hold it in a state. The endoscope 12 is connected to the image processing device 14 and the light source device 15 through a universal cord (FIG. 1). Thereafter, while observing the inside of the body cavity with the monitor 13, the flexible tubular member 85 containing the suturing device 3 and the endoscope 12 is inserted to a required site in the body cavity.

(2) The body cavity is inflated using an air supply function such as an endoscope to create a space.
(3) As shown in FIG. 18, the suture instrument 3 is protruded from the flexible tubular member 85 by advancing the endoscope.
(4) The suture instrument 3 is brought close to the suture site, and the movable member 75 shown in FIG. 2 is pushed to open the first and second actuating members 16 and 17 as shown in FIG.
(5) As shown in FIG. 22, the movable member 75 is operated while pressing the curved needle 34 and the fixed needles 41 and 42 against the suture site, and as shown in FIG. 23, the first and second actuating members 16, 17 is closed.
(6) As shown in FIG. 24, the suture thread 4 that has come out of the tissue is hooked with a hook 79 of a thread gripper 68 inserted through a forceps plug 69, and is flexible together with the hook 79 as shown in FIG. The tubular member 78 is retracted.

  (7) As shown in FIG. 26, the thread gripper 68 is pulled out of the body from the channel 35, and the suture 4 is pulled out from the forceps plug 69. At this time, the suture thread 4 slides on the hook 79, whereby one end of the suture thread 4 moves from one of the thread guides 55 and 56 into the channel 35, and together with the thread gripper 68, the channel 35. Pulled out of the body. The other end of the suture 4 is held in a state of being inserted into the other of the thread guides 55 and 56.

(8) As shown in FIG. 27, the movable member 75 is operated to open the first and second actuating members 16 and 17, and the curved needle 34 and the fixed needles 41 and 42 are pulled out from the suture site.
(9) As shown in FIG. 28, the suturing device 3 is pulled back into the flexible tubular member 85, and the suturing device 3 is removed from the body cavity together with the flexible tubular member 85.
(10) A knot is formed in the suture thread 4 outside the body, and this knot is fed into the body cavity several times by a knot pusher 99 as shown in FIG. A knot pusher 99 shown in FIG. 29 has a hood-like cylindrical member attached to the distal end portion of the endoscope, and has two holes on the side surface of the cylindrical member. Of course, not only the illustrated knot pusher 99, but any structure or type of knot pusher that can feed the knot into the body can be used. Further, for example, a knot itself such as a grinch knot or a loader's knot may be formed so as to be movable. In this case, the knot can be sent into the body using an appropriate means.

(11) Finally, an endoscope to which the suturing device 3 is not attached is inserted, and the remaining suture thread 4 is cut using pinch forceps or the like.
According to the endoscope suturing system 1 of the present embodiment, the first and second actuating members 16 and 17 holding the curved needle 34 and the fixed needles 41 and 42 can pass between the pins 28 and 29. By forming the second arm members 24 and 25 integrally, a large opening / closing angle can be formed between the first and second actuating members 16 and 17. This makes it possible to form a suturing device having one or more needles that can move over a sufficiently large angle required for a suturing procedure, even for a small size for an endoscope.

  In addition, since the coils 72 and 76 connected to the holding member 18 that rotatably supports the first and second actuating members 16 and 17 are restrained from expanding and contracting by the flexible tube 73, the coils 76 and 72 are interposed therebetween. Can transmit large force. As a result, a large force required for the suturing procedure can be transmitted to the needles 34, 41, 42 via the coils 76, 72 and the first and second actuating members 16, 17.

Further, by fixing the suturing device 3 to the insertion portion of the endoscope 12, a suturing operation using a flexible endoscope, which is very difficult with the prior art, can be easily performed.
Since there is no need for surgery, a very minimally invasive suture procedure can be performed on the patient.

  As described in the above embodiments, when a biological tissue is sutured, for example, a grasping forceps 152 is inserted into a body cavity from the forceps channel 6 of the endoscope 12 as shown in FIG. In a state where the living tissue is pulled with the forceps 152, the first and second actuating members 16 and 17 can be closed, and the removable needle 131 can be punctured into the living tissue. The subsequent procedure is the same as that described for each embodiment.

[Second Embodiment]
30 to 35 show an endoscopic suturing system according to a second embodiment. Since various embodiments described below are basically the same as the above-described embodiments, the same reference numerals are given to the same portions, and detailed descriptions thereof are omitted.
As shown in FIGS. 30 and 31, the system of this embodiment includes a protective member 100 that is attached to the distal end portion of the insertion portion 7 of the endoscope 12 and covers the distal end portion of the suture instrument 3. The protection member 100 includes, for example, a cylindrical fixed portion 104 that can be detachably fixed to the distal end of the insertion portion 7, and a movable portion 103 that is slidably mounted on the outer periphery of the fixed portion 104. The movable portion 103 is preferably formed of a transparent resin such as polycarbonate, norbornene resin, cycloolefin resin, polyethylene terephthalate, or the like.

  As shown in FIGS. 32 to 34, the wall portion of the fixed portion 104 has an axial hole 111 and radial holes 113 and 114 communicating with the outer peripheral surface of the axial hole in the vicinity of each end portion. Is formed. In addition, the locking member 106 shown in FIG. 35 is fixed to the outer peripheral portion of the fixing portion 104 with, for example, a screw (not shown) inserted through the mounting holes 118 and 119, for example. When the lock member 106 is fixed to the fixing portion 104, the locking portions 116 and 117 are arranged so as to be substantially upright with respect to the outer peripheral surface of the fixing portion, and between these locking portions and toward the tip. And an inclined portion 115 gradually descending, and the whole is formed of an elastic material such as metal or resin. An opening 112 is formed on the outer peripheral surface of the fixing portion 104 at a position corresponding to the locking portions 116 and 117. Thereby, when it presses toward the outer peripheral surface of the fixing | fixed part 104, the latching | locking parts 116 and 117 are accommodated in the opening 112, and the whole lock member 106 becomes flat shape.

  On the other hand, the movable portion 103 has a recess 120a whose tip side is limited by a locking wall 120 that can be engaged with the locking portions 116 and 117 of the lock member 106, and a recess 120a that communicates with the recess 120a. And the rear end side of these recesses 108 a and 120 a is limited by the engagement wall 109. In the recess 108 a, the inclined portion 115 of the lock member 106 and the moving member 107 that controls engagement / disengagement between the lock member 106 and the locking wall 120 are accommodated.

  The moving member 107 of the present embodiment is made of, for example, a hard material and is formed in a substantially cylindrical shape or a flat shape, and the length thereof is longer than the axial dimension of the concave portion 120a, and the engaging portions 116 and 117 and the engaging wall. It is preferable that the inclined portion 115 is formed to a length that can be accommodated in the recess 108 a without pressing the inclined portion 115 when engaged with 120. Transmission members 105 and 121 extend from the end of the moving member 107, respectively. The transmission member 105 extends from the recess 120a through a pore penetrating the engagement wall 109, the transmission member 121 extends from the slit 110 communicating with the recess 108a to the inner peripheral side of the moving unit 103, and The fixing portion 104 extends to the outer peripheral portion of the fixing portion via the radial hole 113, the axial hole 111, and the radial hole 114. These transmission members 105 and 121 extend to an operation unit main body 77 shown in FIGS. 30 and 31 through an appropriate flexible tube (not shown), and are coupled to the operation units 101 and 102 of the protection member 100.

  As shown in FIG. 32, the protection member 100 is in a state where the locking wall 120 formed on the movable portion 103 and the locking portions 116 and 117 of the lock member 106 fixed to the fixed portion 104 are in contact with each other. Sometimes, the movement of the movable portion 103 in the right direction on the paper is restricted. Thereby, as shown in FIG. 30, the needle fixed to the distal end portion of the suture instrument is covered with the movable portion 103 and is not exposed to the outside.

  When the protection member operation unit 101 connected to the transmission member 105 is pulled from this state, the moving member 107 moves to the right as shown in FIG. At this time, since the moving member 107 rides on the inclined portion 115 of the lock member 106, the locking portions 116 and 117 are accommodated in the opening 112 and the engagement with the locking wall 120 is released. The movable portion 103 can move to the rear end side, that is, to the right in the drawing. Further, when the protective member operation unit 101 is pulled, the moving member 107 comes into contact with the locking wall 109 as shown in FIG. 34, and the movable unit 103 moves to the right side together with the moving member 107, resulting in the state shown in FIG. . At this time, the lock member 106 is in contact with the inner peripheral surfaces on both sides of the slit 110 formed in the movable portion 103. Conversely, when the protective member operation unit 102 connected to the proximal side of the transmission member 121 is pulled, the moving member 107 moves to the left side and engages with the locking wall 108, and the movable unit 103 together with the moving member 107 moves to the left side. Moving. When the engagement wall 120 exceeds the opening 112, the lock member 106 returns to the state shown in FIG. Again, the locking portions 116 and 117 protrude from the outer peripheral surface of the fixed portion 104, and the movement of the movable portion 103 in the right direction can be restricted.

Next, a suturing procedure using the suturing system will be described.
(1) After attaching the above-described protection member 100 to the suture device and endoscope assembled in the same manner as in the above-described embodiment, the protection member operation unit 102 is pulled. Thereby, the moving part 103 is protruded to the front end side, and the state shown in FIG. In this state, the body 12 is inserted into the body cavity while observing the body cavity through the endoscope 12.
(2) After insertion into the body cavity, the protection member operation unit 101 is pulled, and the moving unit 103 is retracted to the state shown in FIG. Thereby, the front-end | tip part of the suturing device 3 is exposed, and a suturing operation can be performed in the same procedure as in the first embodiment.
(3) After the suturing is completed, the protective member operation unit 102 is pulled to cause the moving unit 103 to protrude into the state shown in FIG. In this state, the suture instrument and endoscope are removed from the body cavity.

  In this embodiment, since the moving part 103 of the protection member 100 moves in the axial direction, the outer diameter of the apparatus can be reduced in addition to the effects of the first embodiment. In addition, the procedure can be further simplified.

[Third Embodiment]
FIG. 36 shows a protective member 122 used in the endoscope suturing system according to the third embodiment.
The protection member 122 of this embodiment includes a fixed portion 124 that is fixed to the distal end portion of the insertion portion 7 and a movable portion 123 that can slide on the fixed portion 124, and between these fixed portions and the movable portion. An annular space 128 sealed from the outside is formed. A base 125 communicating with the annular space 128 is attached to the outer peripheral portion of the movable portion 123, and the fluid 127 can be injected into or discharged from the annular space 128 via a tube 126 connected to the base 125. . The fluid 127 may be liquid or gas.

  In the present embodiment, the protection member 122 fills a fluid injection device (not shown) such as a syringe with a suitable fluid 127 such as physiological saline, water, air, etc., and injects the fluid into the annular space 128, thereby moving the movable member. 123 slides to the right side of the page. On the other hand, when the fluid injection device 129 is set to a negative pressure and the fluid 127 is discharged from the annular space 128, the movable portion 123 can slide to the left.

  By using this protective member 122, the same effects as those of the above-described embodiments can be obtained.

[Fourth Embodiment]
37 to 41 show an endoscopic suturing system according to a fourth embodiment.
As shown in FIG. 37, in this embodiment, the needle holder 132 is fixed to the first operating member 16 of the suturing device 3, and the removable needle 131 is detachably connected to the tip of the needle holder 132. The removable needle 131 has a shaft portion 138, and one end of the suture thread 130 is fixed to the tip of the shaft portion 138. As shown in FIG. 41, the needle holder 132 has a groove 137 opened along substantially the entire length on the inner peripheral side, and the suture thread 130 is detachably extended in the groove 137.

  On the other hand, the other end of the suture 130 extends to the vicinity of the hand of the endoscope through the thread locking means 135 formed on the needle thread fixing tool 133. The thread locking means 135 is formed so that the suture 130 can be freely moved in the direction of arrow B, that is, the direction in which the suture is pulled, and conversely, it is not moved in the direction of arrow A, that is, the direction in which the suture is fed out. ing.

  Furthermore, as shown in FIG. 38, the needle thread fixing tool 133 is also formed with a needle locking means 134 capable of locking the removable needle 131. The needle lock means 134 is preferably formed of an elastic member or the like. In this embodiment, the needle thread fixing tool 133 is detachably attached to the tip of the needle thread fixing body 139. This needle thread fixture main body 139 can be inserted into a body cavity through a suitable channel 35. Further, although the needle thread fixing tool 133 is locked to the needle thread fixing body 139 by press-fitting, it can be held and fixed with a suitable treatment tool such as a gripping forceps instead.

  Here, the detachable needle 131 and needle thread fixture 133 described above are at least partially biocompatible with metals such as stainless steel, pure titanium and titanium alloys, or biocompatible resins such as polyimide, poly It is made of ether ether ketone (PEEK), polysulfone, liquid crystal polymer, polyamide, or a biocompatible ceramic such as alumina or silicon nitride. Similarly to the first embodiment, the suture thread 130 is configured in a monofilament shape or a stranded wire shape using a material such as nylon, polyester, silk, fluorine resin, or bioabsorbable.

This endoscopic suturing system can be used as follows.
(1) The suturing device in the state where the distal end portion thereof is protected by the insertion assisting tools 84 and 95 of the first embodiment, the protection member 100 of the second embodiment, the protection member 122 of the third embodiment, or the like. 3 is inserted into the body cavity. At this time, the inside of the body cavity can be observed through the endoscope 12 as in the above-described embodiment.
(2) When suturing, the first operating member 16 and the second operating member 17 are closed so that the removable needle 131 and the fixed needles 41 and 42 are pressed against the suture site, and the removable needle 131 is attached to the living tissue. Puncture.

(3) As shown in FIG. 38, the detachable needle 131 after the puncture protrudes from the living tissue. Thereafter, the removable needle 131 is inserted into and locked by the needle locking means 134 of the needle thread fixture 133 by pushing the needle thread fixture main body 139 toward the distal end side.
(4) When the first actuating member 16 and the second actuating member 17 are opened, the detachable needle 131 is locked to the needle locking means 134, so that the detachable needle 131 is detached from the needle holder 132 and the suture 130. Is disengaged from the groove 137 of the needle holder 132. As a result, as shown in FIG. 39, the portion of the suture 130 between the needle thread fixing tool 133 and the thread locking means 135 forms a loop and remains in the living tissue.

(5) As shown in FIG. 39, the needle thread fixing tool main body 139 is advanced toward the living tissue while pulling the end portion of the suture thread 130 arranged outside the body toward the hand side. Thereby, the loop of the suture thread 130 is narrowed, and the living tissue is tightly bound to the state shown in FIG.
(6) Finally, the remaining suture thread 130 is cut with the thread cutter 136. The needle thread fixing tool 133 left in the body cavity can be removed when the thread is removed.
According to the system of the present embodiment, in addition to the advantages of the first and second embodiments described above, it is not necessary to make a knot outside the body and send it into the body, so that the time of the procedure can be shortened and the treatment is easy. become. In addition, the tissue tightness state can be easily adjusted.

[Fifth Embodiment]
44 and 45 show a fifth embodiment. The fifth embodiment is basically the same as the fourth embodiment described above, and differs in the following points.
As shown in FIG. 44, the needle thread fixture 133 of the present embodiment is detachably attached to a holding member 145 formed on the second operating member 17. Needle thread fixture 133 is at least partially biocompatible metal such as stainless steel, pure titanium or titanium alloy, or biocompatible resin such as polyimide, polyetheretherketone, polysulfone, liquid crystal polymer, polyamide. Or made of a biocompatible ceramic, such as alumina, silicon nitride or the like.

This endoscopic suturing system can be used as follows.
(1) When the suturing device 3 is inserted into a body cavity, the distal end portion thereof is particularly protected by the insertion assisting tools 84 and 95, the protection member 100, the protection member 122, or the like of the above-described embodiment. Since the needle thread fixing tool 133 is attached to the second actuating member 17, it is not necessary to use the needle thread fixing tool main body 139 or a normal gripping forceps, for example.
(2) When suturing, the first actuating member 16 and the second actuating member 17 are closed and detached by pressing the removable needle 131 and the fixed needles 41 and 42 against the stitching site as in the fourth embodiment. A possible needle 131 is punctured into the tissue.

(3) As shown in FIG. 45, the detachable needle 131 after puncturing protruding from the living tissue is inserted into and engaged with the needle locking means 134 of the needle thread fixture 133 held by the holding member 145. .
(4) When the proximal side of the suture thread 130 is pulled, one end of the suture thread 130 is fixed to the removable needle 131, and the groove 137 of the needle holder 132 is opened on the inner peripheral side. Is done.
(5) When the first actuating member 16 and the second actuating member 17 are opened, the detachable needle 131 and the needle thread fixing tool 133 are held by the holding member since the detachable needle 131 is locked to the needle locking means 134. 145 and the state shown in FIG.
(6) Finally, the remaining suture thread 130 is cut with the thread cutter 136.
In this embodiment, the same advantages as in the fourth embodiment can be obtained. Furthermore, in this embodiment, since it is not necessary to hold the needle thread fixing tool 133 alone, the suturing procedure is further facilitated.

[Sixth Embodiment]
46 to 49 show a sixth embodiment. The sixth embodiment is basically the same as the fourth embodiment except for the following points.
As shown in FIG. 46, in this embodiment, the four locking members 146 for holding at least one loop formed in advance on the suture 130 made of the same material and configuration as in the first embodiment include: The second actuating member 17 is provided. These locking members 146 are formed in a claw shape from an elastic material, and are fixed on the side facing the first actuating member 16 in a state of facing each other. A part of the suture 130 is hooked on these locking members 146 to form, for example, two large loops 148. The removable needle 131 can pass through these large loops 148. Further, at least one small loop 149 for forming a knot, which will be described later, is formed on the periphery of the suture 130 forming the large loop 148, and a knot such as a pre-knot 232 shown in FIG. ing.

  The needle fixture 150 includes a needle fixing means 147 that can be engaged with the removable needle 131 and a tubular member 151 to which the needle fixing means is fixed. This needle fixture 150 is formed so as to be able to be inserted through a suitable channel 35. Instead, the needle fixture 150 may be fixed on the suturing device 3. In this case, the position where the needle fixing tool 150 is fixed is a position where the removable needle 131 can be engaged with the needle fixing means 147.

This endoscopic suturing system can be used as follows.
(1) When the suturing device 3 is inserted into a body cavity, it is protected by, for example, the above-described insertion assisting tools 84 and 95, the protection member 100, or the protection member 122 as in the above-described embodiment.
(2) When the detachable needle 131 is punctured into the living tissue, the first operating member 16 and the second operating member 17 are closed by pressing the detachable needle 131 and the fixed needles 41 and 42 against the suture site.
(3) As shown in FIG. 47, the detachable needle 131 after puncture protrudes from the living tissue. Thereafter, the tubular member 151 is pushed out to the distal end side, and the removable needle 131 is inserted into the needle fixing means 147 of the thread fixing device 150 held by the tubular member 151 and locked.

(4) As shown in FIG. 48, when the first operating member 16 and the second operating member 17 are opened, the detachable needle 131 is locked to the needle locking means 147. The large loop 148 is detached from the locking member 146 while being detached from the holder 132. This causes the small loop 149 to cooperate with the large loop 148 to form a knot on the suture 130.
(5) Thereafter, as shown in FIG. 49, the proximal side of the suture thread 130 and the needle fixture 150 are pulled, the knot 149 is tightened, and the wound is sutured.
(6) Finally, as shown in FIG. 49, the remaining suture thread 130 is cut with the thread cutter 136.
The system according to the sixth embodiment can obtain the same advantages as those of the fourth embodiment described above. Furthermore, it is not necessary to place a member other than the suture thread 130 in the body.

  As described in the above embodiments, when a biological tissue is sutured, for example, a grasping forceps 152 is inserted into a body cavity from the forceps channel 6 of the endoscope 12 as shown in FIG. In a state where the living tissue is pulled with the forceps 152, the first and second actuating members 16 and 17 can be closed, and the removable needle 131 can be punctured into the living tissue. The subsequent procedure is the same as that described for each embodiment.

[Seventh Embodiment]
51 to 56 show a seventh embodiment. In this system, the structure of the suturing device 3 is different from that of the above-described fourth embodiment. Furthermore, a needle thread fixing tool 153 is disposed instead of the needle thread fixing tool 133 in the above-described embodiment.
As shown in FIG. 51, the needle thread fixing device 153 includes thread lock means 155 and needle lock means 154. The thread lock means 155 is formed of an elastic tubular member having a thin axial hole, and the suture thread 156 is inserted in a state of being press-fitted into the axial hole. Thereby, the thread locking means 155 can hold the suture thread 156 at an arbitrary position. The thread lock means 155 can be formed of, for example, a silicon tube. On the other hand, if a sufficient strength cannot be obtained by using only a silicon tube such as a tube that is easily torn after ligation, a reinforcing member 200 such as a PTFE resin tube is coaxial with the thread lock means 155 as shown in FIG. 54A. May be arranged.

  Further, the thread lock means 155 may be changed to a thread lock means 565 as shown in FIG. 54B. The thread locking means 565 includes an elastic member 566 and a tubular member 567. The tubular member 567 is disposed on the outer periphery of the elastic member 566 and has at least one recess formed by an external force to increase the sliding resistance between the thread 156 and the elastic member 566. Thereby, the ligation force at the time of suturing can be increased.

  54C to 54E are views showing a configuration in which the manner of crushing the tubular member 567 is changed. FIG. 54C shows a configuration in which a plurality of depressions are provided in the longitudinal direction in the tubular member 567. FIG. 54D shows a configuration in which a depression is provided in the tubular member 567 in a direction orthogonal to the longitudinal direction. FIG. 54E shows a configuration in which the tubular member 567 is swaged to apply pressure evenly and radially to the elastic member 566.

  The suture thread 156 is formed with a loop portion 158 at one end on the proximal side, and the loop portion 158 is detachably engaged with the engagement portion 163. The engaging portion 163 is fixed to the transmission member 165 and is disposed in the coil 164 so as to freely advance and retract. The proximal side of the transmission member 165 is connected to an operation portion (not shown) that can be operated outside the body, and the engagement portion 163 can be advanced and retracted along the coil 164 by advancing and retracting the operation portion. The channel 160 through which the coil 164 is inserted has a flexible tubular member 162 and a receiving portion 161 fixed to the tip, and holds the needle thread fixing tool 153 via the receiving portion 161. ing.

  As shown in FIG. 53, the needle locking means 154 is formed with an inclined portion 167. The detachable needle 157 is similarly formed with an inclined portion 169. For this reason, the needle locking means 154 and the detachable needle 157 are difficult to disengage from each other when they are engaged via these inclined portions 167 and 169. Moreover, in this embodiment, it has the through-hole 170 which penetrates the axial part of the removable needle | hook 157 and opens to the taper surface of a front-end | tip. The through hole 170 is formed in a stepped structure, and as shown in FIG. 53, for example, a knot 166 formed at the other end of the suture thread 156 is accommodated in the through hole 170 and does not move to the other end side. In addition, the knot 166 can be locked at the stepped portion. For example, the suture 156 can fix the knot 166 to the removable needle 157 with a suitable adhesive. Further, a groove 168 similar to that shown in FIG. 41 is formed in the needle holder 159 that holds the detachable needle 157, and the suture thread 156 can be detached from the needle holder 159.

  The detachable needle 157 and needle thread fixture 153 are at least partially biocompatible metal such as stainless steel, pure titanium or titanium alloy, or biocompatible resin such as polyimide, polyetheretherketone, polysulfone. Made of liquid crystal polymer, polyamide, or biocompatible ceramic, such as alumina, silicon nitride, and the like. Similarly to the first embodiment, the suture thread 156 is preferably formed in a monofilament shape or a stranded wire shape using a material such as nylon, polyester, silk, fluorine resin, or bioabsorbable.

This endoscopic suturing system can be used as follows.
(1) When inserting the suturing device 3 into the body cavity, the suturing device 3 is inserted in a state where the distal end portion thereof is particularly protected, as in the above-described embodiment.
(2) The first actuating member 16 and the second actuating member 17 are closed so that the removable needle 157 and the fixed needles 41 and 42 are pressed against the suture site, and the removable needle 157 is punctured into the tissue. Of course, this operation can be observed through the endoscope 12.

(3) As shown in FIG. 52, the removable needle 157 protrudes from the living tissue. Thereafter, the coil 164 is pushed to the distal end side, and the removable needle 157 is inserted and locked into the needle locking means 154 of the needle thread fixing device 153 held at a predetermined position.
(4) When the first actuating member 16 and the second actuating member 17 are opened, the detachable needle 157 is locked to the needle locking means 154, so that the detachable needle 157 is detached from the needle holder 159, as shown in FIG. It becomes a state.

