JP3485608B2 - Ligator - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a ligator mainly used for laparoscopic surgery.

[0002]

2. Description of the Related Art In recent years, in cecal surgery and gallbladder resection, non-laparoscopic laparoscopic surgery performed without laparotomy may be performed in addition to open surgery. In this laparoscopic surgery, a tube body called a plurality of trocar tubes is inserted into the abdominal cavity, the abdominal cavity is monitored by a camera inserted from one trocar tube, and an instrument inserted into another trocar tube, An operation is performed in the abdominal cavity while watching the monitor.

By the way, in the above laparoscopic surgery,
Compared to open surgery, in order to perform procedures such as ligation, it is performed indirectly through an instrument inserted through a trocar tube.
Due to the increased processing procedure and the use of more and more complex instruments, the processing time tends to be long. Prolonging the operation time and using many instruments like this
It is not preferable because the chances of infection increase during surgery.

In recent years, in order to eliminate such trouble,
Although various instruments have been developed, most of them cannot perform a reliable ligation process with one instrument because they cannot be sufficiently tightened with a thread, or other instruments need to be used together.

[0005]

SUMMARY OF THE INVENTION An object of the present invention is to provide a ligature device which can easily ligate in a body cavity.

[0006]

The above objects are achieved by the present invention described in (1) to (12) below.

(1) An insertion rod inserted into a communication tube for communicating the inside of the body cavity with the outside of the body, a pair of gripping members provided at the tip of the insertion rod so as to be openable and closable, and the base end of the insertion rod. An operating device for opening and closing the gripping member, a yarn transfer means for holding a looped yarn having a knot in advance, and winding the loop of the yarn around the gripping object gripped by the gripping member; A ligature device comprising: a thread tensioning means for tightening a thread wound around an object; and a cutting means for cutting the thread.

(2) The ligator according to (1), wherein the cutting means includes a pair of scissors constituting members for cutting a thread, and a link mechanism for opening and closing the scissors constituting members.

(3) An insertion rod inserted into a communication tube for communicating the inside of the body cavity with the outside of the body, a pair of gripping members provided at the tip of the insertion rod so as to be openable and closable, and the base end of the insertion rod. An operating device for opening and closing the gripping member, a yarn transfer means for holding a looped yarn having a knot in advance, and winding the loop of the yarn around the gripping object gripped by the gripping member; A thread tensioning means for tightening the thread wound around the object, a first thread guiding means provided in the vicinity of the gripping member and adjusting the pulling direction of the thread,
Second thread guiding means provided on the base end side of the first thread guiding means for adjusting the pulling direction of the thread, the first thread guiding means and the second thread guiding means, and the insertion rod. And a moving means for moving the yarn loop around the gripping object by the yarn transferring means, and the yarn guided by the first yarn guiding means and the second yarn guiding means. A ligator characterized by pulling in a proximal direction by a thread tensioning means to tighten the grasped object.

(4) The second yarn guiding means includes two guiding members which are openably and closably connected, and each of the guiding members has a body formed with a hole through which a yarn can be inserted at a tip end thereof. The ligator according to (3) above, which further comprises: (5) The ligator according to (3) or (4), wherein the second thread guiding means has a cutting means for cutting the thread. (6) The second thread guiding means has a cutting means for cutting the thread, and the cutting means has a pair of scissors constituting members for cutting the thread inserted into the hole, and the scissors constituting member. The ligator according to (4) above, which further comprises a link mechanism for opening and closing.

(7) In the above (3) to (6), the moving means simultaneously advances one of the first guiding means and the second guiding means and retreats the other. The ligator according to any one of claims.

(8) The yarn transfer means operates a holding section for holding the thread, a transfer body for transferring the thread held by the holding section to an object to be gripped by the gripping member, and a transfer of the thread by the transfer body. The ligator according to any one of (1) to (7) above, which further comprises an operating member for (9) The transfer body includes a swing member that transfers the holding portion to an object to be gripped by the grip member, and a conversion mechanism that converts movement of the operation member into rotation of the swing member. The ligator according to (8) above.

(10) The ligator according to any one of (1) to (9), wherein the thread tensioning means is a thread winding means that winds a thread and pulls it in the proximal direction. (11) The yarn winding means includes a winding shaft and a regulating device that regulates a rotation direction of the winding shaft, and is configured so that the once-wound yarn can maintain a tension state without loosening. The ligator according to (10) above.

(12) The ligator according to any one of (1) to (11) above, which is capable of forming two or more knots on a thread.

[0015]

EXAMPLES Preferred examples of the ligation device of the present invention will be described below.
A detailed description will be given with reference to the accompanying drawings. FIG. 1 is a side view of a distal end portion of the ligator 1 of the present invention, and FIG. 2 is a side view of a proximal end portion of an operating device or the like of the ligator 1.

The present invention relates to non-laparoscopic laparoscopic surgery,
When performing the ligation process in the abdominal cavity, the work of grasping the target site is performed by the grasping forceps, and the work of hooking the thread on the grasped target site is performed by the yarn transfer means. It is possible to perform a series of operations such as pulling by the thread winding means and finally tightening the target site with the thread to complete the ligation with one device.

The ligator 1 of the present invention is used by inserting the insertion rod 1a into a trocar tube which is installed through the abdominal wall and communicates with the outside of the abdominal cavity which is a part of the body cavity. It is a thing.

The ligator 1 of the present invention comprises the insertion rod 1a,
Grasping forceps 2 provided at the tip of the insertion rod 1a, an operating device 1b for operating the grasping forceps 2 from outside the body, a yarn transfer means 3, a yarn winding means 4, and two yarn guiding means for guiding the yarn. 5, 6 and a moving means 7 for moving the position of the yarn guiding means 5, 6.

As shown in FIG. 3, the insertion rod 1
The grasping forceps 2 provided at the tip of a has two elongated grasping members 21a and 21b, a fulcrum 22, a wire 23, and a forceps swinging member 24. Gripping members 21a, 21
In b, the base end is connected to the fulcrum 22 so as to be openable and closable,
Concavities and convexities are provided on the surfaces of the gripping members 21a and 21b facing each other so that the living tissue can be easily gripped. One end of a forceps swinging member 24 is swingably connected to the opposite sides of the facing surfaces of the gripping members 21a and 21b. The other end of the forceps swinging member 24 is swingably connected to the tip of the insertion rod 1a. Then, at the fulcrum 22,
The tip of the wire 23 is connected. In the above structure, the grasping forceps 2 is configured to be closed by pulling the wire 23 into the insertion rod 1a and to be opened by pushing the wire 23 toward the tip end of the insertion rod 1a.

On the other hand, the operating device 1b provided at the proximal end of the ligature 1 has a movable gripping member 11 and a fixed gripping member 1.
2 and. Movable gripping member 11 and fixed gripping member 1
2 is swingably connected at a fulcrum 13, and the base end of the wire 23 is connected to the wire connecting portion 14 located at the upper end of the movable gripping member 11.

Leaf springs 15a and 15b are fixed to the surfaces of the movable gripping member 11 and the fixed gripping member 12 which face each other, and the upper ends of the leaf springs 15a and 15b are in contact with each other.
As a result, the movable gripping member 11 is urged in the direction away from the fixed gripping member 12, that is, in the direction in which the wire connecting portion 14 pushes out the wire 23 in the distal direction.

At the lower end of the movable gripping member 11, a check member 17 having saw teeth formed on its upper surface is swingably supported. The lower end of the leaf spring 15b abuts on the base end of the check member 17 and biases the tip to swing upward.

A recess 12 is provided at the lower end of the fixed grip member 12.
1 is formed, and the leaf spring 16 is accommodated in the recess 121. Further, the check member 17 is provided in the recess 12
The tip of the leaf spring 16 is in contact with the sawteeth on the upper surface.

In the above structure, the movable gripping member 11
When both the fixed gripping member 12 and the fixed gripping member 12 are held inside the palm, the movable gripping member 11 swings with respect to the fixed gripping member 12 against the biasing force of the leaf springs 15a and 15b and is connected to the upper end portion. The wire 23 being pulled is pulled toward the base end side, and the grasping forceps 2 is closed. At this time, the check member 17 moves toward the tip, and the tip of the leaf spring 16 moves with respect to the check member 17 while overcoming the ridge of the sawtooth. When the gripping force of the hand is released, the movable gripping member 11 does not return to its original position due to the engagement between the saw teeth of the check member 17 and the leaf spring 16.
Keep it as it is. By such operation,
It is possible to easily maintain the state in which the living tissue is grasped by the grasping forceps 2. That is, after grasping the tissue with the grasping forceps 2,
While maintaining the grasped state, release the hand from the forceps,
It becomes possible to perform other operations, and the work becomes easier.

A yarn transfer means 3 is provided at the tip of the insertion rod 1a.
Is provided. The yarn transfer means 3 will be described in detail below. The yarn transfer means 3 has a swing member 30a, a transmission member 30b, and an operation member 30c.