(5) The transmission member 165 is pulled toward the hand side by an operation unit (not shown), and the living tissue is bound to the state shown in FIG. Thereafter, the distal end portion of the transmission member 165 is protruded from the coil 164, and the loop portion 158 is removed from the engaging portion 163.
(6) Finally, the remaining thread 156 is cut with the thread cutter 136.
The system according to the seventh embodiment can obtain the same advantages as those of the fourth embodiment described above. Furthermore, in this embodiment, since the length of the suture thread 156 may be short, the suturing operation is further facilitated.

[Eighth Embodiment]
57 to 63 show an endoscopic suturing system according to an eighth embodiment.
As shown in FIG. 57, a needle thread fixture 171 is detachably mounted on the second operating member 17 instead of the holding member 145 (see FIG. 44) of the fifth embodiment. Needle fixing means 177 is formed on the needle thread fixture 171. One end of the suture thread 172 is fixed to the needle thread fixture 171. Further, the other end of the suture thread is extended into the coil 164 via a thread lock means 173 similar to that of the seventh embodiment, and a loop portion 174 is formed.

  A needle holder 178 that holds the removable needle 175 at the tip is fixed to the first operating member 16. One end of another suture thread 176 is fixed to the detachable needle 175, and the other end of the suture thread is also extended into the coil 164 via the thread lock means 173 to form a loop portion 174. . These loop portions 174 are engaged with the engaging portions 163 of the transmission member 165 as in the seventh embodiment.

When suturing using this endoscope system, it is performed as follows.
(1) As in the above-described embodiments, the suturing device 3 is inserted into the body cavity, particularly with the distal end portion protected by the insertion aids 84 and 95, the protection member 100, the protection member 122, or the like.
(2) As shown in FIG. 58, the detachable needle 175 and the fixed arms 41 and 42 are pressed against the suture site, the first and second actuating members 16 and 17 are closed, and the detachable needle 175 is punctured into the living tissue. .
(3) As shown in FIG. 58, the detachable needle 175 after puncture is inserted and locked in the needle fixing means 177 of the needle thread fixing tool 171 held at a predetermined position.

  (4) As shown in FIG. 59, when the first and second actuating members 16 and 17 are opened, the needle thread fixture 171 is second actuated while the removable needle 175 is locked to the needle thread fixture 171. Detach from member 17.

  (5) From the state shown in FIG. 60, the transmission member 165 is pulled by an operation unit (not shown), and the living tissue is tied up with the suture thread 176 until the state shown in FIG. Thereafter, as shown in FIG. 62, the distal end portion of the transmission member 165 is pushed out from the coil 164. The loop part 174 is removed from the engaging part 163 of the transmission member. If necessary, it is possible to further pull only the loop portion 174 of one suture.

  The detachable needle 157 and needle thread fixture 171 are at least partially biocompatible with metals such as stainless steel, pure titanium and titanium alloys, or biocompatible resins such as polyimide, polyetheretherketone, and polysulfone. Made of liquid crystal polymer, polyamide, or biocompatible ceramic, such as alumina, silicon nitride, and the like. Similarly to the first embodiment, the suture thread 172 is preferably formed in a monofilament shape or a stranded wire shape using a material such as nylon, polyester, silk, fluorine resin, or bioabsorbable.

(6) Finally, as shown in FIG. 63, the remaining suture thread 172, 176 is cut with the thread cutter 136.
The system according to the eighth embodiment can obtain the same advantages as those of the fourth embodiment described above. Furthermore, also in this embodiment, since the lengths of the suture threads 172 and 176 may be short, the suturing operation is further facilitated.

[Ninth Embodiment]
64 to 66 show an endoscopic suturing system according to a ninth embodiment.
The ninth embodiment differs from the eighth embodiment in the following points.
As shown in FIG. 64, in the present embodiment, the first operating member 190 is disposed in needle holders 179 and 180 for attaching removable needles 184 and 185, respectively. In these needle holders 179 and 180, as illustrated in FIG. 41, grooves opened inwardly extend. One end of each of the suture threads 186 and 187 is fixed to the two removable needles 184 and 185 in the same manner as in the seventh embodiment.
A needle fixture 181 is detachably attached to the second operating member 191. Needle locking means 182 and 183 for locking the removable needles 184 and 185 are formed on the needle fixture 181.

As shown in FIG. 65, the other ends of the sutures 186 and 187 are extended into the coil 164 via thread lock means 188 similar to the thread lock means 155 of the seventh embodiment, and a loop portion 189 is formed. ing. The loop portion 189 is also engaged with the engaging portion 163 of the transmission member 165, as in the seventh embodiment.
Detachable needles 184 and 185 and needle thread fixture 181 are at least partially biocompatible metals such as stainless steel, pure titanium and titanium alloys, or biocompatible resins such as polyimide and polyetheretherketone. Made of polysulfone, liquid crystal polymer, polyamide, or biocompatible ceramics such as alumina, silicon nitride and the like. In addition, the sutures 186 and 187 are preferably formed in a monofilament shape or a stranded wire shape using a material such as nylon, polyester, silk, fluorine resin, or bioabsorbable, as in the first embodiment.

When suturing using this endoscope system, it is performed as follows.
(1) As in the above-described embodiments, the suturing device 3 is inserted into the body cavity, particularly with the distal end portion protected by the insertion aids 84 and 95, the protection member 100, the protection member 122, or the like.

  (2) The first and second actuating members 190 and 191 are closed so that the needle locking means 182 and 183 and the removable needles 184 and 185 are pressed against the suture site, and the removable needles 184 and 185 are punctured into the tissue.

  (3) As shown in FIG. 65, the detachable needles 184 and 185 after puncturing are inserted and engaged with the needle locking means 182 and 183 of the needle fixture 181 held at a predetermined position.

  (4) When the first and second actuating members 190 and 191 are opened, the removable needles 184 and 185 are locked to the needle fixture 181, so that the removable needles 184 and 185 are detached from the needle holders 179 and 180. The needle fixture 181 is also detached from the second operating member 191. Thereby, the state shown in FIG. 65 is obtained.

(5) Thereafter, as in the seventh embodiment, the thread locking means 188 is pressed against the living tissue, and the engaging portion 163 is pulled via the transmission member 165 to bind the living tissue. Thereafter, the engaging portion 163 is pushed out from the coil 164, and the loop portion 189 is removed.

  (6) Finally, the surplus sutures 186 and 187 are cut with the thread cutter 136 as in the fourth embodiment.

On the other hand, as shown in FIG. 66, the binding force may be adjusted by the length of one suture 192 instead of the two sutures 186 and 187. In this case, the thread locking means 188, the engaging portion 163, the coil 164, the transmission member 165, the loop portion 189, and the like are not necessary.
The system according to the ninth embodiment can obtain the same advantages as those of the fourth embodiment described above. Furthermore, in this embodiment, the two suture threads 186 and 187 can be sutured simultaneously by the two removable needles 184 and 185.

[Tenth embodiment]
67 to 99 show a tenth embodiment.
(Constitution)
The tenth embodiment differs from the first to third embodiments in the following points.
This embodiment uses a pre-knot cartridge 365 as shown in FIGS. The pre-knot cartridge 365 includes a detachable needle 213, a thread 214, a needle gripper 212, a flexible tubular member 215, and the like. The thread 214 is inserted into the hole 366 of the detachable needle 213, and a stopper 272 is provided on the distal end surface so as not to come out of the detachable needle 213. In this embodiment, the end surface of the yarn is formed into a spherical shape by heat. Further, an adhesive may be applied around the stopper 272 or the hole 366 may be crimped in order to further secure the thread and the removable needle. Further, before the end surface of the yarn is made spherical by heat, a knot may be formed on the end surface of the yarn, and then the knot may be thermoformed using a mold that can be divided into two pieces formed into a spherical shape. 69, 76, and 89, the thread 214 forms a pre-knot 232 on the surface of the needle gripper 212. The pre-knot is preferably a knot like a loader knot that can slide a knot as shown in FIG. A flexible tubular member 215 is slidably passed through the thread 214. Further, the hand side of the yarn 214 is bundled by forming a loop 273. 86 and 87, the pre-knot 232 is pressed by the cover 274 to prevent the pre-knot cartridge 365 from being detached from the needle gripper 212 before using the pre-knot cartridge 365.

  As shown in FIG. 69, the needle-catching sheath 211 includes a distal tip 249, a flexible tubular member 247, a flexible rod 248 passed through the lumen of the flexible tubular member 247, and the like. A female screw 250 is formed on the distal tip 249, and a flexible rod 248 is fixed to the other end. The flexible rod 248 prevents extension when a force is applied to the flexible tubular member 247.

  Moreover, it may replace with the needle catching sheath 211 and may use the needle catching sheath 527 as shown in FIG. The needle catching sheath 527 has a tip tip 528, a flexible tubular member 529 (for example, made of a flat coil), a flexible tubular member 531 (for example, made of a coil), and a connection for connecting the flexible tubular member 529 and the flexible tubular member 531. A member 530, a connecting member 532 connected to the handle 533 on the proximal side of the flexible tubular member 531, a buckling preventing means 536 covering the flexible tubular member 531 and a part of the connecting member 532 with heat shrinkage, a tip 528, and the like A flexible tubular member 529 having both ends connected to the connecting member 532, a stylet 534 for preventing expansion of the flexible tubular member 531, and a flexible tubular body 535 (for example, a fluororesin) disposed on the outer periphery of the flexible tubular member 529 by heat shrinkage or the like. Etc.) and the like.

  Unlike the needle catching sheath 211, the needle catching sheath 527 is provided with a flexible tubular body 535. Therefore, the pre-knot 232 is placed on the flexible tubular body 535 and a suturing operation (FIGS. 90 to 98) described later is performed. However, the thread is not pinched between the windings forming the flexible tubular member 529. Further, since the flexible tubular body 535 is easier to slide the thread than the coil, the operation becomes easier when the pre-knot 232 as shown in FIGS. 94 to 95 is removed from the needle catching sheath.

  As shown in FIG. 69, the channel member 367 includes a tip pipe 233 and a tube 245 fixed to the tip pipe 233, and is fixed to the holding member 223 via a support member 234. The tip pipe 233 is formed with holes 368 and 369 having different inner diameters. The inner diameter of the hole 369 is designed to be slightly larger than the outer diameter of the needle catching sheath 211 and the needle gripper 212 and smaller than the outer diameter of the pre-notch 232. A needle catching sheath 211 is inserted through the lumen of a channel member 367 having the same diameter as that of the hole 369. A needle gripper 212 that is a component of the pre-knot cartridge 365 is detachably connected to the tip of the needle catching sheath 211 by screwing. The needle gripper 212 is detachably connected to the tip chip 249 by screwing, and is loaded into the hole 368. As shown in FIG. 69, the removable needle 213 of the pre-knot cartridge 365 is detachably fixed to the needle holder 216, and a thread 214 is disposed in a groove 217 formed in the needle holder 216.

  Further, a slit 537 may be formed in the needle holder 216 as shown in FIGS. By providing a slit in this way, it is possible to form a press-fit type structure in which elasticity is imparted to a fitting portion with the removable needle 213 and the removable needle 213 is not easily detached from the needle holder 216. . As shown in FIGS. 69 and 77 to 80, the needle gripper 212 includes a needle catching body 275, an insertion member 276, and a spring 277.

As shown in FIG. 78, when the needle catching sheath 211 is moved to the left side in the drawing, the removable needle 213 is inserted into the funnel-shaped recess 278 of the insertion member 276, and pushes the spring 277 (see FIG. 88). Thereafter, when the needle catching sheath 211 is further moved, the spring 277 returns to its original shape as shown in FIG. 79 and engages with the contact surface 370 formed on the removable needle 213. Thereby, the removable needle 213 can be locked to the needle gripper 212 as shown in FIG.
The needle holder 216 is provided with a taper 253 to reduce resistance when puncturing tissue.

  As shown in FIGS. 74 and 75, a suture instrument operating portion 255 is provided on the proximal side of the flexible tubular members 225 and 226 and the transmission member 224. A ratchet mechanism is incorporated in the operation unit 255. When the button 261 is pushed in as shown in FIG. 74, the ratchet mechanism is released, and the slider 257 can be freely pushed and pulled. . Further, when the button 261 is slid to the right side in the drawing, the stopper 267 formed on the button 261 is released from the engaging portion 268 formed on the slider 257, and the engaging portion 262 urged downward by the spring 263 is formed on the drawing. It is pushed downward and engages with the notch member 260 formed in the operation portion body 256. The slider 257 can move only in the right direction. As a result, the first active member 218 and the second active member 219 cannot move in the opening direction.

  On the other hand, the flexible tubular member 215 of the pre-knot cartridge 365 is press-fitted into the recess 241 of the holder 240 fixed to the tube 245 as shown in FIG. Here, since the flexible tubular member 215 is made of a flexible resin member such as silicon, the thread 214 can slide with respect to the flexible tubular member 215 even in a state of being press-fitted into the recess 241.

  Further, the needle gripper 212, the detachable needle 213, and the needle holder 216 of the present embodiment may be changed to a structure as shown in FIGS.

  As shown in FIGS. 81 to 88, the needle gripper 283 includes a needle holding body 279, an insertion member 280, a spring 281 and the like. As shown in FIG. 81, when the needle gripper 283 is moved to the left side of the drawing, the removable needle 364 is inserted into the funnel-shaped recess 282 of the insertion member 280, and pushes the spring 281 (see FIG. 88). Thereafter, when the needle gripper 283 is further moved, the spring 281 returns to its original shape as shown in FIG. As a result, the spring 281 engages with the recess 371 formed in at least a part of the removable needle 364. After that, as shown in FIG. 84, when the needle gripping tool 283 is moved to the right side of the drawing, the spring 281 including the removable needle 364 moves until it comes into contact with the contact surface 372 formed on the insertion member 280. Then, since the movement of the spring 281 in the expanding direction is restricted by the wall of the engaging portion 285 formed on the insertion member 280, the removable needle 364 can be locked to the needle gripper 283.

  The removable needle 364 is provided with a recess 371 in order to reduce resistance when puncturing tissue. Also, as shown in FIGS. 175 and 176, a slit 538 is formed in the needle holder 216 that does not have the taper 253, so that the fitting between the detachable needle 364 and the needle holder 216 is not easily released. Also good.

(Function)
The suturing procedure will be described with reference to FIGS.
(1) The suture instrument 210 protected by the insertion assisting tools 84 and 95 of the first embodiment, the protection member 100 of the second embodiment, the protection member 122 of the third embodiment, and the like is inserted into the body cavity.
(2) As shown in FIGS. 90 and 91, the detachable needle 213 and the two fixed needles 229 are pressed against the suture site to close the first and second active members 218 and 219, and the detachable needle 213 is attached to the tissue. Puncture.
(3) As shown in FIG. 92, the needle catching sheath 211 is pushed into the removable needle 213 after puncturing, and the removable needle 213 is engaged with the needle gripper 212.
(4) As shown in FIG. 93, the needle catching sheath 211 is pulled and the removable needle 213 is pulled out from the needle holder 216.
(5) As shown in FIG. 94, the first and second active members 218 and 219 are opened, and the needle holder 216 is pulled out of the tissue.

  (6) As shown in FIG. 95, the needle catching sheath 211 is further retracted, and the pre-knot 232 is removed from the needle gripper 212.

(7) As shown in FIGS. 96 and 97, the needle catching sheath 211 is further pulled to move the pre-notch 232 to the opening of the tissue, and the opening is sutured. (8) As shown in FIG. Is cut using a thread cutter 136 or the like.

(effect)
According to the present embodiment, in addition to the advantages of the first and second embodiments described above, it is not necessary to tie a knot outside the body and send it into the body, so that the procedure time can be shortened and the treatment becomes easier. . In addition, the tissue tightness state can be easily adjusted. Furthermore, it is not necessary to place a member other than a suture in the body.

[Eleventh embodiment]
100 to 111 show an eleventh embodiment.
(Constitution)
The eleventh embodiment differs from the tenth embodiment in the following points.
As shown in FIG. 101, the pins 303 and 304 of the suture instrument 373 of the eleventh embodiment are larger than the distance between the pins 235 and 236 of the tenth embodiment. Further, the distance between the pin 303 and the pin 305, the distance between the pin 304 and the pin 306, the distance between the pin 305 and the pin 307, and the distance between the pin 306 and the pin 307 are also larger than those in the tenth embodiment. With such a configuration, as shown in FIG. 108, the rotational movement of the first active member 287 can be made larger than that of the first active member 218 (see FIG. 90) of the tenth embodiment, and is further fixed to the needle holder 310. The force for puncturing that acts on the removable needle 213 can be increased.

  As shown in FIGS. 102 and 106, the second active member 288 can be rotated about the pin 304 as an axis. A pipe 375 is rotatably inserted into a part of the pin 304, and a spring 308 is disposed around these pipes. The arm portion 376 of the spring 308 is in contact with a contact surface 378 provided on the second active member 288. On the other hand, as shown in FIG. 107, a force accumulating member 300 is connected via a pin 306 to a second connecting member 290 that is pivotally connected to the rod 291 on the axis of the pin 307. Can be rotated about a pin 304 as an axis. The other arm portion 377 of the spring 308 is disposed so as to come into contact with a ring member 311 that is rotatably disposed on a cylindrical portion 379 of the force accumulation member 300 formed on the axis of the pin 306. . Here, the ring member 311 is arranged so as to reduce the resistance of the arm portion 377, but it goes without saying that it can be omitted. Similarly to the tenth embodiment, two fixed needles 298 are attached to the second active member 288 at the U-shaped end. As shown in FIG. 177, these fixed needles 298 may have a hook-like needle shape with the tip directed inward. In this way, when the tissue is punctured, it becomes difficult for the fixed needle to slip from the tissue. Such a change of the fixed needle can be applied to other embodiments.

  As shown in FIG. 101, a stopper 309 is fixed to the second active member 288 so that the second active member 288 does not further rotate clockwise from the state of FIG.

  The other components, that is, the pre-knot cartridge 365 including the detachable needle 213, the needle catching sheath 211, and the operation unit 255 are the same as those in the tenth embodiment, and thus the description thereof is omitted. Further, the configuration of the removable needle 364 and the needle gripper 283 described in the tenth embodiment may be used.

(Function)
The operation of the suturing device 373 when puncturing the sutured tissue will be described with reference to FIGS.
(1) By operating the operation unit 255 (not shown) and pushing the rod 291 to the left side of the sheet as shown in FIG. 108, the first active member 287 can be largely opened to the position shown in the figure. At this time, since the external force is not applied in the opening direction, the second active member 288 is opened only to the position shown in the drawing by the spring 308. Further, when the removable needle 213 is punctured so that the angle θ in the figure is 45 ° <θ <110 ° (particularly 90 °), the tissue is deeply pierced and the suture is ensured.

  (2) Next, as shown in FIG. 109, when the rod 291 is moved to the right side of the page, the removable needle 213 and the two fixed needles 229 puncture the tissue. At this time, the counterclockwise force applied to the second active member 288 is the same as the spring force of the spring 308.

  (3) As shown in FIGS. 110 and 111, when the rod 291 is further moved to the right side of the drawing, the contact surface 312 of the force accumulating member 300 and the contact surface 380 of the second active member 288 are engaged in addition to the spring force. As a result, the force of the force accumulating member 300 acts on the second active member 288. As a result, the second active member 288 is reliably rotated in the clockwise direction. Further, as shown in FIG. 111, the position where the contact surface 312 and the contact surface 380 are engaged is set to the second active member so that the first active member 287 can be completely closed even when a large amount of tissue is sandwiched. 288 is set in the opening direction. In other words, in a state where no tissue is sandwiched, the second active member 288 contacts the first active member 287 only by the force of the spring 308, and at this time, the contact surfaces 312 and 380 are not in contact with each other. In this way, since the axis of the needle gripper 212 shown in FIG. 101 and the axis of the removable needle 213 can be aligned to some extent, the needle gripper 212 can easily collect the removable needle 213. . Since the stitching procedure is the same as that of the tenth embodiment (see FIGS. 90 to 98), a description thereof will be omitted.

(effect)
In addition to the effects of the tenth embodiment, it is possible to puncture the tissue even deeper. Further, the removable needle 213 can be easily collected.

[Twelfth embodiment]
112 to 122 show a twelfth embodiment.
(Constitution)
The twelfth embodiment differs from the tenth embodiment in the following points.
As shown in FIG. 113, the pins 329 and 330 of the suture instrument 374 of the twelfth embodiment are larger than the distance between the pins 235 and 236 of the tenth embodiment. Further, the distance between the pin 329 and the pin 331, the distance between the pin 330 and the pin 332, the distance between the pin 331 and the pin 333, and the distance between the pin 332 and the pin 333 are larger than those in the tenth embodiment. With this configuration, the rotational movement of the first active member 313 can be increased as in the eleventh embodiment, and the force for puncturing applied to the removable needle 213 fixed to the needle holder 336 can also be increased.

  As shown in FIGS. 114 and 117, the second active member 314 can rotate around the pin 330. A pipe 381 is rotatably inserted into a part of the pin 330, and a spring 334 is disposed around them. The arm portion 382 of the spring 334 is in contact with a contact surface 340 provided on the second active member 314. On the other hand, as shown in FIG. 118, a force accumulating member 326 is connected to the second connecting member 316 that is pivotally connected to the rod 317 on the axis of the pin 333 via the pin 332, and the first arm portion 325 is connected. Can rotate around a pin 329. The other arm 383 of the spring 334 is engaged with a pin 339 fixed to the holder 318. Similarly to the tenth embodiment, two fixed needles 324 are attached to the U-shaped end of the second active member 314.

  As shown in FIGS. 113 and 119, a stopper 335 is fixed to the second active member 314 so that the second active member 314 does not further rotate counterclockwise from the state of FIG. 119.

  Since other components such as the pre-knot cartridge 365 including the detachable needle 213, the needle catching sheath 211, and the operation unit 255 of the suturing device are the same as those in the tenth embodiment, description thereof will be omitted. Further, the configuration of the removable needle 364 and the needle gripper 283 described in the tenth embodiment may be used.

(Function)
The operation of the suturing device 374 when puncturing a sutured tissue will be described with reference to FIGS.
(1) By operating the operation unit 255 (not shown) and pushing the rod 317 to the left side of the sheet as shown in FIG. 119, the first active member 313 can be largely opened to the position shown in the figure. At this time, the second active member 314 is biased counterclockwise by the spring 334, but can be opened only to the position shown in the drawing by the stopper 335. However, the biasing force of the spring 334 in the state of FIG. 119 is designed to be small. Similarly to the eleventh embodiment, when the detachable needle 213 is punctured so that the angle θ in the figure is 45 ° <θ <110 ° (particularly 90 °), the tissue is deeply pierced and the suturing is ensured.

(2) Next, as shown in FIG. 120, when the rod 317 is moved to the right side of the page, the removable needle 213 and the two fixed needles 229 puncture the tissue. At this time, since the second active member 314 is biased counterclockwise, it does not rotate.
(3) As shown in FIGS. 121 and 122, when the rod 317 is further moved to the right side of the drawing, the contact surface 341 of the force accumulation member 326 and the contact surface 342 of the second active member 314 are engaged, thereby causing the second active member. 314 rotates clockwise. Since the stitching procedure is the same as that of the tenth embodiment (see FIGS. 90 to 98), a description thereof will be omitted.
(effect)
In addition to the tenth embodiment, it is possible to puncture the tissue even deeper.

[Thirteenth embodiment]
123 to 126 show a thirteenth embodiment.
(Constitution)
In the thirteenth embodiment, the configuration of the twelfth embodiment is changed as follows.

  The spring 334 and the pin 339 are eliminated. A stopper 384 was fixed to the second active member 349. The holder 353, the first active member 348, and the second active member 349 are partially thinned as shown in FIG.

(Function)
The operation of the suturing device 385 when puncturing the sutured tissue will be described with reference to FIGS. 123 to 125B.
(1) As in the twelfth embodiment, the needle holder 357 is opened largely to the position shown in the figure by operating the operation unit 255 (not shown) and pushing the rod 352 to the left as shown in FIG. it can. At this time, the second active member 349 opens to the position shown in FIG. 123 when the force transmission member 355 and the contact surface 386 of the second active member 349 interfere with each other.
(2) Next, as shown in FIG. 124, when the rod 352 is moved to the right side of the drawing, the removable needle 213 and the two fixed needles 363 puncture the tissue. At this time, the second active member 349 is biased counterclockwise by the reaction force pressed against the tissue as shown in FIG.

  (3) As shown in FIGS. 125A and 125B, when the rod 352 is further moved to the right side of the drawing, the contact surface 387 of the force transmission member 355 and the contact surface 388 of the second active member 349 are engaged, whereby the second active member. 349 rotates clockwise. Since the stitching procedure is the same as that of the tenth embodiment (see FIGS. 90 to 98), a description thereof will be omitted.

(effect)
In addition to the tenth embodiment, it is possible to puncture the tissue even deeper. Further, the suture instrument can be made thinner than in the eleventh embodiment and 12, and the visual field of the endoscope is improved.

[Fourteenth embodiment]
127A and 128B show a fourteenth embodiment.
(Constitution)
In the fourteenth embodiment, the first embodiment or other suturing device can be projected and retracted with respect to the endoscope as shown in FIG. 127A.

  The tubes 245 and 227 described in the first embodiment and the like are inserted into the lumens of the tube holder 343 and the tubes 345 and 344 so as to freely advance and retract as shown in FIG. 127B. An airtight valve (not shown) is provided on the proximal side of the tubes 344 and 345, and the tubes 245 and 227 can be advanced and retracted while keeping the airtightness in the tubes 344 and 345. The tube holder 343 is fixed by a fixing member 346 in the vicinity of the distal end portion of the endoscope. The fixing member 346 may be anything such as an adhesive tape or a press-fitting method.

  Also, as shown in FIG. 128, the protective member 347 may be fixed to the tube holder 343 and inserted into the body without using the insertion aid 84 as shown in FIG.

(Function)
By pushing and retracting the hands of the tubes 245 and 227 with respect to the tubes 344 and 345, the suture instrument is advanced and retracted with respect to the scope to approach the suture site.

(effect)
It becomes easier to approach the stitched part.
Even after the approach, a deeper suture can be performed by pressing the suture device against the tissue.

[Fifteenth embodiment]
FIG. 129 to FIG. 143 show the fifteenth embodiment.
(Constitution)
The fifteenth embodiment is for continuous tissue suturing using the suturing device shown in the fourth to fourteenth embodiments.

  As shown in FIG. 129, in the fifteenth embodiment, the needle holders 216, 336, and 357 shown in the fourth to thirteenth embodiments are used as the needle holder 396, the pre-knot cartridge 365 is used as the pre-knot cartridge 407, the needle gripper 212, The needle gripper 283 is changed to a needle gripper 390. The pre-knot cartridge 407 includes a detachable needle 389, a thread 391, a pre-knot 397, and the like. Further, the detachable needle 389 includes a needle 392, a slider 393, a spring 399, a lock member 394, 395, and the like. The needle 392 is a stopper formed on the thread 391 similarly to the detachable needle 213 of the tenth embodiment. 408 secures the thread. The slider 393 and the needle 392 are slidably fitted to each other, and the slider 393 is urged to the left side by the spring 399. The needle 392 is engaged with the needle holder 396 by lock members 394 and 395. In the state of FIG. 129, the removable needle 389 is prevented from being detached from the needle holder 396. The needle gripper 390 includes a tip member 402, an insertion member 403, a spring 401, a release member 404, and the like. Although not shown, the proximal side of the tip member 402 is connected to a flexible member as shown by the needle catching sheath 211. The spring 401 is connected to the release member 404 as shown in the figure, and can move the spring 401 to the right in the drawing. An operation unit (not shown) is attached to the hand side of the release member 404 so that the release member 404 can be advanced and retracted.

  A pre-knot 397 is wound around the outer surface of the needle gripper 390.

(Function)
The procedure of continuous stitching will be described below.
(1) As shown in FIG. 129, the removable needle 389 is punctured into the tissue.
(2) When the needle gripping tool 390 is moved to the left side of the page as shown in FIG. 130, the spring 401 spreads as shown in the figure and engages with the recess 400 of the slider 393 as shown in FIG.
(3) As shown in FIG. 132, when the needle gripping tool 390 is moved to the right side of the drawing, the spring 401 is moved to the left side of the drawing and the spring 401 is prevented from spreading by the engaging portion 405.

  (4) As shown in FIG. 133, when the needle gripper 390 is moved to the right side of the page, the spring 399 that has urged the slider 393 to the left side of the page until now is compressed, and the slider 393 is moved to the right side of the page. At this time, the lock members 394 and 395 are released from the restriction in the vertical direction of the paper and can move as shown in the figure. In this way, the removable needle 389 is detached from the needle holder 396 as shown in FIG.

(5) Next, the needle holder 396 is removed from the tissue as shown in FIG. 135, and then the needle holder 396 is returned to the position shown in the figure as shown in FIG.
(6) Next, as shown in FIG. 137, when the needle gripping tool 390 is moved to the left side of the page, the lock members 394 and 395 ride on the engaging member 398. At this time, since the lock members 394 and 395 partially enter the recesses 406 and 409 formed in the slider 393, the lock members 394 and 395 can ride on the engagement member 398. In this manner, as shown in FIG. 138, the detachable needle 389 can be attached to the needle holder 396 again.

(7) Next, as shown in FIG. 139, the release member 404 is moved to the right side of the drawing by an operation unit (not shown) to return the spring 401 to the position shown in the figure. When the needle gripping tool 390 is moved to the right side of the drawing while maintaining this state, the spring 401 spreads out of the slider 393 as shown in FIGS.
(8) The tissue is continuously sutured by repeating the above operation. When the suturing is completed, a knot can be formed as shown in FIGS. 94 to 98, and continuous suturing as shown in FIGS. 142 and 143 can be performed.

(effect)
In addition to the effects of the fourth to fourteenth embodiments, further continuous stitching can be performed.

[Sixteenth Embodiment]
144 to 164 show a sixteenth embodiment.
(Constitution)
The sixteenth embodiment differs from the eleventh embodiment in the following points.
Since the length of the spring 432 is shortened with respect to the eleventh embodiment shown in FIG. 102, the convex portion 466 formed at the distal end of the holding member 292 that obstructs the visual field of the endoscope is eliminated, and at the time of suturing. The field of view was improved (see FIG. 145).

  In this embodiment, an end loop cartridge 440 as shown in FIGS. 146 and 158 is used to sew the pre-knot cartridge 365 shown in the eleventh embodiment. The end loop cartridge 440 includes a detachable needle 441, a suture thread 442, a needle lock mechanism 475, a case 446, a release member 447, an elastic member 448, a rigid member 449, and the like.

In the drawing, the suture thread 442 fixed to the detachable needle 441 passes through the hole 450 and the hole 457 formed in the needle lock mechanism 475, is press-fitted into the elastic member 448 disposed in the case 446, and is further released. A loop 451 is formed on the base end side through a hole 476 formed in the member 447. In order to increase the sliding resistance between the elastic member 448 and the suture thread 442, the rigid member 449 is brought into close contact with the elastic member 448 by swaging or caulking. The locking portion 454 provided in the release member 447 is engaged with a hole 456 formed in the case 446 so that the release member 447 is not detached from the case 446. The detachable needle 441 is press-fitted into the needle holding member 434 so as to be detachable. Here, the detachable needle 441 and the needle holding member 434 fit the detachable needle 489 having the groove 490 into the needle holding member 434 having the elastically deformable stopper 492 as shown in FIGS. A structure in which the removable needle 489 is not detached from the needle holding member 491 may be employed. Furthermore, as shown in FIGS. 175 and 176, a slit may be provided so that the removable needle 441 is not easily removed.
The case 446 can be fitted into the tip pipe 425.

  Further, as shown in FIGS. 147 and 159, a locking tubular member 465 including two locking members 458, a pipe 459 that fixes these proximal ends, a tube 460 that is connected to the pipe 459, and the like. Is configured so that the hook device 461 can be moved forward and backward. The hook device 461 includes a flexible coil 462, a hook 463, a transmission member 464 fixed to the hook 463, and an operation unit (not shown), and the hook 463 can be advanced and retracted by operating the operation unit. An airtight structure such as an O-ring (not shown) is provided on the proximal end side of the locking tubular member 465 to ensure airtightness with the hook device 461.

  As shown in FIG. 144, the holding member 416 has a cylindrical portion 467 and is disposed in the outer tube 468 so as to freely advance and retract. As shown in FIGS. 144 and 160, the outer tube 468 includes a guide pipe 436, a guide tube 437, a base 471, an airtight member 472, and the like. With this configuration, the tube 420 of the suturing device 410 can keep the inside of the outer tube 468 airtight. In addition, an inner tube 479 shown in FIGS. 144 and 161 includes a tube 439 connected to the tip pipe 425, a base 474, an airtight member 478, and the like, and passes through an outer tube 480 having a larger inner diameter. Has been. Here, the outer tube 480 includes a guide tube 438, a base 473, an airtight member 477, and the like. With this airtight structure, the outer tube 480 is kept airtight by the airtight member 477. Further, a locking tubular member 465 in a state where the hook device 461 shown in FIG. 147 is passed is passed through the inner tube 479 from the airtight member 478. At this time, airtightness is also maintained between the tube 460 and the airtight member 478.

  Further, in the drawing, the outer tube 468 and the inner tube 479 are constituted by flexible tubular members 437 and 439, respectively. However, as shown in FIG. You may change the part which does not cover the curved part of the front-end | tip part of a mirror to the rigid tubular members 481 and 482 (for example, the tube which embedded the thin wire inside in the grid | lattice form) with little expansion / contraction. By doing in this way, a big force can be applied to what was passed in the outer tube 468 and the inner tube 479 without disturbing the bending operation of the endoscope.

  The locking tubular member 465 in the state where the hook device 461 shown in FIG. 147 is passed is passed through the airtight member 478 shown in FIG. 161 and comes out of the tip pipe shown in FIG. By operating an operation unit (not shown) of the hook device 461 coming out from the tip pipe, the loop 451 of the end loop cartridge 440 is hooked on the hook 463 and the hook 463 is pulled as shown in FIG. Next, as shown in FIGS. 147, 158, and 157, the locking member 458 of the locking tubular member 465 is engaged with the hole 455 of the end loop cartridge 440, and then loaded into the tip pipe shown in FIG. A loaded state is shown in FIG.

  The structure in which the detachable needle 441 is locked to the needle lock mechanism 475 is exactly the same as the structure shown in FIGS.

(Function)
The stitching procedure will be described below with reference to FIGS. 147 to 157. However, the suture instrument 410 is omitted in the figure for easy understanding of the operation. Therefore, originally, as shown in FIG. 164, stitching is performed with the end loop cartridge 440 loaded.

(1) The operation unit of the suture instrument 410 (not shown) is operated, and the removable needle 441 is punctured into the tissue as shown in FIG.
(2) As shown in FIG. 148, the detachable needle 441 is engaged with the needle lock mechanism 475 of the end loop cartridge 440 by pushing the hook device 461 and the locking tubular member 465.
(3) As shown in FIG. 149, when the hook device 461 and the locking tubular member 465 are moved to the right side in the drawing, the removable needle 441 is detached from the needle holding member 434. At this time, since the locking member 458 is engaged with the needle catching body 445 of the end loop cartridge 440, the removable needle 441 can be reliably removed from the needle holding member 434.

  (4) As shown in FIG. 150, when the hook device 461 is pushed to the left side of the drawing, the release member 447 is pushed into the case 446 and the inclined portion 453 is engaged with the hole 455. At this time, since the locking member 458 rides on the inclined portion 453, it is detached from the hole 455. (Refer to FIG. 151) Further, the case 446 is elastically deformed so that the release member 447 can be engaged with the hole 455.

(5) Remove the needle holding member 434 from the tissue as shown in FIG.
(6) As shown in FIGS. 153 and 154, the hook 463 is pulled in and the suture thread 442 is tightened. At this time, the suture portion 442 is prevented from loosening due to sliding resistance with the elastic member 448.
(7) As shown in FIGS. 155 and 156, the hook 463 is pulled out from the coil 462 and the loop 451 is removed from the hook 463.

  (8) As shown in FIG. 157, the remaining suture thread 442 is cut with the thread trimmer forceps 469. Here, as shown in FIG. 162, the thread trimmer forceps 469 is configured to cut the thread by opening and closing the collars 483 and 484 having sharp blade surfaces. The concave portions 485 and 486 are provided to prevent the yarn from escaping from the blade when the yarn is cut. Further, the thread cutting forceps 469 can be rotated with respect to the shaft by the rotatable tubular member 487, so that the directions of the hooks 483 and 484 can be freely changed. Further, as shown in FIG. 157, since the suture thread 442 is exposed in the space 488, if it is desired to remove the end loop cartridge 440 after stitching, the end loop cartridge 440 can be easily removed by cutting the suture thread 442 in this portion. Can be removed from the organization.

(effect)
In addition to the effects of the tenth embodiment, the once stitched portion can be easily removed. Moreover, it becomes easy to approach the stitched portion. Further, even after approaching, deeper suturing can be performed by further pressing the suturing device against the tissue.

[Seventeenth embodiment]
169 to 171 show a seventeenth embodiment.
(Constitution)
The seventeenth embodiment differs from the sixteenth embodiment in the following points.
As shown in FIGS. 169 to 171, the third operating member 494 is rotatably connected to the first operating member 501 and the third connecting member 502 by pins 511 and 510, respectively. The first actuating member 501 is rotatably connected to the holding member 499 by a pin 504 that is a holding shaft, and is further connected to the first connecting member 496 by a pin 507. On the other hand, the third connection member 502 is rotatably connected to the holding member 499 by a pin 509. The second actuating member 495 is rotatably connected to the holding member 499 by a pin 505 that is a holding shaft, and is further rotatably connected to the second connecting member 497 by a pin 508. The first connection member 496 and the second connection member 497 are rotatably connected to the push rod 498 by a pin 506. By pushing and pulling the rod 498, the first operating member 501 and the second operating member 495 can be opened and closed as shown in FIGS. As a result, the third operating member 494 is moved between the first operating member 501 and the third connecting member 502. Other configurations are the same as those in the sixteenth embodiment, and thus are omitted.

(Function)
The sewing is performed in the same manner as in the sixth embodiment shown in FIGS. 147 to 157. Here, the end loop cartridge 440 and the tip pipe are omitted in FIGS.

(effect)
In addition to the effect of the sixteenth embodiment, the locus of the tip of the detachable needle 441 can be different from the circular locus centered on the pin 504, and the tissue can be pierced deeper.
The stroke of the rod 498 when opening and closing the third operating member 494 and the second operating member 495 can be reduced.

[Eighteenth embodiment]
FIG. 172 shows an eighteenth embodiment.
(Constitution)
The eighteenth embodiment differs from the sixteenth embodiment in the following points.
As shown in FIG. 172, a first grip member 519 and a second grip member 520 that rotate on the pins 522 and 523 are disposed. Needle-like members are formed at the distal ends of the first and second gripping members 519 and 520 so as not to slip with respect to the tissue when gripping. Further, the first and second gripping members 519 and 520 can operate independently of the opening / closing operation of the first operating member 517 and the second operating member 518 by a link structure (not shown). Other configurations are the same as those in the sixteenth embodiment, and thus are omitted.

(Function)
The stitching is performed in the same manner as in the sixteenth embodiment shown in FIGS. 147 to 157. However, before the detachable needle 441 is punctured into the tissue, the tissue is gripped using the first and second gripping members 519 and 520, and the detachable needle 441 is punctured after the tissue is pulled up as shown in FIG. To.

(effect)
In addition to the effect of the sixteenth embodiment, the removable needle 441 can be punctured while pulling up the tissue by the first and second gripping members 519 and 520, so that the tissue can be punctured deeper.

[Nineteenth Embodiment]
178 and 179 show a nineteenth embodiment.
(Constitution)
The nineteenth embodiment differs from the sixteenth embodiment in the following points.
As shown in FIGS. 178 and 179, the end loop cartridge 440 is changed to the end loop cartridge 539, and the locking tubular member 465 is changed to the locking tubular member 543.
The end loop cartridge 539 includes a detachable needle 441, a suture thread 442, a needle locking mechanism 475, an elastic member 448, a rigid member 449, a case 540, and the like as in the sixteenth embodiment. The locking tubular member 543 includes two locking members 545, a pipe 549 that fixes these proximal ends, a tube 550 that is connected to the pipe 549, and the like, and the hook device 461 is disposed so as to be able to advance and retract. It is configured so that it can be installed.

  As shown in FIG. 178, after the loop 451 of the end loop cartridge is hooked on the hook 463 of the hook device and the loop 451 and a part of the suture thread 442 are pulled into the hook device 461, The locking member 545 is aligned with the position of the hole 546 formed in the case 540. Thereafter, as shown in FIG. 179, the hook device 461 is moved to the left side in the drawing, and the locking member 545 is pushed up and down in the drawing to engage with the hole 546. By doing so, the locking tubular member 543 and the end loop cartridge 539 can be integrally engaged. The locking member 545 has an arm 559 having an elastic characteristic.

(Function)
The suturing procedure is substantially the same as that of the sixteenth embodiment shown in FIGS. 147 to 157 except for the following points.
The operation for releasing the engagement between the end loop cartridge 440 and the locking tubular member 465 shown in FIGS. 149 and 150 is changed to the operation shown in FIGS. 179 to 178. At this time, when the hook device 461 is moved to the right side of the drawing, the locking member 545 is released from the restriction of the hook device 461, and the locking member 545 is detached from the hole 546 due to the elastic characteristics of the arm 559.
Since other operations are the same as those in the sixteenth embodiment, the description thereof is omitted.

(effect)
In addition to the effects of the sixteenth embodiment, the end loop cartridge 539 and the locking tubular member 543 can be easily attached and detached.

[20th embodiment]
180 and 181 show a twentieth embodiment.
(Constitution)
The twentieth embodiment differs from the sixteenth embodiment on the following points.
As shown in FIGS. 180 and 181, the end loop cartridge 440 is changed to the end loop cartridge 539, the locking tubular member 465 is changed to the locking tubular member 551, and the distal end pipe 425 is changed to the distal end pipe 552.
The end loop cartridge 539 includes a detachable needle 441, a suture thread 442, a needle lock mechanism 475, an elastic member 448, a rigid member 449, a case 540, and the like as in the sixteenth embodiment. The locking tubular member 551 is composed of two locking members 553, a pipe 554 fixing these proximal ends, a tube 555 connected to the pipe 554, and the like, and a hook device 461 is disposed so as to be able to advance and retract. It is configured to be able to.

  As shown in FIG. 180, the loop 451 of the end loop cartridge is hooked on the hook 463 of the hook device, and the loop 451 and a part of the suture thread 442 are pulled into the hook device 461, thereby The member 553 is aligned with the position of the hole 546 formed in the case 540. Thereafter, as shown in FIG. 181, the locking tubular member 551 and the hook device 461 are moved to the left side of the drawing, and the end loop cartridge 539, the locking tubular member 551, and the hook device 461 are housed in the tip pipe 552. At this time, the outer surface of the locking member 553 comes into contact with the inner surface of the hole 556 formed in the tip pipe 552, whereby the arm 558 is elastically deformed, and the locking member 553 and the hole 546 are engaged. By doing so, the locking tubular member 551 and the end loop cartridge 539 can be integrally engaged.

  Further, a hole 557 having a larger inner diameter than the hole 556 is formed in the tip pipe 552. This is enlarged because the tip portion of the end loop cartridge 539 is partially enlarged, but if the maximum outer diameter of the end loop cartridge 539 is made smaller than the hole 556, a hole 557 that is larger by one step is provided. It goes without saying that it is not necessary.

(Function)
The suturing procedure is substantially the same as that of the sixteenth embodiment shown in FIGS. 147 to 157 except for the following points.
The operation of releasing the engagement between the end loop cartridge 440 and the locking tubular member 466 shown in FIGS. 149 and 150 is changed to the operation of releasing from the hole 556 of the tip pipe 552 as shown in FIGS. ing. At this time, the locking tubular member 551 and the hook device 461 are moved to the left side of the drawing.
The other operations are the same as those in the sixteenth embodiment, and will be omitted.

(effect)
In addition to the effects of the sixteenth embodiment, the end loop cartridge 539 and the locking tubular member 543 can be easily attached and detached.
[Twenty-first embodiment]
182A to 190 show a twenty-first embodiment.

(Constitution)
This embodiment is characterized by the configuration of a new end loop cartridge, and differs from the sixteenth embodiment in the following points.

  As shown in FIG. 182A, the suturing device 3 according to the present embodiment includes a locking member 458, a tubular member 681 connected thereto, an end loop cartridge 440, and a hook device 463. FIG. 182A shows a state before the end loop cartridge 440 is assembled to the suturing device 3 and a state in which the end loop 451 is hooked on the hook 463. Note that a part of the suture instrument is omitted.

  The locking member 458 is not limited to the opened state (FIG. 182A), but may be parallel as shown in FIG. 182B. Such a locking member 458 can be connected to the tubular member 681 via a screw portion 687, as shown in FIG. 182C.

  As shown in FIG. 183, the end loop cartridge 440 is assembled to the suturing device 3 and stored in the guide member 462 of the suturing device 3, and then the end loop cartridge 440 is passed through the tubular member 681 through the tubular member 681. , The end loop cartridge 440 can be engaged with the removable needle 441 as shown in FIG.

  As shown in FIGS. 185 and 186, the end loop cartridge 440 is formed in the same structure as in the sixteenth embodiment, although the shape is different. As shown in FIG. 187, the end loop cartridge 440 has a cylindrical outer shape, and has a groove 600 on the outer periphery. The end loop cartridge 440 is preferably formed of, for example, polyphenylsulfone, polyphthalamide, polyether ether ketone, titanium alloy, or pure titanium.

  The locking member 458 is connected to a tubular member 681 that can be moved by an operation unit (not shown), and can be pulled into the guide member 462 by such an operation unit and the tubular member 681. The locking member 458 is closed by contacting the guide member 462 and is in a state of being fitted into the groove portion 600 of the end loop cartridge 440. Accordingly, the locking member 458 can reliably hold the end loop cartridge 440. The locking member 458 is provided with a C surface 672 (see FIG. 182A). The locking member 458 is preferably formed of an elastic material such as SUS402J2 (Japanese Industrial Standard).

  As shown in FIG. 183, the second active member 412 of the suturing device 3 is provided with a curved portion 676, and the guide member 462 is provided with an inclined portion 677.

(Function)
Suture can be performed as follows.

  The locking member 458 connected to the tubular member 681 that can be moved by the operation unit outside the body is drawn into the guide member 462 in advance.

  By operating an operation portion of the suture instrument 3 (not shown), the removable needle 441 is punctured into the tissue as shown in FIG. 188A. Then, with the detachable needle 441 puncturing the tissue, the end loop cartridge 440 is moved leftward in the drawing, thereby engaging with the detachable needle 441 as shown in FIG. 188B.

  Thereafter, the end loop cartridge 440 is moved rightward from the state shown in FIG. 188B to remove the removable needle 441 from the needle holding member 434 (curved needle) as shown in FIG. 188C. The removable needle 441 is collected in the cartridge 440. At this time, the locking member 458 is in contact with the guide member 462 and does not spread, but is in a state of being fitted into the groove portion 600 of the end loop cartridge 440, and the locking member 458 continues to hold the end loop cartridge securely.

  Next, an operation unit (not shown) is operated to remove the needle holding member from the tissue as shown in FIG. 188D, and then the hook 463 is moved rightward on the paper surface to bind the thread 442 as shown in FIG. 188E. .

  By providing the locking member 458 with the C surface 672, the groove 600 can be smoothly entered and exited, and when the end loop cartridge 440 is removed, it is only necessary to push the hook 463 to the left as shown in FIG.

  The end hoop cartridge 440 is separated from the locking member as shown in FIG.

(effect)
In addition to the same effects as in the sixteenth embodiment, the end loop cartridge 440 can be securely held. In the case of the sixteenth embodiment, when the coil 462 and the hook device 461 expand and contract due to stress, the relative positional relationship is shifted, so that the end loop cartridge may come off as shown in FIG. Such a situation does not occur in this embodiment.

  The appearance of the end loop cartridge 440 is cylindrical, and the groove portion 600 is formed instead of the hole 455 of the sixteenth embodiment, so that there is no mounting direction and the end loop cartridge can be mounted in an arbitrary direction.

  Since the locking member 458 and the tubular member 681 are connected via the screw portion 687, they can be separated as necessary. For example, they can be disassembled during cleaning to improve the cleaning performance.

  The curved portion 676 of the second active member 412 and the inclined portion 677 of the guide member 462 provide a shape that hardly damages the tissue when the suturing device 3 is inserted into the body.

  When the end loop cartridge 440 is made of a material such as polyphenylsulfone, polyphthalamide, or polyetheretherketone, it has excellent chemical resistance and acid resistance, so it is difficult to be denatured in vivo and has excellent weldability. Therefore, it can be assembled using ultrasonic welding or laser welding. Pure titanium and titanium alloys are excellent in biocompatibility.

[Twenty-second embodiment]
FIG. 191 shows a twenty-second embodiment.

  FIG. 191 shows the end loop cartridge 440 assembled to the suturing device 3 and housed in the guide member 462 of the suturing device 3. Only the following points differ from the twenty-first embodiment.