The swinging member 30a includes a shaft portion 33 and a shaft portion 33.
A swinging portion 32 having a base end portion fixed to and swinging by rotation of the shaft portion 33, and a holding portion 3 formed at a tip end portion of the swinging portion 32.
1 and a crank portion 34 formed substantially in the center of the shaft portion 33.
It consists of and. In addition, the shaft portion 33 includes the insertion rod 1a.
It is axially supported inside, and both ends thereof project to the outside of the insertion rod 1a. Both ends of the protruding shaft portion 33 are bent at a right angle, and an insertion portion 330 through which the thread passes is formed inside.

The operating member 30c is composed of a shaft portion 37, an arm 38 provided at one end portion of the shaft portion 37, and a crank portion 39 formed in the central portion of the shaft portion 37.

The transmission member 30b includes the crank portion 34,
39, end portions 35 that are respectively rotatably connected,
35 and a rod-shaped portion 36 that is a rigid body.

In the configuration of the thread transfer means 3 as described above, when the ligature device 1 of the present invention is inserted into the trocar tube, the swinging portion 32 of the swinging member 30a falls to the proximal side. ing. At this time, from the holding portion 31 to the insertion portion 330
The thread has been threaded through. Arm 38 of operation member 30c
4 is swung from the position (A) in FIG. 4 to the position (B), the crank portion 39 of the operation member 30c moves in an arc shape and pushes the transmission member 30b in the axial direction. Transmission member 30b
Pushes the crank portion 34 of the swinging member 30a to rotate the same about the shaft portion 33, thereby rotating the shaft portion 33. The rotation of the shaft portion 33 causes the swinging portion 32 to move into the insertion rod 1a.
1 toward the tip, and the position is as shown in FIG. 4 (b).
As shown in FIG.
Transfer 1. At this time, the shaft portion 3 forming the insertion portion 330
Since the bent portion at the end of 3 is directed downward, the thread easily separates from the insertion portion 330.

As shown in FIGS. 2 and 5, a yarn winding means 4 is provided in front of the operating device 1b and below the insertion rod 1a. The accommodating portion 18 is provided below the insertion rod 1a, and the yarn intake port 181 is formed at the distal end side of the accommodating portion 18. A yarn winding means 4 which is a yarn tensioning means is provided in the accommodating portion 18. FIG. 5 is an overall perspective view showing the configuration of the yarn winding means 4. The yarn winding means 4 includes a winding shaft 41, a saw gear 42, and a regulating means 43 for regulating the rotation of the winding shaft 41.
It consists of and. Both ends of the take-up shaft 41 have the housing portion 1
It penetrates the cylindrical body which constitutes 8 and protrudes outside, and by this, is pivotally supported in the accommodation part 18 rotatably. An arm is projectingly provided at one end of the projecting winding shaft 41, and a winding operation section 412 is provided.

A saw gear 42 is provided at the center of the winding shaft 41, and thread insertion holes 411 are formed on both sides of the saw gear 42, respectively. The winding shaft 41
A rotary shaft 431 that constitutes the restricting means 43 is provided in the vicinity of. The rotary shaft 431 is axially supported by a pair of support members 434 that project into the accommodating portion 18, and one end thereof projects outside the accommodating portion 18. The projecting end is bent at a right angle to form an arm 432.

A leaf spring is fixed to the rotary shaft 431. The lower end of this leaf spring engages the saw teeth of the saw gear 42 and acts as a locking claw 433. When winding the yarn, the rotation of the rotary shaft 431 is locked while the locking claw 433 is engaged with the saw teeth of the saw gear 42. In this state, the winding shaft 41 is restricted in its rotation direction in only one direction by the engagement of the saw gear 42 and the engagement claw 433. The thread is passed through the thread insertion hole 411, the winding operation section 412 is operated in the direction of the arrow in FIG. 5, and the winding shaft 41 is rotated to wind the thread around the winding shaft 41.

At this time, the saw gear 42 rotates, but when the saw gear 42 rotates in the yarn winding direction, the locking claw 433 bends.
The saw gear 42 can rotate, but cannot rotate in the opposite direction due to the locking claw 433 locking to the saw teeth. Therefore, even if the yarn once wound up is released from the winding operation section 412, it can be maintained in a tense state without being loosened, and other operations or work can be performed in that state.

When loosening or unwinding the yarn, the arm 432 of the rotary shaft 431 is moved from the position (D) shown in FIG. 5 to the position (d). As a result, the rotary shaft 431 rotates, the engagement between the locking claw 433 and the saw gear 42 is released, and the winding shaft 41 becomes free to rotate.

As shown in FIG. 1, a first thread guiding means 5 and a second thread guiding means 6 are provided on the proximal end side of the grasping forceps 2.
And are provided. Each of the yarn guiding means 5 and 6 transfers the yarn held by the yarn transfer means 3 to the yarn winding means 4
It will guide you to.

The yarn guiding means 5 and 6 will be described in detail below. The thread guiding means 5, 6 winds the thread around the living tissue grasped by the grasping forceps 2, and then, when tightening the thread, pulls the thread in a direction parallel to the thread wound around the grasped object. It guides in a direction close to parallel and acts so that ligation can be performed reliably.

As shown in FIG. 6, the first yarn guiding means 5 is provided at the tip of the operating rod 51 inserted in the moving tube 50, and the base end portion thereof can be opened and closed at a fulcrum 520. It has two connected guide members 52a and 52b.

As shown in FIG. 7, the guiding members 52a and 52b are rectangular plate-shaped bodies, and have a body 521 having a semicircular tip portion, and a tip portion of the body 521. The formed hole 523, the opening 527 formed at the tip of the main body 521, the pair of loop forming members 56a and 56b housed in the main body 521 to open and close the opening 527, and the loop forming It has a link mechanism 55 that opens and closes the members 56a and 56b, and a slider 53 that moves the link mechanism 55.

The main body 521 includes a guide member 52a,
A guide slit 524 formed in the long side direction is formed on the base end side on the surface located outside 52b, and an accommodating portion 526 for accommodating the link mechanism 55 and the like is provided inside.

As shown in FIG. 8, a slider 53 is accommodated in the guide slit 524, and the slider 53 slides in the guide slit 524. In the slider 53, a spherical concave portion is formed in a portion protruding outward from the guide slit 524, and a joint portion 531 is provided. The joint portion 531 has a spherical connection portion 541 provided at the tip portion of the swing member 54.
Is inserted and has a two-dimensionally swingable joint structure. The base end of the swinging member 54 is swingably connected to the tip end of the moving tube 50. In addition, a stopper 525 is provided in the accommodating portion 526 to regulate the moving distance of the slider 53 in the front end direction.

On the other hand, a slide rod 532 is connected to the slider 53 and moves in the main body 521 in the axial direction as the slider 53 moves. A link mechanism 55 is connected to the tip of the slide rod.

The link mechanism 55 shown in FIG. 9 includes link members 551 and 552 and loop forming members 56a and 5a.
6b. As shown in FIG. 10, the loop forming members 56a and 56b forming the link mechanism 55 have loop forming portions 561a and
61b and link constituent parts 562a and 562b.

One end of each of the link members 551 and 552 is swingably connected to the tip of the slide rod 532, and the other end of each of the link members 551 and 552 is swingably connected to the base ends of the loop forming members 56a and 56b. Has been done. Loop forming member 5
6a and 56b are base end portions of the loop forming portions 561a and 561b formed at the tip end portions of the loop forming members 56a and 56b, and are swingably connected to each other. The loop forming portions 561a and 561b are connected to the link forming portion 562a,
The loop forming member 56 is formed by bending with respect to 562b, and when the link mechanism 55 has a rhombus shape as shown in FIG. 9, the loop forming member 56 forms a loop 57.

Then, as shown in FIG. 11, when the link mechanism 55 is extended, the loop is opened, and as shown in FIG. 12, the opening 527 is opened.

On the other hand, the moving tube 50 is movably inserted into the moving tube housing portion 19a provided in the main body of the ligator 1. Further, an operation protrusion 511 as an operation portion is connected to the base end portion of the operation rod 51, and the operation protrusion 511 is
As shown in FIG. 2, it projects to the outer surface of the storage portion 19a. The operation protrusion 511 is provided in the storage unit 1.
It is located in the slit 191a formed in 9a and moves in the slit 191a.

The operation projection 511 is provided with the slit 191.
The operating rod 51 can be moved in the axial direction by moving it along a. By moving the operating rod 51 in the axial direction, opening / closing of the guide member 52 and opening / closing of the opening 527 can be operated.

The opening / closing of the guide member 52 and the opening 52 will be described below.
The operation of opening and closing 7 will be described. When the operating rod 51 is pushed forward through the operating protrusion 511, the fulcrum 53 moves toward the tip end, and the slider 53 connected to the tip end of the swinging member 54 moves relative to the guide members 52a and 52b. The guide members 52a and 52b are moved toward the base end. As a result, the opening 527 at the tip is opened.

Further, when the operating rod 51 is pushed out, the guide members 52a and 52b are opened. Guide members 52a, 52b
The opening direction is substantially the same as the grasping forceps 2. By opening in this direction, the hole 52
The thread inserted in 3 can be guided to the living tissue in a direction parallel to or close to the thread wound around the living tissue. When the first yarn guiding means 5 is set in the above-described state and the yarn is wound by the yarn winding means 4, the yarn can be sufficiently tightened and reliable ligation can be performed.