  In the twenty-first embodiment, the hook device 461 includes a coil 601 and an extension tube 602 that covers the coil 601, but in the twenty-second embodiment, an extension wire 602a is used instead of the extension tube 602. Yes.

(Function)
This is the same as the twenty-first embodiment.

(effect)
In the 22nd embodiment, since there is no stretch tube 602 that covers the coil 601 of the 21st embodiment, the cleaning property is more excellent.

[Twenty-third embodiment]
192A to 195 show a twenty-third embodiment. The following points are different from the sixteenth embodiment.

(Constitution)
In this embodiment, a flexible coil 507, a tube 460, an engagement tool 503 attached to the tip of the tube 460, a hook 463, and an end loop cartridge 440 are provided.

  FIG. 192A shows a state before the end loop cartridge 440 is assembled to the suturing device 3 and a state in which the end loop 451 is hooked on the hook 463. In FIG. 192B, as shown in the outer appearance of the end loop cartridge 440, an elastic protrusion 504 and a protrusion 505 are added to that of the twenty-first embodiment.

  FIG. 193 shows a state in which the end loop cartridge 440 is attached to the guide member 462, and FIG. 194 shows a cross section of FIG. It should be noted that the inside of the end loop cartridge 440 is omitted. FIG. 195 shows a state in which the protrusion 505 of the end loop cartridge 440 has been pulled away from the engagement tool 503.

  The engaging member 503 attached to the distal end of the tube 460 is provided with a groove portion 506 with which the protrusion 505 can be engaged.

(Function)
When attaching the end loop cartridge, the end loop 451 is hooked on the hook 463, the hook 463 is moved to the right in the drawing by an operation unit (not shown), and the end loop 451 is pulled. Next, the protruding portion 505 of the end loop cartridge 440 is attached and stored in accordance with the groove portion 506 of the engaging tool 503.

  Although illustration is omitted, when the end loop cartridge 440 collects the detachable needle 441, the end loop cartridge 440 is also moved by moving the tube 460 to the left in the drawing by an operation unit (not shown).

  When removing the end loop cartridge 440 from the engaging tool 503, if the force is applied to the coil 507 in the left direction in the drawing with an operation unit (not shown), the protrusion 505 is broken (stripped), and the end loop cartridge 440 is engaged. The tool 503 is disengaged leftward.

(effect)
As described above in connection with the twenty-first embodiment, the end loop cartridge 440 may be inadvertently detached in the sixteenth embodiment, but in the present embodiment, the end loop cartridge 440 is attached. In the state, the protrusion 505 does not move upward on the paper surface due to the effect of the elastic portion 504, and does not inadvertently disengage from the engaging tool 503.

[Twenty-fourth embodiment]
196 to 199 show a twenty-fourth embodiment. The following points are different from the sixteenth embodiment.

(Constitution)
A plurality of windows 612 are opened in the engaging tool 503. The end loop cartridge 440 is provided with a hook-shaped portion 611. A thread locking means 609 for locking the suture thread 442 is fixed to the end loop cartridge 440.

(Function)
When attaching the end loop cartridge 440 to the engaging tool 503, the end loop 451 is hooked on the hook 463, the hook 463 is moved to the right in the drawing by an operation unit (not shown), and the end loop 451 is pulled. Next, when the end loop cartridge 440 is pushed into the engagement tool 503, the hook-shaped portion 611 of the end loop cartridge is deformed as shown in FIG. 199 and attached as shown in FIG.

  When removing the end loop cartridge 440 from the engagement tool 503, the hook-shaped portion 611 of the end loop cartridge 440 is deformed and detached as shown in FIG. 199 by moving the flexible coil 607 to the right in the drawing.

(effect)
As described above in connection with the twenty-first embodiment, the end loop cartridge 440 may be inadvertently detached in the sixteenth embodiment. However, in the case of the present embodiment, the hook is attached when the end loop cartridge is attached. Due to the effect of the shape portion 611, the engagement member 503 is not inadvertently detached.

[25th Embodiment]
200 and 201 show a twenty-fifth embodiment.

(Constitution)
As is clear from comparison with the hooks 463 used in the sixteenth and twenty-first embodiments shown in FIG. 200, the hooks 463 of this embodiment shown in FIG.

(Function)
The following points are different from those of the sixteenth and twenty-first embodiments.

  The hook having the shape shown in FIG. 200 has a role of drawing the end loop 451 shown in the sixteenth and twenty-first embodiments in the right direction of the drawing, but FIG. 201 has a different hook shape, and instead of the end loop. A similar effect is obtained by hooking the knot 614 made on the yarn to the slit portion 615 having a smaller width and moving it to the right in the drawing.

(effect)
It is easier to manufacture the knot 614 than to manufacture the end loop 451.

[Twenty-sixth embodiment]
202 to 208 show a twenty-sixth embodiment.

  In FIG. 16 of the first embodiment, the insertion assisting tool 84 uses two valves 86 and 87 as means for preventing air leakage. In this embodiment, the following airtight valve 616 is used.

(Constitution)
FIG. 202 shows a state in which the suturing device 3 and the endoscope 12 are combined. The suturing device 3 and the endoscope 12 are fixed using the scope holder 628 and the fixing member 70. FIG. 203 shows a state where the suturing device 3 and the endoscope 12 shown in FIG. 202 are inserted into the insertion assisting tool 84 and the suturing device 3 is inside the insertion assisting tool 84. 204 shows a state in which the suturing device 3 comes out of the insertion assisting tool 84 from the state of FIG.

  FIG. 205 shows a state where the endoscope 12 is passed through the airtight valve 616. FIG. 206 shows an embodiment in which an endoscope 12 is passed through an airtight valve 616 and a metal or resin band 618 is wound to further improve airtightness. FIG. 207 shows a state where the band 618 is attached as viewed from the direction of the arrow AA in FIG. FIG. 208 shows a state where the band 618 has been attached as viewed from the direction of the arrow AA in FIG.

  The airtight valve 616 of this embodiment is made of a material such as silicon rubber, natural rubber, or isopropylene rubber, and is fixed to the tubes 37 and 73 with an adhesive or the like. Then, it is used through the endoscope 12 as shown in FIG. As shown in FIGS. 206 to 208, a band 618 can be wound and reinforced to ensure the fixation of the airtight valve 616 and the endoscope 12.

(Function)
As shown in FIG. 205, when the suturing device 3 and the endoscope 12 are fixed, the endoscope 12 is passed through the airtight valve 616. Furthermore, when securing the airtight valve 616 and the endoscope 12 securely, a band 618 is wound around the airtight valve 616 and the U-shaped portion 629 is hooked and fixed.

  In any case, as shown in FIGS. 203 and 204, before the suturing device 3 exits from the tip 617 of the insertion assisting device 84, the airtight valve 616 enters the insertion assisting device, and the suturing device reaches the wound part. Sometimes the airtight valve 616 is located in the insertion aid.

  The total length of the insertion assisting tool 84 is desirably 500 mm or less, and ideally 200 mm or less.

(effect)
While the suturing device 3 is out of the distal end 617 of the insertion assisting tool 84, the body cavity can always be kept airtight.

[Twenty-seventh embodiment]
209 to 213 show a twenty-seventh embodiment. The present embodiment is characterized by the operation unit used in the sixteenth embodiment and the twenty-first embodiment.

(Constitution)
As shown in FIG. 209 to FIG. 211, the embodiment in which the sliders 619 and 620 and the knob 621 which are the operation parts are collectively held so that they can be held together with one hand is shown. The sliders 619 and 620, the knob 621, and the lock button 626 are color-coded. The sliders 619 and 620 and the knob 621 can be moved by hand. The grip 625 is a part that the operator holds by hand. Further, cleaning ports 622 to 624 are provided for cleaning the inside of the tube.

  When the lock button 626 is operated, for example, the slider 619 moves only in the left direction on the paper surface by the ratchet mechanism (see FIG. 74) described in the tenth embodiment.

  As shown in FIG. 211, the guide rod 634 is inside the guide pipe 635 and can move relatively. The rotary knob 630 is fixed to the outside of the guide pipe 635 via a fixing member 636. As shown in FIGS. 212 and 213, the rotary knob 630 has a groove portion 633 extending in the circumferential direction and along the axial direction on the outer peripheral portion, and a groove portion or linear portion 638 extending in the axial direction. The groove portion 633 of this embodiment is formed symmetrically with respect to a plane passing through the straight line portion 638 and the axis of the rotary knob 630. A spring 637 is inserted between the rotary knob 630 and the fixing member 636.

(Function)
When the slider 619 is moved in the left-right direction with respect to the paper surface, the first active member 411 and the second active member 412 move via the transmission member 417 shown in FIG. When the slider 620 is moved in the left-right direction with respect to the paper surface, the hook 463 is moved via the transmission member 464. The knob 621 is connected to the coil 601 shown in FIG. 183. When the knob 621 is moved in the left-right direction with respect to the paper surface, the coil 601 is moved.

  As shown in FIGS. 189 and 190 of the twenty-first embodiment, when the end loop cartridge 440 is moved to the left in the drawing and then to the right, the detachable needle 441 is detached from the needle holding member 434 (of the curved needle). As shown in FIG. 211, the guide pin 632 fixed to the connecting plate 631 is engaged with the groove 633 (FIG. 212) of the rotating knob 630, and the connecting plate 631 and the guide rod 634 are rotated by rotating the rotating knob 633. Through this, the knob 621 moves, and a series of reciprocating movements can be performed.

  When the rotary knob 630 is rotated and the end loop cartridge 440 is moved to the right in the drawing, the rotary knob 630 is brought into contact with the needle holding member 434 (FIG. 183) and cannot move any more. Can be shrunk and moved leftward on the page to relieve stress. Further, when the knob 621 is moved and operated without using the rotary knob, the angle of the rotary knob 621 may be set so that the guide pin 622 is positioned at the linear portion 638 of the groove.

(effect)
The sliders 619 and 620 and the knob 621 which are the parts to be operated can be held together with one hand. In addition, by color-coding, mistakes during operation can be prevented and instructions can be easily issued.

  In the case of the method of operating with the knob 621, whether or not the needle lock mechanism of the end loop cartridge 440 has been reliably operated has been checked depending on the touch. However, when the removable needle 441 is removed from the needle holding member 434, the rotary handle 630 is used. All you need to do is turn.

[Twenty-eighth embodiment]
214 to 216 show a twenty-eighth embodiment.

(Constitution)
214 shows the operation unit 641 of the twenty-eighth embodiment, FIGS. 215A and 216B show details of the scope holder 628 shown in FIG. 202, and FIG. 216 shows the guide rail 639 of the operation unit 641 and the scope holder. A state in which the guide groove 640 of 628 is fitted is shown.

  The operation unit 641 is provided with a guide rail 639. The scope holder 628 is provided with a guide groove 640 and cleaning ports 642 and 643 for cleaning the inside of the tube. Oredome 644,645 covers the tubes 73,37.

(Function)
When the guide rail 639 of the operation unit 641 and the guide groove 640 of the scope holder 628 are fitted, the operation unit 641 and the scope holder 628 can be integrated into the state shown in FIG. Further, the inside of the tube can be cleaned using the cleaning ports 642 and 643 provided in the scope holder 628.

(effect)
By integrating the operation unit 641 and the scope holder 628, there is no problem with the location of the operation unit 641 when the end loop cartridge 440 shown in the twenty-first embodiment or the like is attached. Oredome 644 and 645 prevent breakage when an excessive force is applied to the tubes 73 and 37.

[Twenty-ninth embodiment]
217 to 223C show a twenty-ninth embodiment.

  As shown in FIGS. 217 and 218, the scope holder 628 includes a projecting / retracting handle 646, a projecting / retracting pipe 647, a scope holder main body 651, and a pin 648 connected to the projecting / retracting handle 646. A plunge pipe 647 connected thereto is shown.

  As shown in an enlarged view in part of FIG. 218, an outer pipe 652 is bonded to the scope holder main body 651. An inner pipe 653 is bonded to the protrusion handle 646. The inner pipe 653 is movable using the inner surface of the outer pipe 652 as a guide. The inner surface of the inner pipe 653 is bonded to the outer surface of the tube 420. Therefore, when the projecting handle 646 is moved in the left-right direction on the paper surface, the tube 420 is moved with respect to the scope holder 628.

  Similarly, an outer pipe 654 is bonded to the scope holder main body 651. An inner pipe 655 is bonded to the protrusion handle 646. The inner pipe 655 is movable using the inner surface of the outer pipe 654 as a guide. The inner surface of the inner pipe 655 is bonded to the outer surface of the tube 439. Accordingly, when the projecting handle 646 is moved in the left-right direction on the paper surface, the tube 439 is moved with respect to the scope holder.

  As shown in FIG. 221, a groove 656 is provided in the projecting pipe 647, and a pin 648 (FIG. 217) is fitted therein.

  With the scope holder 679 and the suture device 3 attached to the endoscope 12, the scope 12 can be hung using the scope place 680 shown in FIG. 223B. At this time, an angle 678 formed by the projecting handle 646 with respect to the axis passing through the operation knob 12a of the endoscope 12 so that the projecting handle 646 does not interfere with the scope storage place 680 and the pole 681 (see FIG. 223C). ) Is preferably 90 degrees.

(Function)
When the projecting handle 646 is moved in the left-right direction on the paper surface, the tubes 439 and 420 move with respect to the scope holder, and the suturing device 3 attached to the endoscope 12 moves as shown in FIGS. 219 and 220.

(effect)
By fitting the groove portion 656 and the pin 648, the projecting and retracting handle 646 does not rotate, and the tubes 37 and 73 are not twisted as shown in FIG. Furthermore, the outer pipes 652 and 654 and the inner pipes 653 and 655 prevent the tubes 37 and 73 from being bent as shown in FIG. 223A. Then, as shown in FIG. 223B, when carrying out the twenty-first embodiment, the scope holder 680 can be hung with the scope holder 679 and the suturing device 3 attached to the endoscope 12.

[Thirty Embodiment]
224 to 225B show a thirtieth embodiment.

(Constitution)
As is apparent from FIG. 224 showing the attachment of the endoscope 12 and the suturing device 3, the jig 664 is provided with a projection 665. The inner surface 658 of the jig 664 is dimensioned to fit with the outer periphery 659 of the scope fixing portion 666. Further, the jig 664 is provided with a notch 660 and a flat surface 661.

(Function)
The suturing device 3 and the endoscope 12 are fixed via a scope fixing portion 666 and a hood 603 made of a soft material fixed thereto. At this time, when the inner surface 658 of the jig 664 is fixed so as to be aligned with the outer periphery 659 of the scope fixing portion 666 (FIG. 225A), the flat surface 662 of the suture instrument and the flat surface 661 of the jig 664 coincide. Further, the notch portion 660 of the jig 664 is fitted into the scope fixing portion 666. Further, the jig 664 has a protrusion 665, and the endoscope 12 is inserted into the hood 603 at a position where the protrusion 665 enters the forceps channel 6 of the endoscope 12.

(effect)
When the endoscope 12 is inserted into and fixed to the hood 603, the fixing angle 657 of the endoscope is determined by using the fixing jig 664, and the suture device 3 is fixed to the endoscope visual field as shown in FIG. 225B. The position can be fixed.

[Thirty-first embodiment]
FIG. 226 shows a thirty-first embodiment.

(Constitution)
As is apparent from the state in which the endoscope 12 is attached to the suturing device 3 shown in FIG. 226, the present embodiment differs from the thirtieth embodiment in the following points.

  The scope fixing portion 666 has a protrusion 663. Window portions 683, 684, 685, and 686 are provided in accordance with the light guides 8 and 9, the CCD camera 10, and the suction device 11 shown in FIG.

(Function)
In the thirtieth embodiment, the endoscope is attached to the suture instrument 3 using the jig 664. However, in the present embodiment, the projection 663 of the scope receiver 666 enters the forceps channel of the endoscope 12. It is attached.

(effect)
Even without preparing a jig for mounting, the endoscope can always be mounted at an accurate angle.

[Thirty-second embodiment]
The thirty-second embodiment shown in FIG. 227 is an embodiment of another shape of the fourteenth embodiment.

(Constitution)
FIG. 227 shows a state in which the endoscope 12 is attached to the suturing device 3. The scope fixing portion 666 is movable along the tubes 227 and 245 around the tubes 227 and 245.

(effect)
Compared to the case where the scope fixing portion 666 shown in FIG. 228 is not stable with one of the tubes 227 and 245 as an axis, the use of two axes makes it possible to more reliably fix the endoscope 12 and the suture instrument 3. Become.

[Thirty-third embodiment]
FIGS. 229 to 231 show a thirty-third embodiment, which differs from the twenty-first embodiment in the following points.

(Constitution)
FIG. 229 shows the endoscope field F with the removable needle 441 attached to the needle holding member, and FIG. 230 shows the endoscope field F with the removable needle 441 removed from the needle holding member. Indicates. As shown in FIG. 231, in the present embodiment, a mark 627 is provided on the outer periphery of the end loop cartridge 440 similar to that in the twenty-first embodiment.

(Function)
Since it is the same as that of the 21st embodiment, it is omitted.

(effect)
In the case of the twenty-first embodiment, when moving from the state shown in FIG. 188 to the state shown in FIG. 189, the removable needle 441 is moved depending on whether or not the needle lock mechanism of the end loop cartridge 440 has been reliably operated. In the present embodiment, as shown in FIG. 230, if the end loop cartridge 440 is moved to a position where the mark 627 can be seen, the needle lock mechanism is surely operated, so that it is not necessary to rely on the touch.

[Thirty-fourth embodiment]
232 to 234 show a thirty-fourth embodiment.

(Constitution)
FIG. 232 is an appearance of the suturing device 3 according to the twenty-first embodiment, and shows a state where the thread 442 is tangled. On the other hand, in FIG. 233, the shape of the second active member 412 is a loop. As shown in FIG. 234, the end loop cartridge 440 is dimensioned to pass through the second active member 412.

(effect)
The second active member 412 shown in FIG. 232 may be entangled with the thread 442. On the other hand, in the present embodiment, it is possible to prevent the yarn 442 from being tangled by forming the second active member 412 in a loop shape as shown in FIG.

  As shown in FIG. 234, the end loop cartridge 440 can be attached and detached while the second active member 412 is opened.

[Thirty-fifth embodiment]
FIG. 235 shows a thirty-fifth embodiment, which differs from the twenty-first embodiment in the following points.

(Constitution)
As shown in FIG. 235, the suturing device 3 of this embodiment is obtained by adding a liquid feeding circuit 668, a liquid feeding tube 667, and a base 688 to the suturing device 3 of the twenty-first embodiment.

(Function)
Liquid is fed from the base 688 using a syringe (not shown).

(effect)
When the suture instrument 3 is inserted into the body, even if mucus or the like adheres and the visual field is obstructed, the visual field can be secured by removing the mucus by feeding the liquid from outside the body using the liquid feeding circuit. .

[Thirty-sixth embodiment]
236A to 237C show a thirty-sixth embodiment, which is different from the twenty-first embodiment in the following points.

(Constitution)
FIG. 236A shows a needle holding member 434 and a removable needle 441. Similar to the twenty-first embodiment, a hole 670 and a slit 693 are provided at the tip of the needle holding member 434. A knot 689 is used to fix the removable needle 441 and the thread 442, as shown in FIGS. 236B and 236C, in which the fixing part of the removable needle 441 and the thread 442 is shown. The removable needle 441 is provided with a hole 691 that opens to the rear end surface and a hole 690 that opens to the tapered surface at the tip. The hole 690 is larger than the hole 691 and the knot enters the hole 690 but does not enter the hole 691.

  As in the modification shown in FIG. 237A, a cylindrical protrusion 699 may be provided at the tip of the needle holding member 434, and a hole 691 and a slit 692 may be provided in the removable needle 441. A knot 689 is used to fix the removable needle 441 and the thread 442, as shown in FIGS. 237B and 237C, which show the fixing part of the removable needle 441 and the thread 442. The hole 690 is larger than the hole 691 and the knot enters the hole 690 but does not enter the hole 691.

(Function)
In the case of the detachable needle 441 shown in FIGS. 236B and 236C, the knot 689 used for fixing enters the hole 690 but does not enter the hole 691, so the thread 442 is pulled out even if the thread 442 is pulled leftward in the drawing. There is no end. The same applies to the removable needle 441 shown in FIGS. 237B and 237C.

  When the columnar protrusion 671 of the removable needle 441 is inserted into the hole 670 of the needle holding member 434 shown in FIG. 236A, the hole 670 and the slit 692 are expanded to hold the removable needle 441. The hole 670 is made of, for example, SUS420J2 in order to obtain a spring property.

  In the modification of FIG. 237A, the relationship between the hole and the protrusion in FIG. 236A is reversed.

(effect)
By using a springy material, the hole 670 and the slit 692 will not be deformed and spread even if the removable needle 441 and the needle holding member 434 are attached and detached many times.

  Since the removable needle 441 is used only once, when the removable needle 441 and the needle holding member 434 are attached and detached many times, durability on the needle holding member 434 side is required. The modified example shown in FIG. 237A is provided with a hole 671 in the removable needle 441 that is not required to have much durability, so even when a combination of the same materials is used, it is relatively durable compared to FIG. 236A. Is expensive.

[Thirty-seventh embodiment]
(Constitution)
FIG. 238 shows an end loop cartridge 440 used in the twenty-first embodiment. FIG. 239 shows this embodiment, and shows a state in which the central axis of the thread locking means 155 of FIG. 238 is shifted from the central axis of the end loop cartridge 440.

(effect)
In the case of the end loop cartridge 440 shown in FIG. 238, the suture 156 is fixed by the thread locking means 155. This amount of fixing force is further increased by the edges 673 and 674, and the amount of fixing force when the suture is pulled in the direction of the arrow 676 is larger than the amount of fixing force of the thread lock means 155 alone. On the other hand, in the end loop cartridge 440 according to the present embodiment, since the central axis of the locking means 155 is offset as shown in FIG. 239, the edge 675 for locking the suture 156 is increased by one place, and the fixing force amount is further increased. Becomes larger.

[Thirty-eighth embodiment]
240 to 246 show a thirty-eighth embodiment.

(Constitution)
The present embodiment is characterized by a configuration for locking a new end loop cartridge, and differs from the twenty-first embodiment in the following points.

  As shown in FIG. 240, the suturing device 3 according to the twenty-first embodiment includes a locking member 458, a tubular member 681 connected thereto, an end loop cartridge 440, and a hook 463. FIG. 240 shows a state in which the loop 451 is hooked on the hook 463 before the end loop cartridge 440 is assembled to the suturing device 3. The suturing device 3 is shown with a part thereof omitted.

  FIG. 241 is a diagram illustrating a problem to be solved by the present embodiment. The locking member 458 of the twenty-first embodiment can enter the fitting recess 694 of the end loop cartridge 440.

  In the following, various examples for preventing the locking member 458 from entering the fitting recess 694 will be described.

  FIG. 242 shows the first embodiment. Unlike the one shown in FIG. 240, the locking member 458 of this embodiment is formed integrally with a cylindrical cover member 695. Thus, the locking member 458 of this embodiment is devised so as not to enter the fitting recess 694.

  FIG. 243 shows a second embodiment. The tubular member 681 of this embodiment extends through the central hole 696 of the circular member 695 that connects to the locking member 458. A retaining member 697 is fixed to the distal end of the tubular member 681. In addition, the guide member 462 is provided with a groove 698 that opens into a cylindrical space 699 in which the tubular member 681, the locking member 458, the circular member 695, and the end loop cartridge 440 are stored.

  FIG. 244A shows a state in which the tubular member 681 connected to the operation unit (not shown) is moved leftward from the position shown in FIG. The locking member 458 is caught in the groove portion 698, and both the locking member 458 and the circular member 695 are in a state where they do not move further to the left in the drawing.

  FIG. 244B is a diagram for supplementing FIG. 244A. Inside the tubular member 681, there is a hook 463 connected to an operation unit (not shown), and the hook 463 is removed from the thread 442 of the end loop cartridge 440 that has been punctured.

  FIG. 245 shows a third embodiment. Unlike the one shown in FIG. 240, the end loop cartridge 440 is provided with a lid member 700. The lid member 700 is provided with a cylindrical projection 701 having a cylindrical shape.

  FIG. 246 shows a fourth embodiment. Unlike the one shown in FIG. 240, the end loop cartridge 440 is configured such that the inner diameter of the fitting recess 694 is small and the locking member 458 does not enter.

  In the fifth embodiment, the hook 463 shown in FIG. 240 is urged so as to be always pulled in the right direction of the drawing by an elastic member such as a spring provided in an operation unit (not shown).

  With the configuration as described above, in each of the embodiments shown in FIGS. 240 to 246, the locking member 458 does not enter the fitting recess 694 of the end loop cartridge 440.