Next, the second yarn guiding means 6 will be described. As shown in FIG. 13, the second yarn guiding means 6
Is provided at the tip of the operating rod 61 that is inserted into the moving tube 60, and the base end of the operating rod 61 is openably and closably connected at a fulcrum 620.
It has two guide members 62a and 62b.

As shown in FIG. 14, the guide members 62a and 62b are rectangular plate-like members, and have a body 621 whose tip is formed in a semicircular shape, and a tip of the body 621. A hole 623 formed, a pair of scissors constituting members 66a, 66b for cutting the thread inserted through the hole 623, a link mechanism 65 for opening and closing the scissors constituting members 66a, 66b,
It has a slider 63 for moving the link mechanism 65.

The main body 621 includes a guide member 62a,
A guide slit 624 formed in the long side direction is formed on the base end side on the surface located outside of 62b, and an accommodating portion 626 for accommodating the link mechanism 65 and the like is provided inside.

As shown in FIG. 8, a slider 63 is accommodated in the guide slit 624, and the slider 63 slides in the guide slit 624. In the slider 63, a spherical concave portion is formed in a portion protruding outward from the guide slit 624, and a joint portion 631 is provided. The connecting portion 631 has a spherical connecting portion 641 provided at the tip of the swinging member 64.
Is inserted and has a two-dimensionally swingable joint structure. The base end of the swinging member 64 is swingably connected to the tip end of the moving tube 60. In addition, a stopper 625 is provided in the accommodating portion 626 to regulate the moving distance of the slider 63 in the front end direction.

On the other hand, a slide rod 632 is connected to the slider 63 and moves in the main body 621 in the axial direction as the slider 63 moves. A link mechanism 65 is connected to the tip of the slide rod.

The link mechanism 65 shown in FIG.
Link members 651 and 652 and scissors constituting members 66a and 66
and b. As shown in FIG. 16, the scissors-constituting members 66a and 66b constituting the link mechanism 65 are composed of blade portions 661a and 661b at the tip end and link constituting portions 662a and 662b.

One end of each of the link members 651 and 652 is swingably connected to the tip of the slide rod 632, and the other end thereof is swingably connected to the base ends of the scissors constituting members 66a and 66b. Has been done. Scissors constituent members 66a, 6
6b is a base end portion of the blade portions 661a, 661b formed at the tip portions of the scissors constituting members 66a, 66b, which are swingably connected to each other, whereby scissors 6 serving as a thread cutting means.
7 are configured. As shown in FIG. 15, the link mechanism 65
The scissors 67 formed by the scissors-constituting member 66 are in an open state when the is shaped like a rhombus.

Then, as shown in FIG. 17, when the link mechanism 65 is extended, the scissors 67 are closed and the thread in the hole 623 is cut. The blade portions 661a, 66
A semicircular cutout 663 is formed at the base end portion of 1b so that a hole through which a thread can be inserted is formed with the scissors 67 closed as shown in FIGS. 17 and 18. Is configured.

On the other hand, the moving tube 60 is movably inserted into the moving tube housing portion 19b provided in the main body of the ligator 1. Further, an operation protrusion 611 as an operation portion is connected to the base end portion of the operation rod 61, and the operation protrusion 611 is
As shown in FIG. 2, it projects to the outer surface of the storage portion 19b. The operation protrusion 611 is provided in the storage unit 1.
It is located in the slit 191b formed in 9b and moves in the slit 191b.

The operation protrusion 611 is formed on the slit 191.
The operating rod 61 can be moved in the axial direction by moving it along b. By moving the operating rod 61 in the axial direction, the guide member 62 is opened and closed, and the scissors 67 are opened.
It can be opened and closed.

The operation of opening / closing the guide member 62 and opening / closing the scissors 67 will be described below. Through the operation protrusion 611,
When the operating rod 61 is pushed forward, the fulcrum 620 moves toward the tip end, and the slider 63 connected to the tip end of the swinging member 64 moves the guide members 62a and 62b relative to the guide members 62a and 62b. Move toward the base end of. Thereby, the scissors 67 are closed.

Further, when the operating rod 61 is pushed out, the guide members 62a and 62b are opened. Guide members 62a, 62b
The opening direction is substantially the same as that of the grasping forceps 2. By opening in this direction, the hole 62
The thread inserted in 3 can be guided to the living tissue in a direction parallel to or close to the wound thread. When the second yarn guiding means 6 is set in the above-described state and the yarn is wound by the yarn winding means 4, a reliable knot can be formed to such an extent that it cannot be unraveled, and a reliable ligation is possible.

The positions of the first yarn guiding means 5 and the second yarn guiding means 6 can be changed by the moving means 7. The moving means 7 rotates the racks 501 and 601 provided on the moving tubes 50 and 60, the pinion gear 71 provided between the racks 501 and 601, the rotating shaft 72 of the pinion gear 71, and the pinion gear 71. And an operating knob 73 for operating.

The racks 501 and 601 have movable tubes 50 and 6 respectively.
The pinion gear 71 is axially supported between the moving pipes 50 and 60 so as to mesh with both racks 501 and 601 at the same time.
The rotating shaft 72 of the pinion gear 71 projects to the outside of the main body of the ligature device 1, and a cylindrical operation knob 73 is connected to the projecting end thereof.

By rotating the operation knob 73, the pinion gear 71 is rotated and the moving pipes 50, 60 are rotated.
To move. By the operation of the moving means 7, the moving tubes 50 and 60 simultaneously move in opposite directions, and the positions of the first yarn guiding means 5 and the second yarn guiding means 6 are exchanged.

When the first yarn guiding means 5 retreats from the tip end toward the base end, the moving tube 50 retreats with respect to the operating rod 51, so that the operating rod 51 relatively projects and the guiding member. 52a and 52b are open, and the opening 52
7 is also open. And it retreats in this state.

At the same time, the second yarn guiding means 6 moves from the base end toward the tip. In this case, since the moving tube 60 moves forward in the distal direction with respect to the operating rod 61, the operating rod 61 is relatively retracted, the guide members 62a and 62b are closed, and the scissors 67 are as shown in FIG. , It becomes an open state.

The ligature device 1 of the present invention configured as described above
The action of will be described. Before inserting the ligature device 1 of the present invention into the trocar tube, the swinging member 30a of the thread transfer means 3 is tilted to the base end side (shown by an imaginary line in FIG. 1) and directed from the tip end to the base end. , The first yarn guiding means 5 and the second yarn guiding means 6 are arranged in advance. The yarn 10 is installed on the holding portion 31, a loop is formed by the yarn 10, and the yarn 10
After forming the second knot 10a, the yarn 10 is passed through the hole 523 of the first yarn guiding means 5 and the second knot 10 of the yarn is formed.
After b is formed in the direction opposite to that of the knot 10a, the yarn is passed through the hole 623 of the second yarn guiding means 6, and the yarn winding means 4 winds and holds the end of the yarn 10.

Next, the insertion rod 1a is inserted into the trocar tube. At this time, the guiding members of the first and second yarn guiding means 5 and 6 are in the closed state, and do not interfere with the insertion. As shown in FIG. 1, the target portion is clamped by the grasping forceps 2, the operating member 30c is operated, the swinging member 30a is tilted forward, and as shown in FIG. 10 is dropped around the clamped living tissue, and the living tissue is surrounded by the loop formed by the thread 10.
The moving means 7 is operated to move the first thread guiding means 5 to the vicinity of the living tissue. Here, as shown in FIG. 20, the guide members 52a and 52b are opened and the holes 52 are
The direction of the thread 10 inserted in 3 is made closer to the direction of the thread being wound, and the thread 10 is pulled by the thread winding means 4 to sufficiently tighten the living tissue.

By operating the moving means 7, the first yarn guiding means 5 is moved backward and the second yarn guiding means 6 is moved forward. At this time, the yarn 10 is restricted by the regulating means 4 of the yarn winding means 4.
Since the reverse rotation is regulated by 3, the tension of the yarn 10 is sufficiently maintained and the knot does not loosen.

When the first yarn guiding means 5 retracts, the opening 527 is opened.
The thread 10 comes out of the inside of 3. Even if the first thread guiding means 5 and the second thread guiding means 6 pass each other, the thread 10 is reliably held by the second thread guiding means 6 even if the thread 10 is caught in the hole 523 and does not come out. Therefore, the thread 10 can be reliably removed from the hole 523.

The moving means 7 is operated to move the second thread guiding means 6 to the vicinity of the living tissue, and the second knot 10b is brought close to the first knot 10a. Next, the operating rod 61 is operated to open the guide members 62a and 62b. At this time, the thread 10 moves toward the base end side in the hole 623, and even if the scissors 67 are closed together with the opening of the guide members 62a and 62b, they are not cut because they are located in the hole formed by the notch 663. In this state, the yarn winding means 4 can wind the yarn 10 again, and the second knot can be securely tightened to form a solid knot.