(Function)
Suture can be performed as follows.

  In advance, the locking member 458 connected to the movable tubular member 681 is drawn into the guide member 462 by the operation unit outside the body.

  By operating an operation portion of the suture instrument 3 (not shown), the removable needle 441 is punctured into the tissue as shown in FIG. 188A.

  Thereafter, as shown in FIG. 188B, the end loop cartridge 440 is moved leftward in the drawing. The removable needle 441 is locked to the end loop cartridge 440.

  As shown in FIG. 188C, when the end loop cartridge 440 is moved to the right side in the drawing, the detachable needle 441 is detached from the needle holding member (curved needle) 434. At this time, the locking member 458 is in contact with the guide member 462 and does not spread, and is in a state of being fitted into the groove portion 600 of the end loop cartridge 440, and the locking member 458 continues to hold the end loop cartridge 440 reliably. .

(effect)
In addition to the twenty-first embodiment, the locking member 458 does not enter the fitting recess 694 of the end loop cartridge 440, improving operability.

  As shown in FIG. 244A, the locking member 458 is prevented from moving leftward by the groove 698, so that the locking member 458 does not hit the second active member 412. For this reason, operability is improved.

[Thirty-ninth embodiment]
247 and 248 show a thirty-ninth embodiment.

(Constitution)
FIG. 247 is a diagram illustrating an overall configuration of the endoscope suturing system 1.

  FIG. 248 shows the operation unit of the suturing device 3. The present embodiment is characterized in preventing the relative movement of the drive shaft of the operation unit. Specifically, the slider 706 of the operation unit is connected to a transmission member 224 that is a drive shaft via a spring 707. The details of the suturing device 3 are the same as those shown in FIG.

(Function)
Prior to use, the endoscope 12 equipped with the suturing device 3 as shown in FIG. 247 is hooked on the scope place 680 with the insertion portion 705 bent, and the insertion portion 705 is bent. As shown in FIG. 4, the suturing device 3 positioned on the distal end side of the endoscope 12 has a locking member 458 connected to a movable tubular member 681 drawn into the guide member 462 by an operation unit outside the body. The first active member 411 and the second active member 412 are closed.

  When the insertion portion 705 of the endoscope 12 with the suturing device 3 attached in this way is inserted into the body, the first active member 411 and the first active member 411 and the first active member 411 are moved as the shape of the endoscope insertion portion 705 becomes closer to a straight state. There is a possibility that the positional relationship between the transmission member 224 that drives the two active members 412 and the sheath (not shown) that covers the outside of the transmission member 224 may change relatively. However, the spring 707 disposed inside the operation unit 706 constantly absorbs the change by urging the transmission member 224 rightward through the stopper 845.

(effect)
When the shape of the insertion portion 705 of the endoscope changes, the length of the transmission member 224 that drives the first active member 411 and the second active member 412 and the sheath (not shown) that covers the outside of the transmission member 224 are relative to each other. In some cases, the first active member 411 and the second active member 412 are slightly opened.

  When the suture instrument 3 is inserted into the body with the first active member 411 and the second active member 412 slightly open, the detachable needle 441 disposed on the first active member 411 and the second active member 412 and the fixed Needle 298 can damage tissue. However, the relative change in length can be absorbed by the effect of the spring 707, and the first active member 411 and the second active member 412 can be prevented from opening.

[40th Embodiment]
FIG. 249 shows a fortieth embodiment. This embodiment is characterized by the shape of the needle and differs from the twenty-first embodiment in the following points.

(Constitution)
FIG. 249 shows the needle holding member 434 and the removable needle 708.

  The removable needle 708 is obtained by adding a plurality of flat surfaces 709 to the removable needle 441 of the twenty-first embodiment. By adding these planes, the distal end side of the removable needle 708 forms a triangular or quadrangular pyramid shape.

(Function)
The conical removable needle 441 is replaced with a pyramidal removable needle 708, which is the same as the twenty-first embodiment.

(effect)
Compared to the detachable needle 441, the detachable needle 708 requires less force when penetrating the tissue, and therefore requires less operating force.

[Forty-first embodiment]
FIG. 250 shows a forty-first embodiment.

(Constitution)
FIG. 250 shows an endoscopic image. A mark 709 is provided on the guide member 462 of the suturing device 3.

(Function)
This is the same as the twenty-first embodiment.

(effect)
When the first active member is moved to the closed position when puncturing the tissue, it is easy to confirm whether or not the first active member has been moved to the fully closed position because of the mark 709. By moving the first active member to a position where the mark 709 and the detachable needle 441 overlap, the operator can recognize that the mark is completely closed, and the axes of the detachable needle 441 and the end loop cartridge 440 coincide with each other. The detachable needle 441 can be locked to the end loop cartridge 440.

[Forty-second embodiment]
The forty-second embodiment will be described with reference to FIGS. 251 and 252. The following points are different from the twenty-first embodiment.

(Constitution)
FIG. 251 shows a state in which tissue is punctured using the suturing device 3 of the twenty-first embodiment. In contrast, FIG. 252 shows a state in which tissue is punctured using the suture instrument 3 in which the depression 711 is added to the first active member 411 and the depression 710 is added to the second active member 412.

(Function)
The same as in the twenty-first embodiment.

(effect)
By adding the depression 711 to the first active member 411 and the depression 710 to the second active member 412, even if more tissue enters between the first active member 411 and the second active member 412, The active member 411 and the second active member 412 can be closed. For this reason, the removable needle 441 can be penetrated deeper into the tissue, and the axes of the removable needle 441 and the end loop cartridge 440 coincide with each other to securely lock the removable needle 441 to the end loop cartridge 440. be able to.

[Forty-third embodiment]
FIG. 253 shows the forty-third embodiment. This embodiment is characterized by the shape of the scope receiver.

(Constitution)
In the scope receiver 666 of this embodiment, an eaves member 711 is added to the scope receiver of the 30th embodiment shown in FIG.

(Function)
The scope receiver 666 is inserted into the body together with the closed first active member 411 and second active member 412.

(effect)
When the endoscope 12 equipped with the suturing device 3 is inserted into the lumen, the eaves member 711 can advance while expanding the lumen, and the insertability is improved.

[Embodiment 44]
FIGS. 254 to 255B show a 44th embodiment, which differs from the seventh embodiment shown in FIGS. 51 to 56 in the following respects.

(Constitution)
FIG. 254 shows the thread locking means 712A. The thread locking means 712A includes a caulking pipe 712 and an elastic tube 713 disposed in the caulking pipe 712. The thread locking means 712A of the present embodiment is mainly characterized by the addition of the C surface to the caulking pipe and the fixing of the caulking pipe.

  As shown in FIG. 255A, the caulking pipe 712 used for the thread locking means 712 </ b> A is formed in a cylindrical pipe shape provided with a C surface 714. Further, as shown in FIG. 255B, the end loop cartridge 440 is provided with a pressing member 718 that sandwiches the caulking pipe 712 so that the thread lock unit 712 </ b> A is incorporated in the end loop cartridge 440.

(Function)
As shown in FIG. 254, the tube 713 is disposed outside the thread 442, and the caulking pipe 712 is crushed together with the tube 713. The caulking pipe 712 is inserted into the end loop cartridge 440 in a crushed state and fixed in a state of being press-fitted between the pressing members 718.

(effect)
Providing the C surface 714 on the caulking pipe 712 makes it difficult to damage the yarn 442 when the caulking pipe 712 is crushed, and the strength of the yarn 442 is not inadvertently reduced. Further, when the caulking pipe 712 is assembled between the presser members 718 in a press-fitted state, the caulking pipe 712 can remain in the cartridge 440 even when the thread 442 is pulled in the right direction in FIG. Will improve.

[Forty-fifth embodiment]
FIG. 256 shows a forty-fifth embodiment. This embodiment is intended to improve the insertability of the endoscope into the airtight valve, and differs from the twenty-sixth embodiment in the following points.

(Constitution)
As shown in FIG. 256, the airtight valve 616 is provided with a plurality of windows 715.

(Function)
This is the same as the twenty-sixth embodiment.

(effect)
When the endoscope 12 is passed through the airtight valve 616, it may be difficult to pass due to the frictional resistance between the endoscope 12 and the airtight valve 616. The window 715 reduces the contact area between the airtight valve 616 and the endoscope 12, which is improved.

[The 46th embodiment]
257 to 262 show a 46th embodiment. This embodiment is mainly characterized by improving the accuracy of the attachment angle of the endoscope, and differs from the thirtieth embodiment in the following points.

(Constitution)
FIG. 257 shows a state immediately before the endoscope 12 is attached to the suturing device 3. The scope receiver 666 has a mark 716. The mark can be given by appropriate means such as unevenness formed on the scope receiver 666, coloring, laser marking or the like.

  FIG. 258A shows a state immediately before the suturing device 3 is attached to the endoscope 12.

  FIG. 258B shows a state where the endoscope 12 and the suturing device 3 are attached.

  FIG. 259 shows the insertion aid 84. The insertion aid has a flexible tubular shape.

  260-262 show three embodiments of scope receiver 666 along section AA of FIG. 258A. The scope receiver 666 and the hood 717 may be fixed using an adhesive or may be integrally formed.

  The first embodiment of the scope receiver 666 shown in FIG. 260 is formed so that the outer diameter X is smaller than the hood 717, and the second embodiment of the scope receiver 666 shown in FIG. It is formed larger than. In the third embodiment of the scope receiver 666 shown in FIG. 262, a hood 717 is attached to the inner surface.

(Function)
When attaching the suturing device 3 to the endoscope 12, the endoscope 12 is inserted into a hood 717 attached to the scope receiver 666. At this time, the fixing angle 657 is determined by using the jig 664 in the thirtieth embodiment. However, in this embodiment, the position of the mark 716 and the position of the forceps channel 6 of the endoscope are aligned with the suture instrument 3. The endoscope 12 is attached.

  An insertion aid 84 is inserted in advance into the esophagus, and the endoscope 12 with the suturing device 3 attached is inserted therein.

(effect)
The fixed angle 657 between the endoscope 12 and the suturing device 3 is constant. Thereby, the fixing position of the suturing device 3 with respect to the visual field of the endoscope can be made constant, and the needle tip can always be confirmed in the visual field of the endoscope when the first active member 411 and the second active member 412 are opened and closed.

  When the endoscope 12 and the suturing device 3 that are integrally attached are inserted into the insertion assisting tool 84, the hood 717 rubs against the inner surface of the insertion assisting tool. For this reason, in the first embodiment shown in FIG. 260, the hood 717 may come off the scope wall 666, but in the second embodiment shown in FIG. 261, the outer diameter of the scope receiver 666 is larger than the outer shape of the hood 717. Therefore, the hood 717 can be prevented from coming off and the durability can be improved. In the case of the third embodiment shown in FIG. 262, the same effect can be obtained because the hood 717 is attached to the inner surface of the scope receiver 666.

[47th embodiment]
263 to 267 show a 47th embodiment. In this embodiment, the connecting method of the thread and the hook is improved, and the following points are different from the twenty-first embodiment.

(Constitution)
FIG. 263 shows the external appearance of the suturing device 3 before the suturing containing the end loop cartridge 440, and FIG. 264 shows the hook shown in the twenty-first embodiment so that the end loop cartridge after the suturing is separated. An engaging male member 720 is provided instead of 463. As shown in FIG. 265, the end loop cartridge 440 is disposed inside the guide member 462, and an engaging female member 721 is attached to the end surface of the thread 442 attached to the end loop cartridge 440. Further, an engaging male member 720 is fitted to the engaging female member 721.

  FIG. 266 shows the appearance of the engaging female member 721 attached to the end loop cartridge 440 via the thread 442 and the engaging male member 720 fitted to the engaging female member 721. FIG. 267 shows a state where the engaging female member 721 and the engaging male member 720 are fitted.

(Function)
In the twenty-first embodiment, the thread 442 is hooked on the hook 463, but in this embodiment, the engaging female member 721 and the engaging male member 720 are engaged.

(effect)
The operation of fitting the engaging female member 721 and the engaging male member 720 can be performed more easily than the operation of hooking the hook 463 on the thread 442.

[Forty-eighth embodiment]
268 to 276 show a 48th embodiment. This embodiment is an improvement of the method of connecting the thread and the hook, and differs from the 47th embodiment in the following points.

(Constitution)
As shown in FIG. 268, in this embodiment, a hook 723 is provided on the engaging female member 722 that fits with the engaging male member 720. The hook 723 is hooked on the end loop of the thread 442 extending from the end loop cartridge 440.

(Function)
269 to 276 show a suturing procedure according to this embodiment.

  Prior to stitching, the engaging female member 722 and the engaging male member 720 are connected as in the 47th embodiment, and the end loop cartridge 440 is pulled into the guide member 462 as in the 21st embodiment.

  As shown in FIG. 269, a first active member 411 (not shown) is moved by an operation unit (not shown) to puncture a tissue with a needle holding member 434 and a removable needle 441 connected to the first active member. Thereafter, as shown in FIG. 270, the end loop cartridge 440 is moved to the left in the drawing by an operation unit (not shown), and the end loop cartridge 440 is engaged with the removable needle 441.

  As shown in FIG. 271, the end loop cartridge 440 is moved rightward in the drawing by an operation unit (not shown), and the removable needle 441 is removed from the needle holding member 434. Thereafter, as shown in FIG. 272, a first active member 411 (not shown) is moved by an operation unit (not shown), and the needle holding member 434 connected to the first active member is removed from the tissue.

  As shown in FIG. 273, the end loop cartridge 440 is moved in the left direction on the paper surface by an operation unit (not shown) to approach the tissue, and then the engaging male member 720 is moved in the right direction on the paper surface, and the thread 442 is pulled to pull the tissue. Tie up. Thereafter, as shown in FIG. 274, the end loop cartridge 440 is moved leftward with respect to the guide member 462 by an operation unit (not shown), and the free end of the locking member 458 is separated from the end loop cartridge 440.

  As shown in FIG. 275, the engaging male member 720 is moved to the right in the drawing by an operation unit (not shown), and the thread 442 is ligated. Thereafter, as shown in FIG. 276, the engaging male member 720 is further moved leftward in the drawing, and the thread 442 is removed from the hook 723.

(effect)
The operation is easier when the engaging female member 722 and the engaging male member 720 are fitted than when the hook 463 is hooked on the thread 442. Further, when the thread 422 is removed from the hook 723, it is easy as in the 47th embodiment, and the engaging female member 722 remains fitted to the engaging male member 722, so that it does not remain in the body and is inconvenient. There is no risk of damaging the tissue.

[49th Embodiment]
FIGS. 277 to 282 show a forty-ninth embodiment, which relates to an improvement in the method for connecting a thread and a hook, and differs from the forty-eighth embodiment in the following points.

(Constitution)
As shown in FIG. 277, the thread fixing means 155 is fixed to the end loop cartridge 440, and a thread end member 726 is provided at the end of the thread 442. The thread end member 726 may tie a knot on the thread itself, or may be attached with another member. The engaging portion 725 of the engaging female member 724 fitted to the yarn end member 726 has an open shape. As shown in FIG. 278, the engaging female member 724 is incorporated into the end loop cartridge 440 by engaging the engaging portion 725 with the thread end member 726.

  FIG. 279 shows a state in which the end loop cartridge 440 is pulled into the guide member 462, and FIG. 280 shows that the engaging male member 720 is moved to the right in the drawing with respect to FIG. The end member 726 is drawn into the tubular member 681.

  In a state where the engaging portion 725 is drawn into the tubular member 681, the engaging portion 725 does not open in contact with the inner surface. Then, as shown in FIG. 281, when protruding from the tubular member 681, the engaging portion 725 of the engaging female member 724 is opened and the yarn end member 726 is released.

  FIG. 282 is an example in which the present embodiment is applied to the engaging female member 721 shown in FIG. 266 and the free end portion 728 of the engaging female member 721 is open. When the engaging male member 720 is moved to the left in the drawing after puncturing, the free end 728 is opened as shown in FIG. 282 when it comes out of the tubular member 681.

(Function)
In the forty-eighth embodiment, the engaging female member 724 is provided with a hook 723, which is used to connect to the thread 442, whereas in the present embodiment, the engaging female member 724 has an engaging portion 725. Applied to female member 724. When used, as shown in FIG. 278, the engaging portion 725 is fitted in advance to the thread end member 726 of the engaging female member 724, and the engaging female member 724 is incorporated into the end loop cartridge 440.

  When applied to the engaging female member 721 shown in FIG. 282, the engaging male member 720 is moved leftward in the drawing after puncturing. When coming out from the inside of the tubular member 681, the free end 728 of the tubular female member 721 is opened as shown in FIG. 282, and the engaging male member 720 and the engaging female member 721 are separated from each other.

(effect)
In the forty-eighth embodiment, when the thread 442 is removed from the hook 723, the thread 442 may be caught by the hook 723 and may not be removed smoothly. However, in this embodiment, the thread 442 is securely removed from the engaging female member 724. Can be removed.

  In the case of the engaging female member 721 having the pre-opened free end 728 shown in FIG. 282, when the engaging male member 720 is moved to the left in the drawing after puncturing and comes out of the inside of the tubular member 681, Thus, since the free end 728 is in an open state, it is easy to remove the engagement between the engaging female member 721 and the engaging male member 720.

[Embodiment 50]
FIGS. 283 to 285 show a 50th embodiment, which is an improvement of the method of connecting a thread and a hook, and differs from the above-mentioned 47th and 48th embodiments in the following points.

(Constitution)
As shown in FIG. 283, the end loop cartridge 440, the engaging female member 721, and the removable needle 441 used in the suturing device 3 are held in the case 727 by an elastic member 850 such as rubber. In the state of being housed in the case 727, it is desirable that the free end 728 of the engaging female member 721 is held by an elastic member 850 such as rubber so as not to open. The case 727 has a hole 729 formed coaxially with the attachment / detachment needle 441 in the vicinity of the attachment / detachment needle 441, and a hole 730 formed coaxially with the engaging female member 721 below the hole 730. A slit 847 that connects the holes is formed. When the needle holding member 434 of the suturing device 3 is disposed coaxially with the hole 729 and the detachable needle 441 shown in the upper part of the figure, the other hole 730 and the engaging female member 721 are connected to the tubular shape of the suturing device 3. The member 681 is disposed coaxially. As shown in FIG. 284, the detachable needle 441 is provided with a C surface 731.

  FIG. 285 shows a case 734 according to a modification. Inside the case 734, the end loop cartridge 440, the engaging female member 721, and the removable needle 441 are held by an elastic member such as rubber (not shown). A slit 848 is formed between a hole 732 near the detachable needle 441 and a hole 733 near the engaging female member 721.

(Function)
When attaching the detachable needle 441 accommodated in the case 727 of FIG. 283 to the suturing device 3, the holes 729 and 730 of the case 727 are positioned at the holes 670 and the engaging male member 720 of the needle holding member 434, respectively. After matching, move relatively. Thereby, the removable needle 441 and the engaging female member 721 are fitted to the needle holding member 434 and the engaging male member 720 of the suturing device 3, respectively.

  When the case 734 of FIG. 285 is used, first, the engaging male member 720 is inserted into the hole 733 of the case 734, and the engaging male member 720 and the engaging female member 721 are fitted. Subsequently, the direction of the case 734 is changed, the needle holding member 434 is inserted into the hole 732, and the removable needle 441 is attached to the needle holding member 434.

(effect)
In the case of the case 727 shown in FIG. 283, the attachment of the removable needle 441 to the needle holding member 434 and the fitting of the engaging female member 721 to the engaging male member 720 can be performed simultaneously. If the end loop cartridge 440 is too small to be pinched with a finger, it can be easily held by placing it in the case 727. When the detachable needle 441 is provided with a surface 731 as shown in FIG. 284, it is easy to enter the hole 670 of the needle holding member 434.

  In the case of the case 727 in FIG. 283, it is necessary to accurately and simultaneously align the two positions of the alignment of the hole 670 of the needle holding member 434 with respect to the hole 729 and the alignment of the engaging male member 720 with respect to the hole 730. On the other hand, the case 734 in FIG.

[Embodiment 51]
FIGS. 286A to 288 show a fifty-first embodiment, which is an improved method for connecting a thread and a hook, and differs from the forty-seventh embodiment in the following points.

(Constitution)
As shown in FIG. 286A, a removable needle 441 and a thread 442 connected thereto are attached to the end loop cartridge 440, and a thread locking portion 735 is provided on the thread 442. The locking portion 735 may be fixed with a stopper 735a as shown in FIG. 286B instead of being formed with a thread knot.

  As shown in FIG. 287, in a state where the end loop cartridge 440 is fixed by the locking member 458, the thread 442 is located inside the connection member 736 and connected to the distal end of the transmission member 464. It is connected to the member 737. The locking portion 735 is located inside the holding portion 738 of the engaging female member 737 connected to the distal end of the transmission member 464 connected to the operation portion (not shown). Further, an inner diameter enlarged portion 739 is provided on the inner surface of the connection member 736. When the transmission member 464 is moved to the left in the drawing by an operation unit (not shown), the state shown in FIG. 288 is obtained.

(Function)
As shown in FIG. 287, when the end loop cartridge 440 is fixed by the locking member 458, the thread 442 is positioned inside the connecting member 736, and the locking portion 735 is connected to the operation portion (not shown). It is located inside the holding portion 738 of the engaging female member 737 connected to the distal end thereof. An inner diameter enlarged portion 739 is provided on the inner surface of the connecting member 736, and the holding portion 738 of the engaging female member 737 has an open shape. When the transmission member 464 is moved to the right in the drawing by an operation unit (not shown), the holding portion 738 of the engaging female member 737 is closed and the thread locking portion 735 is held therebetween.

(effect)
As in the 47th embodiment, the trouble of hooking the yarn on the hook is unnecessary.

[52nd embodiment]
FIGS. 289A to 289D show a fifty-second embodiment, which relates to an improved method for fixing a removable needle.

(Constitution)
As illustrated in FIG. 289A, the needle holding member 740 is detachably formed on the first active member 411, and the detachable needle 441 is configured to be detachable from the holding member 740.

  As in the modification shown in FIGS. 289B and 289C, the engaging portion 740a can be used at the connecting portion between the first active member 411 and the needle holding member 740. Further, as shown in FIG. 289D, the removable needle 441 and the needle holding member 740c may be connected using a connecting member 740d. In this case, the first active member 411 and the needle holding member 740c are fixed and integrated.

(Function)
The removable needle 441 is fitted in advance to the needle holding member 740 shown in FIGS. 289A to 289C, and these are attached to the first active member 411. When the detachable needle 441 is newly attached, the old needle holding member 740 is removed from the first active member 411.

  When the connecting member 740d shown in FIG. 289D is used, the removable needle 441 and the connecting member 740d are fitted in advance, and these are attached to the needle holding member 740c. When newly attaching the removable needle 441, the old connecting member 740d is removed.

(effect)
A detachable needle 441 is connected to the needle holding member 740 shown in FIGS. 289A to 289C by press-fitting. As described in the forty-ninth embodiment, the two need to be separated during the suturing operation. When the detachable needle 441 is firmly press-fitted to the needle holding member 740, separation work becomes difficult, and when it is loosely press-fitted and connected, it may be unintentionally separated. For this reason, it is necessary to make it an appropriate press-fit connection state. However, if the dimensional tolerance between the two is strict, the manufacturing cost increases. Then, it adjusts at the time of an assembly so that both may be in an appropriate press-fit state, and is shipped in the state made into the appropriate press-fit state. The user attaches these to the first active member 411. When the needle holding member 740 is attached to the first active member 411 by press-fitting, the degree of press-fitting does not need to be maintained in a very severe range, but rather tends to be tightly pressed because both do not come off. . Further, the first active member 411 and the needle holding member 740 are locked by the engaging portion 740a as shown in FIG. 289B, or the first active member 411 and the needle holding member are pressed by pressing the lock release button as shown in FIG. 289C. The engagement portion with the 740 can be released, the first active member 411 and the needle holding member 740 can be easily attached and detached, and the reliability of the engagement is improved.

  The same applies to the case of FIG. 289D. The detachable needle 441 and the connecting member 740d are press-fitted in an appropriate state, and the press-fitting condition of the needle holding member 740c connecting member 740d need not be maintained in a severe range.

[53rd embodiment]
FIGS. 290 to 300B show a 53rd embodiment, which relates to an improvement of the fixing method of the removable needle.

(Constitution)
As shown in FIG. 290, the removable needle 741 attached to the needle holding member 434 is provided with two slits. As shown in FIG. 291, the end loop cartridge 743 that engages the removable needle 741 press-fitted to the needle holding member 434 has an end portion 744 with a narrow inner diameter. It is desirable that at least the end portion 744 is made of an elastic member. As shown in FIG. 292, when the end loop cartridge moves leftward in the drawing, the removable needle is inserted through the end portion 744. 741 and the end loop cartridge 743 are engaged with each other.

  The following FIGS. 293 to 300B show various modifications of the members of the above embodiment.

  FIG. 293 shows a modification in which the needle holding member 745 has two slits 747, and FIG. 294 shows a modification in which the needle holding member 746 has four slits 748.

  FIG. 295 shows a modification in which an elastic material is attached to the inner surface of the hole 670 of the needle holding member 434 to which the removable needle 441 is fitted. Further, FIGS. 296A and 296B show a modification in which the removable needle 750 is combined with an elastic member 751 having a C-shaped cross section.

  FIG. 297A shows a modification in which an elastic member 751 is covered with a thread 442 connected to the removable needle 752, and this elastic member 751 is press-fitted and fixed to the needle holding member 434. FIG. 297B shows a handle 752c of the removable needle 752b. The state which is going to attach the detachable needle | hook 752b by the modification which covered the elastic member 751b to the needle holding member 434 is shown.

  FIG. 298A shows a state where an elastic member 755 is put on the outside of the handle 754 of the removable needle 753 and attached to the needle holding member 434. In this modified example, the thread 442 passes through a lateral hole 756 opened in the handle 754. As shown in FIG. 298B, the needle holding member 840 is provided with a space 837 through which the thread 442 passes.

  A detachable needle 841 of the modification shown in FIG. 299A has a structure in which the thread 442 is pulled out from the end. As shown in FIG. 299B, the needle holding member 841 is provided with a space 839 through which the thread 442 passes.

  In still another modification shown in FIGS. 300A and 300B, a spring 843 is fixed to the needle holding member 842, and a removable needle 844 having a thread 442 fixed thereto is fixed to the needle holding member 842 via the spring 843. The

(Function)
As described in the forty-eighth embodiment, the end loop cartridge 743 pulls out the removable needle 741 from the needle holding member 434 after puncturing. As shown in FIG. 292, when the end loop cartridge 743 is positioned, the end 744 may compress the width of the slit 742 of the removable needle 741, and loosen the fitting state between the removable needle 741 and the needle holding member 434. it can.

  Since various modifications shown in FIGS. 293 to 299B are the same as those in the thirty-sixth embodiment, details thereof are omitted.

  In the modification shown in FIGS. 300A and 300B, the removable needle 844 can be inserted into the spring 843 and fixed so as to expand the inner diameter of the spring 843.

(effect)
Even if the press-fitting of the detachable needle 741 and the needle holding member 434 is a hard press-fitting, the detachable needle 741 can be removed with a small amount of force when removing. For this reason, the removable needle 741 is not unintentionally detached from the needle holding member 434, and the removal can be performed with a small force.

  In the modification shown in FIGS. 293 and 294, two and four slits are described, but the number is not limited as long as one or more slits are provided. When the number of slits is larger, when a detachable needle (not shown) is inserted, the variation in press fit hardness is reduced even if there is a variation in the thickness of the detachable needle.

  In the modification shown in FIG. 295, the elastic material 749 is attached to the inner surface of the hole 670 of the needle holding member 434, so that even when the detachable needle 441 varies in size, it can be held more reliably. If the elastic member 749 is silicon rubber, the resistance to autoclave sterilization is also increased.

  In the modification shown in FIGS. 296A and 296B, by adding the elastic member 751, the diameter of the elastic member 751 is reduced when entering the hole 670, and a frictional force between this and the inner surface of the hole 670 is obtained. Even if the dimension of the detachable needle 441 varies, it can be held more reliably. If the material of the elastic member 751 is SUS304 prescribed | regulated to Japanese Industrial Standard, it has sterilization tolerance and the secular change of a characteristic can also be disregarded.

  In the modified example of FIG. 297A, the needle holding member 434 and the detachable needle 752 can be securely fixed, and the outer diameter of the needle holding member 434 can be reduced because the configuration is simple.

  In the modification shown in FIGS. 298A and 298B, the needle holding member 840 and the detachable needle 753 are reliably held by moderate friction by the elastic member 755. Further, in the modified example of FIG. 298A, the space 837 through which the thread passes is smaller than the space 839 of the modified example shown in FIGS. 299A and 299B, and the processing can be made inexpensive.

  300A and 300B, the needle holding member 842 and the detachable needle 844 are fixed by the spring 843 with appropriate press-fitting even if the finished dimensions of the detachable needle 844 vary.

[Fifty-fourth embodiment]
301 to 308 show a 54th embodiment, which relates to the operation unit of two drive shafts, and is different from the 48th embodiment in the following points.

(Constitution)
301 and 302 are diagrams for explaining the problem to be solved by the present embodiment.

  FIG. 301 shows a state where the first active member 411 and the second active member 412 are opened to the maximum by an operation unit (not shown).

  FIG. 302 shows a state in which the first active member 411 and the second active member 412 are somewhat closed by an operation unit (not shown). Here, FIG. 301 is the embodiment of FIG. 184, and the spring 334 rotates the first active member 411 and the second active member 412 in order to increase the opening angle of the first active member 411 and the second active member 412. The first active member 411 is completely closed even when a large amount of tissue is grasped, and the axes of the removable needle 441 and the end loop cartridge are aligned with each other. The removable needle 441 is aligned with the axis of the end loop cartridge 440 so that the removable needle 441 can be securely locked to the end loop cartridge 440.

  However, since the second active member 412 is driven via the spring 34, the force for rotating the second active member 412 clockwise is weak, and the suture instrument 3 itself is used when the first active member 411 is punctured into the tissue. Slips to the side, making it difficult to puncture. As described above, the second active member 412 does not begin to move until the force is applied to the spring 334. Therefore, compared to FIG. 289A, the suturing device 3 can easily move to the right in the drawing with the tip of the removable needle 441 as a fulcrum. It has become. This is because the second active member 412 cannot always be in contact with the tissue. As a result, the amount of tissue that the first active member 411 and the second active member 412 can capture is small. These problems are solved by the embodiments related to the six structures shown in FIGS. 303 to 308.

  FIG. 303 shows the first embodiment, in which a first active member 411 and a second active member 412 are connected to a drive member 757 and a drive member 758, respectively. Proximal ends of both drive members are movably fitted in grooves 760 a and 760 b provided in the rotation operation unit 759. In this case, the spring 334 is not used in the suturing device 3 as shown in FIG. 301, and the force of the drive shaft 758 is directly transmitted to the second active member 412.

  FIG. 304 shows a second embodiment in which the proximal ends of both drive members are connected to two sliders 761 and 762 as in FIG. In this case, a spring 334 is not used in the suturing device 3 as shown in FIG. 301, but is transmitted directly to the first active member 411 and the second active member 412 by the force of the drive shaft 758.

  FIG. 305 shows the third embodiment, and shows only the operation portion in an example in which the proximal ends of both drive members are connected to the operation portion as in FIG. 304. The drive member 757 is connected directly to the slider 768, and the drive shaft 758 is connected to the slider 768 via an extension member 764 and a spring 765. The extension member 764 and the lock button 766 have a ratchet structure, and the slider 768 and the extension member 764 can move integrally without the spring 765 by pressing the lock button 766 downward in the drawing. In this case, the spring 334 is not used in the suturing device 3 as shown in FIG. 301, and the force of the drive shaft 758 is directly transmitted to the second active member.

  FIG. 306A and FIG. 306B similarly show a fourth embodiment in which the proximal ends of both drive members are connected to the operation portion. The drive member 757 is directly connected to the slider 771 and the drive shaft 758 is connected to the slider 771 via the extension member 774. Reached inside. The extension member 774 and the lock button 772 have a ratchet structure, and the slider 771 and the extension member 774 can move integrally as long as the lock button 772 is not pushed upward in the drawing. When the slider 771 is at the position shown in FIG. 306, the lock release button 772 is pushed up by the lock release arm 773, and the slider 771 moves independently with respect to the extension member 774. In this case, the spring 334 is not used in the suturing device 3 as shown in FIG. 301, and the force of the drive shaft 758 is directly transmitted to the second active member.

  FIG. 307 shows a state in which the first active member 411 and the second active member 412 are slightly closed in the fifth embodiment as in FIG. 302. Unlike the case of FIG. 302, since the link member 775 can move freely, the detachable needle 412 and the second active member 412 reliably contact the tissue. In this case, the first active member fulcrum 776 and the second active member fulcrum 777 do not penetrate so as not to interfere with the link member 775.

  FIG. 308 shows a sixth embodiment in which the suturing device 3 of FIG. 184 includes an L-shaped member having a rotation center 781 and a pin 779 coupled to the driving means of the first active member 411 and the second active member 412. A push member 780 provided on the second active member 412 is added.

(Function)
In FIG. 303, by rotating the rotation operation unit 759, the drive member 757 and the drive member 758 move, and the first active member 411 and the second active member 412 connected to them can be driven independently.

  In FIG. 304, the first active member 411 and the second active member 412 can be individually operated by moving the two sliders 761 and 762 individually.

  In FIG. 305, the first active member 411 and the second active member 412 are driven by moving the slider 768. Further, when the lock button 766 is pressed down, the drive member 757 and the drive member 758 are surely driven simultaneously. With this structure, the first active member 411 and the second active member 412 are simultaneously driven at the time of puncturing, and the lock button 766 is released after puncturing, whereby the second active member 412 becomes free, and the first active member 411 Can be completely closed.

  In FIGS. 306A to 306C, the first active member 411 and the second active member 412 are driven by moving the slider 771. The second active member 412 is disengaged between the extension member 774 and the slider 771 at the moment when the unlocking button 772 gets over the unlocking arm 773, and no force is applied to the second active member 412. Can be completely closed.

  FIG. 307 shows that even when only the first active member 411 moves as shown in FIG. 302, the first active member 411 and the second active member 412 move by pressing the suturing device 3 against the tissue, and the second active member 411 moves. Member 412 also reliably contacts the tissue. Therefore, even if the spring 334 is attached, the suturing device does not slide sideways, and the puncture can be ensured.

  In FIG. 308, when the first active member 411 and the operation member connected to the second active member 412 are pulled in the proximal end direction by an operation unit (not shown), the pin 779 moves in the right direction on the page, and the L-shaped metal fitting 778 is moved. Since the L-shaped bracket can push the push-out member 780 and the second active member 412 can be driven in the closing direction by rotating around the rotation center 781, the suturing device is difficult to slide sideways even if the spring 334 is attached, and puncture is ensured Can be.

(effect)
The movable angle of the first drive member 411 is about 180 degrees, and the movable angle of the second drive member 412 is about 90 degrees. In the embodiment shown in FIG. 303, the drive member 757 and the drive member 758 can be individually moved by a necessary amount by rotating the rotation operation unit 759 as shown in the figure, and therefore, as shown in FIGS. 301 and 302. Therefore, the suturing device 3 is less likely to slide sideways around the removable needle 441.

  In the embodiment of FIG. 304, the first active member 411 and the second active member 412 can be driven by a necessary amount by individually moving the two sliders 761 and 762, as shown in FIGS. 301 and 302. Therefore, the suturing device 3 is less likely to slide sideways around the removable needle 441.

  In the embodiment shown in FIG. 305, when the lock button 766 is pushed down as necessary, the drive member 757 and the drive member 758 can be reliably driven at the same time. 3 does not slide sideways around the removable needle 441.

  The embodiment of FIGS. 306A to 306C shows that when the lock button 772 is pushed up by the unlocking arm 773 before the first active member 411 and the second active member 412 are completely closed, the second active member 412 is moved upward. No further closing occurs, and only the first active member 411 can be completely closed with a sufficient tissue sandwiched between the first active member 411 and the second active member 412.

  In the case of the embodiment of FIG. 307, since the first active member 411 and the second active member 412 are both in contact with the tissue, the suturing device 3 slides around the detachable needle 441 as shown in FIGS. 301 and 302. There is no end to it.

  In the embodiment of FIG. 308, since the second active member 412 moves in the closing direction even when the first active member 411 and the second active member 412 start to close, the suturing device 3 is moved as shown in FIGS. 301 and 302. There is no possibility of skidding with the removable needle 441 as the center.

[55th Embodiment]
FIGS. 309 to 321 show a 55th embodiment, which is an improved play of the second active member.

(Constitution)
FIGS. 317 to 319 show a first embodiment with improved play. In this embodiment, a receiving member 782 fixed to the second active member 412 is added to the suture instrument of FIG. 315. . A sleeve 783a is slidably placed on the outer periphery of the drive rod 783. A first connection member 785 and a second connection member 786 are rotatably connected to the sleeve 783a.

  As shown in FIG. 318, when the drive rod 783 is moved to the left in the drawing, the tip 784 pushes the receiving member 782. At the same time, the sleeve 783 a comes into contact with the drive rod 783. The relationship among the drive rod 783, sleeve 783a, and first and second connecting members 785, 786 is clearly shown in FIG.

  320 to 322 show a second embodiment.

  As shown in FIGS. 320 to 322, unlike FIG. 315, a lock plate 787 is fixed to the force accumulation member 326. The force of the rod 783 is transmitted to the second active member 412 via the force accumulation member 326 and the spring 334. At this time, the force acting on the second active member 412 from the tissue causes the force accumulation member 326 and the second active member 412 to come into contact with each other and the spring 334 is compressed, and as shown in FIG. The plate 787 is engaged with a groove 787d formed in the second active member 412, and the second active member 412 and the force accumulation member 326 are substantially integrated.

  Further, when the second active member 412 is opened, the second active member 412 and the force storage member 326 are substantially integrated, so that the state shown in FIG. 312 can be obtained. Further, a lock release pin 787a is fixed to the holding member 787b. When the second active member 412 is opened, the lock release pin 787a pushes the lock plate 787 as shown in FIG. The engagement of the plate 787 is released.

(Function)
FIGS. 309 to 316 illustrate the procedure for puncturing tissue twice in an embodiment where play is not improved.

  First, as shown in FIG. 309, the first active member 411 and the second active member 412 are fully opened, and the suture instrument 3 is pressed against the tissue. Thereafter, as shown in FIG. 310, the first active member 411 and the second active member 412 are closed and the tissue is punctured.

  FIG. 311 shows a state where the first active member 411 and the second active 412 are slightly opened. At this time, only the first active member 411 is opened, and the second active member 412 has not yet begun to open. The removable needle 441 is starting to come out of the tissue. Thereafter, as shown in FIG. 312, the first active member 411 further opens, and the second active member 412 finally starts to open.

  FIG. 313 shows a state where the tissue has been punctured a second time. As shown in FIG. 314, the first active member 411 and the second active member 412 are completely closed to a predetermined position.

  As shown in detail in FIGS. 310 and 311 in FIGS. 315 and 316, when the first active member 411 starts to open, the second active member 412 has not yet started to open. That is, there is a play in the movement of the second active member.

  Next, the operation of this embodiment will be described. As shown in FIG. 315, the first active member 411 and the second active member 412 are completely closed to a predetermined position.

  FIG. 318 shows a state where the first active member 411 and the second active member 412 are slightly opened. Here, only the first active member 411 opens, and the second active member 412 has not yet started to open. This is because the second active member 412 does not begin to open until the force storage member 326 rotates and pushes the second active member 412 apart. FIG. 318 shows a state immediately before opening. The removable needle 441 is starting to come out of the tissue.

  When the drive rod 783 is moved to the left in the drawing by an operation unit (not shown) from the state of FIG. 317 (first embodiment) as shown in FIG. 318, the sleeve 783a contacts the drive rod 783, and the sleeve 783a The first active member 411 starts to open, starting to move to the left in the drawing. At the same time, the tip 784 is pushed by the receiving member 782, and the second active member 412 starts to open.

  As shown in FIG. 320 (second embodiment), when the first active member 411 and the second active member 412 are closed to a predetermined position, the lock plate 787 is formed on the second active member 412. Engaging with the groove 787d, the second active member 412 and the force storage member 326 are substantially integrated. Further, when the second active member 412 is opened, the second active member 412 and the force storage member 326 are substantially integrated so that the state shown in FIG. 310 can be obtained. When the second active member 412 is further opened, the lock release pin 787a pushes the lock plate 787 as shown in FIG. 319, and the engagement between the second active member 412 and the lock plate 787 is released.

(effect)
Even in a structure in which the second active member 412 is actuated via the spring 334, the first active member 411 and the second active member 412 can be opened simultaneously after tissue puncture, and the tissue can be opened as shown in FIG. Puncture becomes easier.

[56th embodiment]
FIGS. 323 to 352 show a 56th embodiment, which relates to an endoscope fixing method, and differs from the 30th embodiment in the following points.

(Constitution)
FIG. 323 shows an endoscopic image when the suturing device 3 and the endoscope 12 are attached as in the thirtieth embodiment, and FIG. 324 is an illustration of the suturing device 3 and the endoscope 12 in this embodiment to be described later. The endoscope image at the time of changing the positional relationship to attach is shown.

  FIG. 325 shows a first embodiment in which one or more grooves 788 are provided in the endoscope 12. Further, a protrusion member 790 that fits into the groove 788 is attached to the inner surface of the hood 789.

  FIG. 326 shows a second embodiment in which two sheaths 791 and 792 connected to the suturing device 3 are fixed to a sheath fixing member 793, and a binding band 794 is passed through the sheath fixing member 793. The endoscope 12 is fixed with a binding band 794. Since the binding band 794 may be a band that is generally known as a bundle of electric wires and the like, detailed description thereof is omitted. FIG. 327 shows a state in which the positional relationship between the suturing device 3 and the endoscope 12 is changed with respect to FIG.

  FIG. 328 shows a third embodiment in which an opening 795 is formed in the sheath fixing member 797. A scope receiver 666 having a fitting projection member 796 that can be fixed to the opening 795 and a hood 603 fixed to the scope receiver 666 are shown.

  FIG. 329 shows a state in which the scope receiver 666 is attached to the sheath fixing member 797 in FIG. Although illustration is omitted, as in the embodiment of FIG. 325, the positional relationship between the suturing device 3 and the endoscope 12 can be changed.

  FIG. 330 shows the fourth embodiment, the endoscope 12, the suture instrument 3, the two sheaths 791, 792 connected to the endoscope 12, the concave portions 800, 801 having a shape capable of being press-fitted and fixed to the two sheaths 791, 792, and the inner portions. A bundling member 798 having a through hole 799 through which the endoscope 12 can be inserted is shown. FIG. 328 is the same as FIG. 327, but shows a case where the positional relationship between the suturing device 3 and the endoscope 12 is changed.

  FIG. 332 and FIG. 333 show a fifth embodiment in which the through hole 799 described in FIG. 330 and FIG.

  FIG. 334 shows a sixth embodiment in which the endoscope 12 provided with the groove 803 and the two sheaths 791 and 792 connected to the suturing device 3 can be fixed to the sheath fixing member 807 provided with the rail member 805. The configuration is shown. Although illustration is omitted, as in the embodiment of FIG. 325, the positional relationship between the suturing device 3 and the endoscope 12 can be changed. In that case, a groove 806 and a rail member (not shown) are used.

  FIG. 335 shows a seventh embodiment in which the endoscope 12 provided with the rail member 808 and the two sheaths 791 and 792 connected to the suturing device 3 can be fixed to the sheath fixing member 892 provided with the groove 810. The configuration is shown. Although illustration is omitted, as in the embodiment of FIG. 325, the positional relationship between the suturing device 3 and the endoscope 12 can be changed. In that case, a rail member 809 and a groove (not shown) are used.

  FIG. 336 shows an eighth embodiment in which the suturing device 3, a scope receiver 814 that is rotatably fixed to the sheath 791, the hood 603 and the endoscope 12, and two sheaths 791 and 792 are bundled together. The attached adhesive tape 813 is shown.

  FIG. 337 shows that the adhesive tape 813 in FIG. 336 is removed and the scope receiver 814 is rotatably attached to the sheath 791. FIG. 338 is similar to FIG. 336, but shows a state where the positional relationship between the suture instrument 3 and the endoscope 12 is changed.

  FIG. 339 shows a ninth embodiment in which a screw 816, two wire fixing members 817 having holes 818 into which the screws 816 can be inserted, and one or more wires fixed to the wire fixing member 817 are shown. .

  FIG. 340 shows a tenth embodiment. In addition to FIG. 339, two sheaths 791 and 792 extending from the suturing device 3 are fixed to a sheath fixing member 819. Further, the wire fixing member 817 is fixed to the sheath fixing member 819 using a screw 816. One or more grooves 821 are provided on the outer periphery of the endoscope 820, and the interval between them is the same as the interval between the wires 815. FIG. 341 is similar to FIG. 340, but shows a case where the positional relationship between the suture instrument 3 and the endoscope 12 is changed.

  FIGS. 342 to 347 show the eleventh embodiment, in which a sheath fixing member 822 is fixed to two sheaths 791 and 792 connected to the suturing device 3. A band 823 is passed through the sheath fixing member 822 as shown in FIGS. 342 and 343. The band is preferably made of an elastic material having a flat cross section. The endoscope 12 is attached to the state shown in FIGS. 344 and 345 or the state shown in FIGS.

  FIG. 348 shows a twelfth embodiment, in which a sheath fixing member 825 is fixed to the endoscope 12 and two sheaths 791 and 792 connected to the suturing device 3. A female screw 828 is cut in the scope receiver 824. The sheath fixing member 825 has a through hole 827, and the scope receiver 824 can be fixed to the sheath fixing member 825 by a screw 826.

  FIG. 349 is similar to FIG. The attachment position of the endoscope 12 is changed.

  FIG. 350 shows a thirteenth embodiment in which a projection 829 is provided on a scope receiver 666. The endoscope 12 has a forceps channel 6.

  FIG. 351 shows a fourteenth embodiment in which the endoscope 12, the suture instrument 3, and the two sheaths 791 and 792 are provided at the proximal end of the endoscope 12 through the forceps channels 831 and 832. The forceps ports 830 and 833 are shown.

  FIG. 352 shows a fifteenth embodiment in which a sheath fixing member 835 is fixed to the endoscope 12 and two sheaths 791 and 792 connected to the suturing device 3. A band 836 and a fastening screw 834 are attached to the sheath fixing member 835. The band 836 and the tightening screw 834 are generally the same as those known as fixing members when a hose is attached to a faucet, and details thereof are omitted.

(Function)
When assembling the endoscope 12 and the suturing device 3, the endoscope 12 is inserted into the hood 789 as shown in FIG. 325. At this time, the projection member 790 is inserted so as to fit into the groove 788, and finally the endoscope 12 is twisted in accordance with the shape of the groove, whereby the endoscope 12 is fixed to the hood 789.

  As shown in FIGS. 326 and 327, a binding band 794 is wound around the endoscope 12 to fix the suturing device 3 and the endoscope 12. Alternatively, as shown in FIGS. 328 and 329, the fitting projection member 796 of the scope receiver 666 is inserted into the opening 795 of the sheath fixing member 797, and the scope receiver 666 is rotated by a predetermined angle with respect to the sheath fixing member 797. As a result, the sheath fixing member 797 and the scope receiver 666 are integrated.

  330 and FIG. 331, the endoscope 12 is passed through the through hole 799 of the binding member 798 in advance, and the two sheaths 791 and 792 are fitted in accordance with the recesses 800 and 801 of the binding member 798. By fixing, the endoscope 12 and the suturing device 3 are fixed.

  In the embodiment of FIGS. 332 and 333, the endoscope 12 is aligned with the recess 802 of the binding member 798, and the two sheaths 791, 792 are aligned with the recesses 800, 801 of the binding member 798 and are fitted and fixed to these recesses. By doing so, the endoscope 12 and the suturing device 3 are fixed.

  In the embodiment of FIG. 334, the endoscope 12 and the suture instrument are fixed by fitting the groove 803 and the rail member 805. It is also possible to fit the groove 806 and a rail member (not shown).

  In the embodiment of FIG. 335, the endoscope 12 and the suture device 3 are fixed by fitting the rail member 808 and the groove 810. It is also possible to fit a rail member 809 and a groove (not shown).

  In the embodiment of FIG. 336, the endoscope 12 is inserted into the hood 603, and an adhesive tape 813 is wrapped around the two sheaths 791, 792 and the hood 603 so that they are bundled together.

  In the embodiment of FIG. 337, the adhesive tape 813 shown in FIG. 336 is removed, and the scope receiver 814 is rotatable with respect to the sheath 791.

  The embodiment of FIG. 338 is similar to FIG. 337, but the positional relationship is different.

  In the embodiment shown in FIGS. 339 and 340, a band 815 is fitted into the groove 821 of the endoscope 820, and the wire fixing member 817 is fixed to the sheath fixing member 819 using a screw 816. Thus, the suturing device 3 and the endoscope 820 can be fixed.

  In the embodiment shown in FIGS. 342 to 347, the endoscope 12 is attached between the band 823 and the sheath fixing member 822.