When the thread 10 is cut, the operating rod 61 is operated to temporarily close the guide members 62a and 62b, open the scissors 67, and then the moving means 7 retracts the moving pipe 60 to close the scissors 67. . At this time, the guiding members 62a and 62b close the scissors 67 while retreating, so that the thread 10 is guided by the guiding member 62a.
It moves to the tip side of a and 62b and is cut by the scissors 67. The ligation can be completed as described above. The first and second knots are the thread 10
Since it can be changed to an arbitrary state when it is set in the ligature device 1, for example, the number of times the threads are crossed in the knot can be increased to a plurality of times to make a stronger knot.

Further, if the number of the thread guiding means is increased, it will be 3
A heavy or quadruple knot can be used, and similarly, a strong ligature can be obtained.

The grasping forceps 2 in the above-mentioned structure is not limited to the above-mentioned structure, and other known structures can be used.

Further, the yarn transfer means 3 is not a swing member but is, for example, a long and slender rod body slidably held in the insertion rod 1a, and a holding portion similar to that of this embodiment is provided at the tip end portion. It may have a structure in which after holding the target portion, the rod is pushed out in the axial direction and slid to transfer the yarn to the side opposite to the target portion. In this case, the structure is simplified and the number of parts can be reduced.

Further, a roller or sprocket may be provided on the shaft portion 33 of the swing member and the shaft portion 37 of the operation member, and a transmission belt or a chain as a transmission member may be wound around the roller or sprocket. Alternatively, the crank portions 34 and 39 are provided on the opposite sides of the shaft portions 33 and 37, respectively, and the crank portions 34 and 39 are connected by a transmission member such as a wire that transmits only tensile force. You can also In the present invention, it is possible to ligate without providing the thread guiding means 5 and 6, but by providing the thread guiding means, the target site can be more securely tightened, which is preferable. Further, the number of the yarn guiding means may be one, but the provision of two or more is more preferable because the knot can be surely formed.

The structure of the thread guiding means is such that a pair of guiding members are integrally provided rotatably at the tip of the operating rod at the center position, and when inserted into the trocar tube, the posture is almost parallel to the operating rod and tightening is performed. At times, it is possible to obtain a structure that exhibits the same action as that of the present embodiment by rotating the operating rod to a posture perpendicular to the operating rod.

First yarn guiding means 5 and second yarn guiding means 6
The moving means 7 for moving the yarn may be provided for each yarn guiding means, but in the case of the above embodiment, the first yarn guiding means 5 and the second yarn guiding means are operated by a single operation. Since 6 can be moved forward and backward at the same time, the structure is simple and the operation is simple, which is particularly preferable.

[0078]

As described above, according to the ligator of the present invention, ligation can be performed easily and quickly with a single instrument. Therefore, the number of trocar tubes used for surgery can be reduced, and the burden on the patient can be reduced.

Particularly when the thread guiding means is used, the ligation can be completed more reliably. When a plurality of thread guiding means are provided, the knot formed during ligation can be formed more firmly, which is particularly preferable.

The operation of gripping the target portion, the operation of hooking the thread on the object to be gripped, and the operation of tightening the thread can be quickly and reliably performed without a malfunction by a series of operations. In particular, by consolidating the operation system of each part in one place, the operation becomes easier, and further malfunctions can be prevented and the work can be speeded up.

Further, by providing the thread cutting means, it is not necessary to use a cutting tool, and the work can be further speeded up.

[Brief description of drawings]

FIG. 1 is a side view of a distal end portion of a ligator of the present invention.

FIG. 2 is a side view of a proximal end portion of a ligator operation device and the like.

FIG. 3 is a perspective view showing an opening / closing mechanism of grasping forceps.

FIG. 4 is an overall perspective view of a yarn transfer means.

FIG. 5 is an overall perspective view of the yarn winding means.

FIG. 6 is an overall perspective view showing a configuration of a first dielectric material.

FIG. 7 is an overall perspective view showing a configuration of a first induction member.

FIG. 8 is an enlarged partial perspective view showing the structure of a slider housed in a guide member.

FIG. 9 is a plan view showing the structure of the link mechanism of the first dielectric.

FIG. 10 is a plan view showing the shape of a loop forming member.

FIG. 11 is a plan view showing a structure of a link mechanism of the first dielectric body and showing a state in which a loop is opened.

FIG. 12 is an overall perspective view showing a configuration of a first induction member, showing a state in which an opening is opened.

FIG. 13 is an overall perspective view showing the configuration of a second derivative.

FIG. 14 is an overall perspective view showing the configuration of a second induction member, showing a state in which the scissors are open.

FIG. 15 is a plan view showing the structure of the link mechanism of the second derivative.

FIG. 16 is a plan view showing the shape of scissors constituting members.

FIG. 17 is a plan view showing the structure of the link mechanism of the second derivative, with the scissors closed.