  In the embodiment of FIGS. 348 and 349, the scope receiver 824 is fixed to the sheath fixing member 825 using a screw 826.

  In the embodiment of FIG. 350, the protrusion 829 is inserted into the forceps channel 6 when the endoscope is inserted into the hood 603.

  In the embodiment of FIG. 351, the forceps channel 831, 832 of the endoscope is taken out from the forceps port through the two sheaths 791, 792, and an operation unit (not shown) is attached.

  In the embodiment of FIG. 352, the endoscope 12 is inserted into the band 836 and the tightening screw 834 is turned to reduce the diameter of the band 836, so that the endoscope 12 is firmly fixed to the sheath fixing member 835. .

(effect)
In the case of the embodiment of FIG. 325, the endoscope 12 and the suturing device 3 have a stable fixed angle 657 and do not rotate unexpectedly, and the endoscope 12 is unlikely to come out of the hood 789.

  When attached as shown in FIG. 326, the endoscopic image looks like FIG. 323, but when attached as shown in FIG. 327, the endoscopic image looks like FIG. 324. The attachment method can be selected so as to obtain an endoscopic image suitable for treatment. As shown in FIGS. 328 to 329, the endoscope 12 and the suturing device 3 can be fixed easily and reliably, and the attachment method is selected so as to obtain an endoscopic image suitable for treatment as described above. Can do.

  In the embodiment shown in FIGS. 330 and 331, the endoscope 12 and the suture instrument 3 can be fixed easily and reliably, and the attachment method is selected so as to obtain an endoscopic image suitable for treatment as described above. be able to.

  The effects of the embodiment of FIGS. 332 and 333 are the same as those of FIGS. 330 and 331.

  The effects of the embodiments shown in FIGS. 334, 335, 336 to 338, 339 to 341, 342 to 347, and 348 to 349 are the same as those of FIGS. 330 to 331.

  350 and 351, the fixed angle 657 of the endoscope 12 is always constant, and the endoscopic image is always as shown in FIG.

  In the embodiment shown in FIG. 352, the fixed angle 657 of the endoscope 12 is always constant, so that it is not inadvertently shifted.

[57th embodiment]
FIGS. 353 to 360 show a 57th embodiment relating to the procedure.

(Function)
An embodiment of a procedure for binding a part of the stomach will be described.

  First, as shown in FIG. 353, the thread 851 is hooked on the suture instrument 3 fixed to the endoscope 12, and is orally inserted into the stomach. Thereafter, as shown in FIG. 354A, the suture 85 is used to fix the thread 851 with the end loop cartridge 440. Thereafter, the suture device 3 is temporarily removed from the body, the end loop cartridge 440 and the thread 442 attached thereto, and the removable needle 441 are attached to the suture device 3 and inserted again into the stomach, and the thread 851 is inserted by the end loop cartridge 440. Fix to the stomach wall. This process is repeated as many times as necessary. FIG. 354B shows a state in which the yarn 851 is fixed using a plurality of end loop cartridges 440.

  As shown in FIG. 355A, a knot 854 is formed in the thread 851 outside the body, and a cap 852 provided with a hole 853 through which the thread 851 is passed is attached to the endoscope 12, and the knot 854 is placed in the stomach as shown in the figure. Moving. By pushing the knot 854, the thread 851 contracts the tissue in the stomach as shown in FIG. 355B.

  Further, as shown in FIG. 356, the second yarn knot 856 is formed after passing the tube 855 through the yarn 851, and the second yarn knot 856 is pushed into the stomach in the same manner as in FIG. 355A. Then, as shown in FIG. 357, the distance between the previously fed yarn knot 854 and the second yarn knot 856 is shortened, and the yarn 851 is tied until the tube 855 is deformed into a loop shape. Thereafter, the thread 851 is cut in the vicinity of the knot 856, and the proximal end thread is pulled out of the body, resulting in the state shown in FIG.

  FIG. 359 is a modification of the above. In this modification, the end loop cartridge 440 secures the thread 851 over the entire stomach, makes a knot 854 outside the body as shown in the figure, moves it into the stomach, and pulls the thread 851 as shown in FIG. Shrink.

(effect)
By binding a part of the stomach, food accumulates and reaches the cardia even when food intake is low, and the satiety center works. For this reason, the amount of food intake is reduced, which is effective for the treatment of obesity.

  Although the present invention has been described in relation to preferred embodiments shown in the various figures, other similar embodiments may be used to perform the same functions as the present invention without departing from the present invention, or It is clear that the above-described embodiments can be modified or added. Accordingly, the present invention should not be limited to any single embodiment. For example, it is obvious that each of the above-described treatment instruments can be used not only with a flexible endoscope but also with a rigid endoscope or a trocar. When used together with an endoscope, it can be inserted into a body cavity through an appropriate lumen extending in the endoscope, instead of being placed outside the endoscope as described above.

Next, other characteristic technical matters of the present application are appended as follows.
Record
(Additional Item 1) A treatment tool for performing a treatment in a body cavity by operating outside the body, a flexible member having a distal end portion that can be inserted into the body cavity, and a distal end portion of the flexible member A treatment instrument comprising: a link mechanism that is disposed on the body and that is activated by an operation from outside the body; and a curved needle that is actuated by the link mechanism and is movable in a direction of puncturing the tissue and a direction of removal from the tissue.

(Additional Item 2) The additional item 1 according to Additional Item 1, wherein the guide member can be inserted into the body along the guide member having an axis, and the guide member is held movably in the axial direction of the guide member. Treatment tool.

(Additional Item 3) An endoscopic treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body, and has a distal end portion that is inserted into the body cavity, and is outside the body. A transmission member having a flexible structure that can be operated at the same time, a push rod connected to the tip of the transmission member, and first and second connection members connected to the push rod. Each of the connection members has a base end portion rotatably connected to the push rod and a tip end portion, and each base end portion rotatably connected to the tip end portion of the connection member; First and second arm members having tip portions, holding members that rotatably hold the tip portions of the first and second arm members at predetermined intervals, and the first and second arm members, respectively. The arm member is formed integrally with the distal end of the arm member, and the transmission member is connected to the first and second via a push rod. Provided in at least one of the first and second actuating members that can be opened and closed when the two connecting members and the first and second arm members are actuated, and puncture living tissue A treatment instrument for an endoscope, comprising:

(Additional Item 4) The endoscopic treatment instrument according to Additional Item 3, wherein at least one of the first and second actuating members includes at least one tissue fixing means.

(Additional Item 5) The endoscope treatment instrument according to Additional Item 3, wherein the needle is a curved needle.

(Additional Item 6) The endoscope treatment tool according to Additional Item 3, further comprising a protection unit for protecting the living tissue from the needle.

(Additional Item 7) The endoscope according to Additional Item 3, further comprising: a suture thread attached to the needle; and a recovery means for recovering the thread punctured into the tissue by the needle from the needle. Treatment tool.

(Additional Item 8) The treatment instrument can be inserted into the body along a guide member having an axis, and is held so as to be movable in the axial direction of the guide member with respect to the guide member. Item 4. The treatment tool according to Item 3.

(Additional Item 9) An endoscopic treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body, and has a distal end portion that is inserted into the body cavity, and is outside the body. A transmission member having a flexible structure that can be operated at the same time, a push rod connected to the tip of the transmission member, and first and second connection members connected to the push rod. Each of the connection members has a base end portion rotatably connected to the push rod and a tip end portion, and each base end portion rotatably connected to the tip end portion of the connection member; First and second arm members each having a tip portion, a holding member that rotatably holds each tip portion of the arm member, and each of the arm members are integrally formed on the tip portion of the arm member, and the transmission The first and second connecting members and the first and second arm members via the push rod; A first and second actuating members that can be opened and closed when actuated, a needle that is provided on at least one of the first and second actuating members and punctures a living tissue, and a thread attached to the needle And a recovery means for recovering the thread punctured into the tissue from the needle by the needle, and the recovery means has a locking member for removing the needle from one of the first and second actuating members. An endoscopic treatment tool characterized by the above.

(Additional Item 10) The endoscope treatment tool according to Additional Item 9, wherein the recovery means is movable along a direction in which the endoscope treatment tool extends.

(Additional Item 11) The additional item 9, wherein the thread attached to the needle has at least one large loop and at least one small loop wound around the thread forming the large loop. Endoscopic treatment tool.

(Additional Item 12) An endoscopic treatment tool that is used together with an endoscope and performs a treatment in a body cavity by operating outside the body, and includes a needle for puncturing a living tissue. And a recovery means for recovering the needle punctured in the tissue, and a recovery mechanism for recovering the needle punctured into the tissue, the recovery means including a needle locking member capable of locking the needle And a thread locking member capable of locking the thread, whereby a needle thread fixing means capable of tightening the tissue between the needle locked to the needle locking member and the thread locking member An endoscopic treatment tool characterized by comprising:

(Additional Item 13) The treatment instrument for an endoscope according to Additional Item 12, wherein the needle thread fixing means has a space for exposing the thread to the outside, and the thread can be cut in this space. .

(Additional Item 14) An endoscopic treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body, and a distal end portion inserted into the body cavity and disposed outside the body A flexible transmission member having a base end portion, a push rod coupled to the distal end portion of the transmission member, an operation unit coupled to the base end portion of the transmission member, and a push rod coupled to the push rod. Each of the first and second connection members has a base end portion rotatably connected to the push rod and a tip end portion, and each of the first and second connection members. A first and second arm members each having a proximal end portion rotatably connected to the distal end portion of the connection member, and a distal end portion, and a holding member that rotatably holds the respective distal end portions of the arm member Are formed integrally at the tip of the arm member, and the operating portion is First and second operations that are movable in the opening and closing directions when the first and second connecting members and the first and second arm members are moved relative to the connecting member via the member and the push rod. An endoscopic treatment instrument comprising: a member; and a restriction mechanism that is provided on one of the first and second actuating members and restricts a movement range of the one actuating member.

(Supplementary Item 15) The restriction mechanism includes a force accumulation member pivotally attached to the one actuation member and the arm member, and the one actuation member with respect to the force accumulation member in one of the opening and closing directions. 15. The endoscope treatment tool according to item 14, further comprising a spring for biasing.

(Supplementary Item 16) An endoscopic treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body, and has a distal end portion that is inserted into the body cavity, and is outside the body. A transmission member having a flexible structure that can be operated at the same time, a push rod connected to the tip of the transmission member, and first and second connection members connected to the push rod. Each of the connection members has a base end portion rotatably connected to the push rod and a tip end portion, and each base end portion rotatably connected to the tip end portion of the connection member; First and second arm members each having a distal end portion, a holding member that rotatably holds the respective distal end portions of the arm member at a predetermined interval, and each formed integrally with the distal end portion of the arm member The transmission member is connected to the first and second connection members via the push rod and the first When the second arm member is actuated, the first and second actuating members that can be opened and closed with each other, the third actuating member rotatably attached to the first actuating member, the holding member, and the third A third connecting member that is pivotally connected to each of the actuating members and moves together with the first and second actuating members, and provided at at least one of the first and second actuating members for puncturing a living tissue. An endoscopic treatment instrument comprising:

(Additional Item 17) A suturing method using an endoscopic suturing device, comprising: (1) a step of placing an insertion assisting tool in a body cavity; and (2) suturing incorporated in the insertion assisting tool into the endoscope. Inserting the instrument and inserting the suture instrument into the body cavity; (3) opening the curved needle of the suture instrument; (4) pressing the curved needle against the suture site; and (5) placing the curved needle into the tissue. A puncturing step, (6) a step of recovering the needle with the recovery member, (7) a step of removing the curved needle from the tissue, (8) a step of bringing the recovery member closer to the suture site, and (9) a predetermined recovery member. Returning to the position, closing the curved needle and removing the suture device from the body.

(Additional Item 18) A method for contracting the stomach using the endoscope treatment tool, comprising: disposing a thread for contracting the stomach between the first and second actuating members of the treatment tool; A step of inserting a treatment tool combined with an endoscope into the body, a step of fixing the thread to a plurality of locations on the stomach wall using the treatment tool, and a contraction of the thread to contract the stomach A shrinking method comprising the steps of:

(Supplementary Item 19) A step of passing a thread contracted to contract the stomach through the tube, and a step of fixing the tube to the stomach wall in a loop shape in the vicinity of the contracted thread using the treatment instrument The shrinkage method according to Item 18, further comprising:

  Provided is an endoscopic treatment tool that can be inserted into a body cavity together with an endoscope, which has a structure that further increases the opening / closing angle and produces a greater force.

BRIEF DESCRIPTION OF THE DRAWINGS Explanatory drawing which shows the whole structure of the suturing system for endoscopes by the 1st Embodiment of this invention. FIG. 2 is an enlarged view of the endoscope and the suture instrument shown in FIG. 1. Explanatory drawing of the state which closed the 1st, 2nd action | operation member of the suturing device. Explanatory drawing of the state which opened the 1st, 2nd action | operation member of the suturing device. Sectional drawing which shows the internal structure of the suturing device of FIG. Sectional drawing which shows the internal structure of the suturing device of FIG. Sectional drawing which follows the AA line of FIG. The figure of the state which attached the coupler to the endoscope which shows the figure seen from the direction of arrow B of FIG. The figure which removed the endoscope which shows the figure seen from the direction of the arrow B of FIG. 2, and shows only a suturing device. Sectional drawing which follows the CC line | wire of FIG. Sectional drawing which follows the DD line | wire of FIG. Sectional drawing which follows the EE line | wire of FIG. Sectional drawing which follows the FF line | wire of FIG. The figure seen from the direction of arrow G of FIG. The figure of the state which hooked the suture with the hook which shows the relationship between a thread holding tool and a suture. The figure of the state in which the suture thread and hook were drawn in in the sheath which shows the hook of other thread grasping tools. The external view which shows the hook of another thread holding tool. The figure which is showing the hook of another thread gripper and the thread gripper is going to take a thread | yarn with a hook. The figure which is showing the hook of another thread gripper and the thread gripper is going to take a thread | yarn with a hook. The schematic longitudinal cross-sectional view of an insertion auxiliary tool. Explanatory drawing of the state which accommodated the endoscope which attached the suturing device in the insertion auxiliary tool. Explanatory drawing of the state which made the endoscope which attached the suturing device protruded from the insertion assistance tool. The figure which shows the modification of the valve attached to an insertion auxiliary tool. The figure of the insertion auxiliary tool by the modification of the state which accommodated the endoscope and the suturing device. The figure of the state which made the endoscope and the suturing device protrude from the insertion auxiliary tool of FIG. The figure which shows the suturing procedure by a suturing device with FIG. 23 to FIG. The figure in the state where the curved needle punctured the tissue. The figure of the state which the thread | yarn holding tool hooked the suture thread. The figure of the state by which the suture thread was drawn in the flexible tubular member with the hook which hooked this. The figure of the state which pulled out the thread holding tool from the channel member. The figure of the state which extracted the curved needle from the structure | tissue. The figure of the state which extracts a suturing device outside a body cavity with an insertion auxiliary tool. The figure of the state which sends a knot into the body using a knot pusher. The figure similar to FIG. 2 of the suturing system for endoscopes of 2nd Embodiment shown in the state which accommodated the suturing device in the protection member. Explanatory drawing of the state which protruded the suturing device in the suturing system for endoscopes of FIG. The figure which shows the protection member in 2nd Embodiment with FIGS. 33-35, and made the movable part protrude. The figure of the state which the movement member released the latching of the lock member. The figure of the state which retracted the movable part. Detail drawing of a locking member. Explanatory drawing of the protection member used for the suturing system for endoscopes of 3rd Embodiment. The figure which shows the suturing system for endoscopes by 4th Embodiment with FIG. 38-FIG. 41, and shows the suturing device used for this. The figure of the state in which the removable needle after puncturing a structure | tissue was latched by the needle thread fixing tool. The figure of the state which tightened the suture and closed the wound. The figure of the state which cut the surplus part of the suture with the thread cutter. Sectional drawing in alignment with the HH line of FIG. FIG. 17 is a cross-sectional view of a state in which sealing means is incorporated on the proximal side of the auxiliary insertion tool shown in FIG. 16. The cross section which follows the II line | wire of FIG. The figure which shows the suturing device used for the suturing system for endoscopes of 5th Embodiment. The figure of the state in which the removable needle after puncturing a structure | tissue was latched by the needle thread fixing tool. The figure which shows the suturing device used for the suturing system for endoscopes of 6th Embodiment. The figure of the state in which the removable needle after puncturing a structure | tissue was latched by the needle fixing tool. The figure which shows the state in which a knot is formed by the loop which remove | deviated from the latching member when the 1st, 2nd action | operation member opens. The figure of the state which cut the surplus part of the suture with the thread cutter. The figure which shows the state sutured | sutured in the state pulled with the grasping forceps. The figure which shows the suturing device used for the suturing system for endoscopes of 7th Embodiment. The figure of the state in which the removable needle after puncturing a structure | tissue was latched by the needle thread fixing tool. Sectional drawing which follows the JJ line | wire of FIG. The figure which shows the structure of the thread | yarn locking means by which the reinforcement member is arrange | positioned. The figure which shows the structure of the thread | yarn locking means comprised by the elastic member and the tubular member. The figure which shows the structure of the thread | yarn locking means formed of the tubular member provided with the hollow in the longitudinal direction. The figure which shows the structure of the thread | yarn locking means formed of the tubular member provided with the hollow in the direction orthogonal to a longitudinal direction. The figure which shows the structure of the thread | yarn lock | rock means which applies the pressure to the elastic member uniformly and radially by swaging a tubular member. The figure of the state which pulled out the needle holder from the structure | tissue. Diagram of the state of tight binding. FIG. 58 is a diagram showing a suturing procedure by the endoscopic suturing system according to the eighth embodiment together with FIGS. 58 to 63 and showing a state in which the suturing device is brought close to a tissue to be sutured. The figure of the state in which the removable needle after puncturing a structure | tissue was latched by the needle fixing tool. The figure of the state which extracted the needle holder from the structure | tissue. The figure of the state which left the needle thread fixing tool and separated the suture instrument and the endoscope from the tissue. The figure of the state which tied the tissue with the suture thread. The figure of the state which can isolate | separate a suture thread. The figure of the state which cut the surplus part of the suture with the thread cutter. The figure which shows the suturing device used for the suturing system for endoscopes of 9th Embodiment. The figure of the state in which the removable needle after puncturing a structure | tissue was latched by the needle fixing tool. The figure which shows the structure | tissue of the state stitch | sutured. 68 is a cross-sectional view taken along the line AA of FIG. 68, showing the tenth embodiment together with FIGS. FIG. 68 is an external view of the suture instrument (viewed in the direction of arrow B in FIG. 67). FIG. 68 is a view taken in the direction of arrow C in FIG. FIG. 70 is a view on arrow D in FIG. 69. EE sectional drawing of FIG. FIG. 70 is a sectional view taken along line FF in FIG. 69. GG sectional drawing of FIG. The detail drawing of the operation part of a suture instrument. FIG. 75 is a cross-sectional view taken along line HH in FIG. 74. External view of a pre-knot cartridge. The figure of the state which demonstrated operation | movement when removing a removable needle with a needle gripper with FIGS. 78-80, and made the needle gripper and the removable needle face each other. The figure of the state which moved the needle holding tool from the state of FIG. 77, and pushed and extended the spring. The figure of the state which the spring returned from the state of FIG. The figure of the state which locked the detachable needle to the thread gripper. FIG. 78 is a view similar to FIG. 77, showing a needle gripping tool, a detachable needle, and a needle holder according to a modified example together with FIGS. 82 to 85. FIG. 79 is a view similar to FIG. 78 in a state where the spring is pushed open. FIG. 79 is a view similar to FIG. 79 in a state where the spring has returned. The figure of the state which moved the needle gripper and locked the removable needle to the needle gripper. The figure of the state which isolate | separated the removable needle | hook from the needle holder. The figure of the state which isolate | separated the pre-knot cartridge and the cover. The figure of the state which attached the cover so that the pre-knot of a pre-knot cartridge may not remove from a needle gripper. The external view of a spring in order to lock the removable needle incorporated in the inside of a needle gripper. The figure which showed the detail of how to tie a knot. The figure of the state which showed the procedure of suturing with FIGS. 91-98, and pressed the detachable needle and two fixed needles against the suturing site. The figure of the state which punctured the structure | tissue with the detachable needle and the fixed needle. The figure of the state which pushed the needle catching sheath in the removable needle | hook after puncture. The figure of the state which pulled out the removable needle from the needle holder. The figure of the state which pulled out the needle holder from the structure | tissue. The figure of the state which removed the pre-knot from the needle gripper. The figure of the state which moved the pre-knot to the opening part of the structure | tissue. The figure of the state which closed the opening part of the structure | tissue with the pre-knot. The figure of the state which cut | disconnected the excess thread | yarn. The figure which showed the needle catching sheath which is another modification of a needle catching sheath. FIG. 102 is an external view of the suturing device showing the eleventh embodiment together with FIGS. 101 to 111 (viewed in the direction of arrow G in FIG. 102). FIG. 100 is a partial cross-sectional view of FIG. 100. AA sectional drawing of FIG. 101 is a view on arrow B in FIG. 101. FIG. FIG. 101 is a sectional view taken along the line CC in FIG. 101. DD sectional drawing of FIG. EE sectional drawing of FIG. FF sectional drawing of FIG. FIG. 111 is a view of the state in which the first active member is opened, showing the operation when the suture instrument punctures the tissue together with FIGS. 109 to 111. The figure of the state which punctures a structure | tissue. The figure of the state which made the force of a force storage member act on the 2nd active member. The figure of the state which closed the 1st active member completely by pinching | tucking a structure | tissue in large quantities. FIG. 114 is an external view of the suture instrument showing the twelfth embodiment together with FIGS. 113 to 122 (viewed in the direction of arrow G in FIG. 114). The fragmentary sectional view of FIG. AA sectional drawing of FIG. The arrow B view of FIG. CC sectional drawing of FIG. EE sectional drawing of FIG. FF sectional drawing of FIG. FIG. 123 is a view showing a state in which the first active member is opened, showing an operation when the suture device punctures tissue together with FIGS. 120 to 122; The figure when a removable needle and two fixed needles puncture a tissue. The figure of the state which the detachable needle and the two fixed needles punctured the tissue deeper. The figure of the state which closed the 1st, 2nd active member. FIG. 126 is a view similar to FIG. 119 showing the thirteenth embodiment together with FIGS. 124 to 126 when the removable needle and the two fixed needles are punctured. The figure when a removable needle and two fixed needles puncture a tissue. The figure of the state in which the detachable needle and the two fixed needles completely puncture the tissue, showing a state in which the detachable needle and the two fixed needles puncture the tissue deeper. The figure of the state which closed the 1st, 2nd active member which shows the state which the detachable needle and the two fixed needles punctured the tissue deeper. Sectional drawing of a suture instrument. The figure which shows 14th Embodiment with FIG. 127B, and showed the fixing method of a scope and a suturing device. FIG. 127B is a cross-sectional view of the tube holder of FIG. 127A. The figure which attached the protection member to the structure of FIG. 127A. The figure which shows 15th Embodiment with FIG. 130 to FIG. 143, and has shown the state which punctured the structure | tissue with the removable needle. The figure of the state which the detachable needle pushed and extended the spring of the needle gripper. The figure of the state which the spring extended and returned and engaged with the recessed part of the slider. The figure which shows the state which an engaging part latches a spring when a needle | hook holding tool is moved. The figure which shows the state which moved the needle | hook holding tool further than FIG. The figure which shows the state which the detachable needle removed from the needle holder. The figure which shows the state which extracted the needle holder from the structure | tissue. The figure which shows the state before mounting | wearing a detachable needle with a needle holder again. The figure which shows the state which moves a needle holding tool and locks a detachable needle. The figure which shows the state which attached the removable needle | hook again to the needle holder. The figure which shows the state which moved the member for cancellation | release and returned the spring. The figure of the state which moved the needle holding tool and pushed the spring. The figure which shows the state which the slider removed from the spring which expanded. The figure which shows the state stitch | sutured continuously. The figure which shows the state which made the knot after continuously stitching | sutures. FIG. 167 is a partial cross-sectional view of the suture instrument, showing the sixteenth embodiment together with FIGS. 145 to 163. 144 is a cross-sectional view taken along the line AA in FIG. 144. FIG. 158 is a partial cross-sectional view of the end loop cartridge shown in FIG. 158. FIG. 158 is a diagram illustrating an operation when the suture device punctures the tissue together with FIGS. The figure of the state which engaged the detachable needle | hook with the needle | hook lock mechanism of an end loop cartridge. The figure which shows the state which removed the removable needle | hook from the needle holding member. The figure which shows the state which pushed in the hook apparatus. The figure which shows the state which the tubular member for latching removed from the end loop cartridge. The figure which shows the state which extracted the needle holding member from the structure | tissue. The figure which shows the state which draws in a hook and fastens a suture. The figure which shows the state which tightened the suture further. The figure which shows the state which pulled out the hook from the coil. The figure which shows the state which removed the loop from the hook. The figure which shows the state which cut | disconnects the excess suture. External view of end loop cartridge. The external view of the tubular member for latching. The figure which shows the airtight structure of the hand side of a suture instrument. The figure which shows the operation part of the hand side of a suture instrument Sectional drawing of the front-end | tip part of the thread trimming forceps used when cutting a suture. The figure which showed another structure plan of the outer cylinder pipe. The figure which loaded the end loop cartridge to the suturing device. The figure which showed another form of the removable needle | hook. FIG. 165 is a diagram in which the removable needle shown in FIG. 165 is attached to the needle holding member. The figure when attaching a suture instrument to an endoscope and bringing the tip of the suture device closest to the tip of the endoscope. The figure when the front-end | tip of a suture device is separated from the front-end | tip of an endoscope. 170 and 171 show the seventeenth embodiment, and are partial cross-sectional views when the first operating member and the second operating member of the suture instrument are opened. FIG. The fragmentary sectional view when the 1st operation member and the 2nd operation member of a suture instrument are closed. 169 is a cross-sectional view taken along line AA in FIG. The figure when the suturing device in 18th Embodiment punctures a structure | tissue. Sectional drawing which shows the modification of the needle holder applicable to 10th Embodiment. FIG. 173 is a schematic perspective view of the needle holder of FIG. 173; Furthermore, the figure which shows the modification of other needle holders. 175 is a schematic perspective view of the needle holder of FIG. 175. FIG. The figure which shows the fixed needle | hook applicable to 10th Embodiment and other embodiment. FIG. 179 shows the nineteenth embodiment together with FIG. 179 and is a view when the end loop cartridge is attached to the locking tubular member The figure of the state in which the end loop cartridge was attached to the tubular member for latching. FIG. 181 shows the twentieth embodiment together with FIG. 181 and is a view when the end loop cartridge is attached to the locking tubular member The figure of the state which accommodated the tubular member for latching and a hook apparatus in the front-end | tip pipe. 182B to FIG. 190 show the twenty-first embodiment and are explanatory diagrams before the end loop cartridge is assembled to the suturing device. FIG. 182A is an explanatory diagram of the locking member of FIG. 182A. FIG. FIG. 182 is an explanatory view showing the locking member and the tubular member in FIG. 182A in an exploded manner. Sectional drawing of the state which accommodated the end loop cartridge in the guide member of the suturing device. Sectional drawing of the state which made the end loop cartridge engage the removable needle | hook. Sectional drawing of various end loop cartridges. Sectional drawing of various end loop cartridges. External view of end loop cartridge. Explanatory drawing of the state which the detachable needle punctured the structure | tissue. Explanatory drawing of the state which the end loop cartridge engaged with the removable needle | hook. Explanatory drawing of the state where the end loop cartridge removed the removable needle from the needle holding member. Explanatory drawing of the state which extracted the needle holding member from the structure | tissue. Explanatory drawing of the state which pulled the thread | yarn through the hook and bound the structure | tissue. Explanatory drawing of the state which moved the end loop cartridge to the paper surface left direction via a latching member and a tubular member, and the latching member opened or opened. Explanatory drawing of the state after removing an end loop cartridge from a locking member. Explanatory drawing when removing an end loop cartridge from a locking member. The sectional view similar to FIG. 183 showing the twenty-second embodiment. 192B to 195 show the twenty-third embodiment and are explanatory diagrams before the end loop cartridge is assembled to the suturing device. FIG. External view of end loop cartridge. Explanatory drawing of the state which accommodated the end loop cartridge in the guide member. The longitudinal cross-sectional view of the state which accommodated the end loop cartridge in the guide member. Explanatory drawing of the state which the end loop cartridge removed from the engagement tool. The longitudinal cross-sectional view of the state which showed 24th Embodiment with FIG. 197 thru | or 199, and accommodated the end loop cartridge in the guide member. Explanatory drawing before attaching an end loop cartridge to an engaging member. The perspective view of the state which attaches an end loop cartridge to an engagement member. 197 is a cross-sectional view of a state in which the end loop cartridge is pushed in from the state of FIG. The external view of the hook used for 16th, 21st embodiment. The external view of the hook which shows 25th Embodiment and is compared with FIG. A figure showing a 26th embodiment with Drawing 203 thru / or 208, and combining a suture instrument and an endoscope. Sectional drawing of the state which has arrange | positioned the suturing device in the insertion assistance tool. Sectional drawing of the state which made the suture device protrude outside from an insertion auxiliary tool. Explanatory drawing of the state which lets an endoscope pass an airtight valve. The explanatory view of the state where the band which raises airtightness further from the state of Drawing 205 is wound. 206 is a cross-sectional view taken along line AA of FIG. 206 showing a state where the band is attached. 206 is a cross-sectional view taken along the line AA in FIG. 206 in a state where the band has been attached. The top view of the operation part which shows 27th Embodiment with FIG. 210 and is applicable to 16th or 21st Embodiment. The side view of the operation part applicable to 16th or 21st Embodiment. 209 is a partial cross-sectional view of the operation unit in FIG. 209. FIG. 220 is an external view of the knob shown in FIG. 211. The expanded view of the groove | channel formed in the outer peripheral part of the knob shown in FIG. The top view which shows the operation part of 28th Embodiment. FIG. 202 is a detailed view of a scope holder shown in FIG. 202. FIG. 202 is a detailed view of a scope holder shown in FIG. 202. Explanatory drawing of the state which fitted the operation part and the scope holder. 228 is a partial cross-sectional view of a scope holder showing the twenty-ninth embodiment together with FIGS. 218 to 223C. FIG. The fragmentary sectional view of a scope holder. Explanatory drawing of the state which attached the suturing device to the endoscope and separated the distal end of the suturing device from the distal end of the endoscope. Explanatory drawing of the state which attached the suturing device to the endoscope and brought the tip of the suturing device closest to the tip of the endoscope. FIG. 3 is an external view of a scope holder projecting handle and projecting pipe. The external view of a part of scope holder shown with a plurality of tubes in a kinked state. The external view of a part of scope holder shown with the tube of the bent state. The figure which shows the whole apparatus used for implementation of 21st Embodiment. The figure which looked at the protrusion handle from the direction of the arrow A of FIG. 223B. Explanatory drawing of the state which shows 30th Embodiment with FIG. 223 thru | or FIG. 225B, and attaches an endoscope and a suturing device. The figure of the state which fixed the jig to the scope fixing part. Explanatory drawing which shows the visual field of an endoscope when using a jig | tool. Explanatory drawing of the state which attached the endoscope to the suturing device which shows 31st Embodiment. 228 shows the thirty-second embodiment together with FIG. 228, and is an explanatory view showing a state where an endoscope is attached to a suture instrument. FIG. Explanatory drawing which shows the state where a scope fixing | fixed part is unstable for a comparison. The figure of the endoscope visual field of the state which shows 33rd Embodiment with FIG.230 and FIG.231, and the detachable needle | hook is attached to the needle holding member. The figure of the endoscope visual field in the state where the removable needle was removed from the needle holding member. Explanatory drawing of an end loop cartridge with a mark. An explanatory view of a part of a suturing device, showing a thirty-fourth embodiment together with FIGS. 233 and 234. Explanatory drawing of the suturing device which has a 2nd active member of loop shape. The figure which shows the relationship between the active member of FIG. 233, and an end loop cartridge. A sectional view of a suture instrument showing a 35th embodiment. 236 is an explanatory view of a needle holding member and a detachable needle showing the thirty-sixth embodiment together with FIGS. 236B to 237C. FIG. Sectional drawing which shows a detachable needle | hook. Sectional drawing which shows the fixing | fixed part of a thread | yarn. Explanatory drawing of the needle holding member and removable needle | hook of a modification. Sectional drawing which shows a detachable needle | hook. Sectional drawing which shows the fixing | fixed part of a thread | yarn. A sectional view of an end loop cartridge of a 21st embodiment. Sectional drawing which shows the state which the centerline of the thread | yarn locking means arrange | positioned in an end loop cartridge which shows 37th Embodiment has shifted | deviated. FIG. 249 is an explanatory diagram showing the thirty-eighth embodiment together with FIGS. 241 to 246 and assembling the end loop cartridge to the suturing device. The figure which shows the subject of the end loop cartridge and locking member of FIG. The figure which shows the locking member by 1st Example of 38th Embodiment. The figure which shows the securing member by 2nd Example of 38th Embodiment. The figure which shows the state by which the latching member by 2nd Example of 38th Embodiment was latched by the guide member. The figure of the state which the end loop cartridge left | separated from the latching member and hook of FIG. 244A. The figure which shows the securing member by the 4th Example of 38th Embodiment. The figure which shows the locking member by 5th Example of 38th Embodiment. FIG. 249 is an explanatory diagram showing the 39th embodiment together with FIG. 248 and hooking an endoscope to which a suturing device used in this embodiment is attached to a scope place. 247 is an explanatory diagram of a slider of the suture instrument shown in FIG. 247. FIG. Explanatory drawing of the removable needle used for this embodiment which shows 40th Embodiment. Explanatory drawing of the guide member used for this embodiment which shows 41st Embodiment. FIG. 252 is an explanatory diagram of a state in which tissue is sutured using the suturing device of the 21st embodiment, showing the 42nd embodiment together with FIG. 252; The figure of the state which sutures a tissue using the suturing device by the suturing device which has a hollow. Explanatory drawing of a scope receiver which shows 43rd Embodiment. The explanatory view of the thread lock member used for this embodiment which shows a 44th embodiment with Drawing 255A and 255B. Sectional drawing of a caulking pipe. Explanatory drawing of the state which fixed the thread | yarn to the end loop cartridge using the thread | yarn lock member. Explanatory drawing of the airtight valve used for this embodiment which shows 45th Embodiment. FIG. 258 is an explanatory diagram illustrating the relationship between the endoscope and the suturing device according to the forty-sixth embodiment together with FIGS. Explanatory drawing just before attaching a suturing device to an endoscope. Explanatory drawing of the state which attached the suturing device to the endoscope. Explanatory drawing of an insertion auxiliary tool. Explanatory drawing of 1st Example of a scope receiver. Explanatory drawing of 2nd Example of a scope receiver. Explanatory drawing of 3rd Example of a scope receiver. The 47th Embodiment is shown with FIG. 262 thru | or 267, and explanatory drawing of the suturing device used for this embodiment. The figure which shows the engagement male member provided instead of the hook of 21st Embodiment. The figure which shows the end loop cartridge and engagement male member in a guide member. The figure of the state to which the engagement female member fitted with an engagement male member was couple | bonded with the thread | yarn. Explanatory drawing of the state which the engagement female member and the engagement male member fitted. FIG. 269 is a diagram showing the forty-eighth embodiment together with FIGS. 269 to 276, and a state in which a thread extending from an end loop cartridge is hooked on a hook provided on an engaging female member. The figure which shows the suturing procedure of 48th Embodiment with FIG. 270 thru | or 276, and the state which punctured the tissue with the removable needle. The figure of the state which moved the end loop cartridge and engaged with the removable needle | hook. Illustration of the end loop cartridge moved and the removable needle removed from the needle holding member The figure of the state which removed the needle holding member from the structure | tissue. Illustration of tied state. The figure of the state which the free end of the securing member left | separated from the end loop cartridge. The figure of the state which moved the thread | yarn and the end loop cartridge. The figure of the state which removed the hook from the thread | yarn. FIG. 298 is a diagram showing a forty-ninth embodiment together with FIGS. 278 to 282 and showing an end loop cartridge and an engaging female member used in this embodiment; The figure which shows the state which attached the engaging female member to the end loop cartridge. The figure which shows the state by which the end loop cartridge was drawn in by the guide member. 290 is a diagram showing a state where the engaging female member and the end member of the yarn are drawn into the tubular member from the position shown in FIG. The figure which shows the state which the engagement female member protruded from the tubular member. The figure which shows the Example which applied this embodiment to the engaging female member shown in FIG. The figure which shows 50th Embodiment with FIG. 282 thru | or 285, and shows the case which accommodates an end loop cartridge, and a suturing device. FIG. 283 is an explanatory diagram of a detachable needle used in the embodiment of FIG. 283. The figure which shows the modification of a case. FIG. 288 is an explanatory diagram of an end loop cartridge according to the 51st embodiment together with FIGS. 286B to 288. 286A is an explanatory diagram of an end portion of the yarn of FIG. 286A. 286 is an explanatory diagram of a state where the end loop cartridge of FIG. 286 is fixed. FIG. 287 is an explanatory diagram of a state in which the yarn of FIG. 287 is held. The figure which shows 52nd Embodiment with FIG. 289B thru | or 289D, and shows the front-end | tip part of a suturing device schematically. The figure which shows the modification of the connection part of an active member and a needle holding member. FIG. 289 is a schematic cross-sectional view of the active member and the needle holding member of FIG. 289B. The figure which shows the modification of the connection part of a detachable needle and a needle holding member. The 53rd Embodiment is shown with FIG. 291 thru | or FIG. 300B, and explanatory drawing of the needle holding member and removable needle used for this embodiment. FIG. 291 is an explanatory diagram of a needle holding member and an end loop cartridge to which the removable needle of FIG. 291 is attached. FIG. 291 is an explanatory diagram of a state where the needle holding member of FIG. 291 is engaged with the end loop cartridge. Explanatory drawing of the needle holding member by a modification. Explanatory drawing of the needle holding member by another modification. 290 is a partial cross-sectional view showing a state where an elastic material is attached to the needle holding member shown in FIG. Explanatory drawing of the state which mounted | wore the removable member by the modification with the elastic member. FIG. 296 is a sectional view taken along line AA of FIG. 296A. The fragmentary sectional view of the state which attached the removable needle | hook by the other modification with which the elastic member was mounted | worn to the needle holding member. Explanatory drawing which shows the state which attaches the detachable needle | hook by another modification with which the elastic member was mounted | worn to a needle holding member. Furthermore, the explanatory view of the needle holding member equipped with the removable needle by other modifications. 298A is a cross-sectional view of the needle holding member shown in FIG. 298A. Furthermore, the explanatory view of the needle holding member equipped with the removable needle by other modifications. FIG. 299 is a cross-sectional view of the needle holding member shown in FIG. 299A. Furthermore, the explanatory view of the detachable needle and needle holding member by other modifications. FIG. 300B is an explanatory diagram of a state in which the removable needle and the needle holding member of FIG. 300A are fixed. FIG. 31 is an explanatory diagram showing the 54th embodiment together with FIGS. 301 to 308, with the first and second active members fully opened. Explanatory drawing of the state which closed the 1st, 2nd active member somewhat. Explanatory drawing of 1st Example which connected the 1st, 2nd active member to the corresponding drive member, respectively. Explanatory drawing of 2nd Example which connected the proximal end of both the drive members to two sliders. Explanatory drawing of 3rd Example which connected the proximal end of both the drive members to the operation part. 306B and 306C are partial sectional views showing a fourth embodiment in which the proximal ends of both drive members are connected to the operation unit. The figure which follows the BB line of FIG. 306A. The figure which follows the CC line of FIG. 306A. Explanatory drawing of 5th Example of the state which closed the 1st, 2nd active member somewhat. Explanatory drawing of 6th Example. FIG. 38 is an explanatory view showing a state in which the first and second active members are opened and the suture instrument is pressed against the tissue, showing the 55th embodiment together with FIGS. 310 to 321. Explanatory drawing of the state which punctured the tissue first. Explanatory drawing of the state which opened the 1st, 2nd active member slightly. Explanatory drawing of the state which opened the 1st and 2nd active member further. Explanatory drawing of the state where the tissue was punctured for the second time. Explanatory drawing of the state which closed the 1st, 2nd active member to the predetermined position. Detailed view of FIG. 3B is a detailed view of FIG. Detailed view of the first embodiment. The detailed drawing just before the 1st, 2nd active member of a 1st Example opens. 1 is a schematic perspective view of a first embodiment. Detailed view of the second embodiment. 322 is an enlarged explanatory view of a part of FIG. 320 in a state where the second active member moves. Partial expansion explanatory drawing of the state which the 2nd active member moved further. The figure which shows 56th Embodiment with FIG. 324 thru | or 352, and shows an endoscopic image when a suturing device and an endoscope are attached. The figure which shows an endoscopic image when the attachment position of a suturing device and an endoscope is changed. Explanatory drawing of the 1st Example of 56th Embodiment. Explanatory drawing of a 2nd Example. 326 is an explanatory diagram when the attachment position of the suture instrument and the endoscope is changed from the state of FIG. Explanatory drawing of a 3rd Example. Explanatory drawing of the 3rd Example of the state which attached the sheath fixing member and the scope receiver. Explanatory drawing of a 4th Example. The explanatory view when changing the attachment position of a suture instrument and an endoscope from the state of FIG. Explanatory drawing of a 5th Example. The explanatory view when changing the attachment position of a suture instrument and an endoscope from the state of FIG. Explanatory drawing of a 6th Example. Explanatory drawing of a 7th Example. Explanatory drawing of an 8th Example. Explanatory drawing of the modification of an 8th Example. 337 is an explanatory view when the attachment position of the suture instrument and the endoscope is changed from the state of FIG. Explanatory drawing of a 9th Example. Explanatory drawing of a 10th Example. 340 is an explanatory view when the attachment position of the suture instrument and the endoscope is changed from the state of FIG. 340. Explanatory drawing of an 11th Example. 342 is a cross-sectional view taken along line AA in FIG. Explanatory drawing of the 11th Example of the state which attached the endoscope. 347 is a cross-sectional view taken along line AA in FIG. 341 is an explanatory view when the attachment position of the suture instrument and the endoscope is changed from the state of FIG. 347 is a cross-sectional view taken along line AA in FIG. Explanatory drawing of a 12th Example. The explanatory view when changing the attachment position of the suture instrument and the endoscope from the state of FIG. Explanatory drawing of a 13th Example. Explanatory drawing of a 14th Example. Explanatory drawing of a 15th Example. FIG. 358 is an explanatory view of a state in which the thread is inserted into the stomach together with the suture instrument fixed to the endoscope, showing the 57th embodiment together with FIGS. 354 to 360. Explanatory drawing of the state which fixed the end loop cartridge to the stomach wall. Explanatory drawing of the state which fixed the some end loop cartridge to the stomach wall. Explanatory drawing when sending the knot of the 1st thread | yarn formed outside the body into the stomach. Explanatory drawing of the state which the structure | tissue contracted in the stomach by the knot of the 1st thread | yarn sent into the stomach. Explanatory drawing when sending the tube which passed the thread | yarn into the stomach with the knot of the 2nd thread | yarn. Explanatory drawing when the knot of a 2nd thread | yarn moved to the vicinity of the knot of a 1st thread | yarn. Explanatory drawing of the state which cut | disconnected the thread | yarn in the vicinity of the knot of the 2nd thread | yarn, and extracted the thread | yarn outside the body. Explanatory drawing of the state which showed the modification and fixed the thread | yarn over the perimeter in the stomach with several end loop cartridges. 359 is an explanatory diagram of a state in which the stomach is contracted by the thread of FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 3 ... Suture machine, 16, 17 ... Actuation member, 18 ... Holding member, 20 ... Push rod, 22, 23 ... Connection member, 24, 25 ... Arm member, 34 ... Curve needle.

Claims (8)

An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
A needle for puncturing a living tissue, the needle being fixed with a thread for suturing the tissue;
A recovery member capable of recovering the needle punctured in the tissue, the recovery member has an outer peripheral portion having a groove and an inner hole,
An elongated guide that can guide the recovery member;
An elongated tubular member that can be inserted into the guide;
And at least one arm provided at the tip of the elongated tubular member,
The treatment member for an endoscope, wherein the recovery member is engaged with the elongated tubular member when the arm and the groove are present in the guide. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
A recovery member capable of recovering the needle punctured in the tissue, the recovery member has an outer peripheral portion formed with a protrusion;
A guide that is elongated and has an inner hole and is capable of guiding the recovery member;
A tubular member having a tip provided with a groove and being able to be inserted into the guide;
An elongated tubular member that can be inserted into the tubular member,
When the protrusion and the groove are engaged, the recovery member and the tubular member can be integrally advanced and retracted,
The treatment instrument for an endoscope, wherein the elongated tubular member and the tubular member are separable from each other. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
A transmission member having a flexible structure having a distal end portion inserted into a body cavity and operable outside the body;
A push rod connected to the tip of the transmission member;
The first and second connection members are connected to the push rod, and each of the first and second connection members has a base end portion rotatably connected to the push rod and a distal end portion. And then
First and second arm members each having a proximal end portion rotatably connected to a distal end portion of the connection member, and a distal end portion;
A holding member for rotatably holding the respective distal end portions of the arm members;
Each is formed integrally at the tip of the arm member, and can be opened and closed when the transmission member operates the first and second connecting members and the first and second arm members via the push rod. First and second actuating members;
A needle provided on at least one of the first and second actuating members for puncturing a living tissue;
A thread attached to the needle;
A recovery member capable of recovering the needle,
One of the first and second actuating members has a loop portion, and the recovery member can pass through the loop. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
A transmission member having a flexible structure having a distal end portion inserted into a body cavity and operable outside the body;
A push rod connected to the tip of the transmission member;
The first and second connection members are connected to the push rod, and each of the first and second connection members has a base end portion rotatably connected to the push rod and a distal end portion. And then
First and second arm members each having a proximal end portion rotatably connected to a distal end portion of the connection member, and a distal end portion;
A holding member for rotatably holding the respective distal end portions of the arm members;
Each is formed integrally at the tip of the arm member, and can be opened and closed when the transmission member operates the first and second connecting members and the first and second arm members via the push rod. First and second actuating members;
A needle provided on at least one of the first and second actuating members for puncturing a living tissue;
A thread attached to the needle,
A collecting member capable of collecting the needle;
An operation member having a cylindrical outer peripheral portion formed with a groove and a central axis,
The treatment instrument for an endoscope, which is capable of operating the recovery member via the groove when the operation member rotates about a central axis. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
Driving means inserted into the body cavity together with the endoscope and operated outside the body;
An arm member disposed in the body cavity and actuated by the driving means;
An actuating member formed integrally with the arm member;
A needle connecting member detachably attached to the operating member;
An endoscopic treatment tool comprising a needle for puncturing a living tissue, to which a thread for suturing the tissue is fixed, and the needle is detachably attached to the needle connecting member. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
A transmission member having a flexible structure having a distal end portion inserted into a body cavity and operable outside the body;
A push rod connected to the tip of the transmission member;
First and second connecting members each having a proximal end portion rotatably connected to the push rod and a distal end portion;
First and second arm members each having a proximal end portion rotatably connected to a distal end portion of the connection member, and a distal end portion;
A holding member for rotatably holding the respective distal end portions of the arm members;
Each is integrally formed at the tip of the arm member, and can be opened and closed when the transmission member operates the first and second connecting members and the first and second arm members via the push rod. First and second actuating members;
A needle provided on at least one of the first and second actuating members for puncturing a living tissue;
A thread attached to the needle, a collecting means for collecting the needle, and an engaging member for engaging the collecting means,
The needle and the thread are fixed to the case in advance,
The treatment instrument for an endoscope, wherein the needle can be attached to the first or second actuating member, and the recovery means can be attached to the engaging member. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
Driving means inserted into the body cavity together with the endoscope and operated outside the body;
An arm member disposed in the body cavity and actuated by the driving means;
A connecting member attached to the arm member;
A needle for puncturing a living tissue having a fixing part that can be attached to and detached from the connecting member is provided, and a thread for suturing the tissue is fixed to the needle,
An elastic member disposed in the vicinity of the fixed portion;
An endoscope treatment tool, wherein the connection member and the needle are fixed via the elastic member. An endoscope treatment tool that is used together with an endoscope and performs a treatment inside a body cavity by operating outside the body,
A transmission member having a flexible structure having a distal end portion inserted into a body cavity and operable outside the body;
A push rod coupled to the distal end portion of the transmission member; a base end portion rotatably coupled to the push rod; and first and second connecting members having a distal end portion;
First and second arm members each having a proximal end portion rotatably connected to a distal end portion of the connection member, and a distal end portion;
A holding member for rotatably holding the respective distal end portions of the arm members;
Each is formed integrally at the tip of the arm member, and can be opened and closed when the transmission member operates the first and second connecting members and the first and second arm members via the push rod. First and second actuating members;
A needle provided on at least one of the first and second actuating members, for puncturing a living tissue, and a thread attached to the needle; and the thread from the portion fixed to the needle; A treatment instrument for an endoscope, which extends in a different direction and has a notch for passing a thread formed at at least one end of the first and second actuating members.

Images