FIG. 18 is an overall perspective view showing the configuration of a second induction member, showing a state in which the scissors are closed.

FIG. 19 is a side view of a moving tube showing a configuration of moving means.

FIG. 20 is a side view of the distal end portion of the ligator showing a state in which living tissue is clamped by the first derivative.

FIG. 21 is a side view of the distal end portion of the ligator showing a state in which living tissue is clamped by the second derivative.

[Explanation of symbols]

1 Ligator 1a Insertion rod 1b Operating device 11 Movable gripping member 12 Fixed gripping member 121 recess 13 fulcrum 14 wire connection 15 leaf spring 16 leaf spring 17 Non-return member 18 Housing 19 Moving tube housing 2 grasping forceps 21 gripping member 22 fulcrum 23 wires 24 Forceps swinging member 3 Thread transfer means 30 Transporter 30a swinging member 30b transmission member 30c operation member 31 holding part 32 Swing part 33 Shaft 34 Crank part 35 edge 36 Rod 37 Shaft 38 arms 39 Crank part 4 Thread winding means 41 winding shaft 411 thread insertion hole 412 Winding operation section 42 saw gear 43 Regulation means 431 rotation axis 432 arms 433 locking claw 434 Support member 5 First derivative 50 moving tubes 501 rack 51 Operation rod 511 Operation protrusion 52 Induction member 520 fulcrum 521 body 523 holes 524 guide slit 525 stopper 526 Housing 527 opening 53 slider 531 junction 532 slide rod 54 Swing member 55 Link mechanism 551 Link member 552 Link member 56 Loop forming member 561 Loop forming part 562 Link configuration section 57 loops 6 Second derivative 60 moving tubes 601 rack 61 Operation rod 611 Operation protrusion 62 induction member 620 fulcrum 621 body 623 holes 624 Guide slit 625 stopper 626 Housing 627 opening 63 slider 631 joint 632 slide rod 64 Swing member 65 link mechanism 651 link member 652 link member 66 Scissors components 661 blade 662 link configuration section 663 Notch 67 scissors 7 means of transportation 71 pinion gear 73 Operation knob

Claims (12)

(57) [Claims] 1. An insertion rod that is inserted into a communication tube that communicates the inside of the body cavity with the outside of the body, a pair of gripping members that are openably and closably provided at the tip of the insertion rod, and a base end of the insertion rod. An operating device that is provided to open and close the gripping member, a yarn transfer means that holds a loop-shaped thread having a knot in advance, and winds the loop of the thread around the gripping object gripped by the gripping member; A ligature device comprising: a thread tensioning means for tightening the thread wound around the thread; and a cutting means for cutting the thread. 2. The ligator according to claim 1, wherein the cutting means includes a pair of scissors constituting members for cutting a thread, and a link mechanism for opening and closing the scissors constituting members. 3. An insertion rod that is inserted into a communication tube that communicates the inside of the body cavity with the outside of the body, a pair of gripping members that are openably and closably provided at the tip of the insertion rod, and a base end of the insertion rod. An operating device that is provided to open and close the gripping member, a yarn transfer means that holds a loop-shaped thread having a knot in advance, and winds the loop of the thread around the gripping object gripped by the gripping member; A thread tensioning means for tightening the thread wound around, a first thread guiding means provided in the vicinity of the gripping member and adjusting the pulling direction of the thread, and a base end side of the first thread guiding means. A second yarn guiding means for adjusting the pulling direction of the yarn, and a moving means for moving the first yarn guiding means and the second yarn guiding means along the insertion rod. , The loop of the thread is grasped by the thread transfer means. Ligator, characterized in that tightening the grip was induced yarn pulled proximally by the yarn tensioning means by winding the object, and the first yarn guide means and said second thread guiding means. 4. The second yarn guiding means includes two guiding members that are openably and closably connected, and each of the guiding members has a main body having a hole through which a yarn can be inserted at a tip thereof. The ligator according to claim 3, which has. 5. The ligator according to claim 3, wherein the second thread guiding means has cutting means for cutting the thread. 6. The second thread guiding means has a cutting means for cutting the thread, and the cutting means has a pair of scissors constituting members for cutting the thread inserted into the hole, and the scissors. The ligator according to claim 4, further comprising a link mechanism that opens and closes the constituent members. 7. The moving means is one for advancing one of the first guiding means and the second guiding means and for retreating the other at the same time, according to any one of claims 3 to 6. Ligator. 8. The yarn transfer means operates a holding section for holding the thread, a transfer body for transferring the thread held by the holding section to an object to be held by the holding member, and a transfer of the thread by the transfer body. The ligator according to any one of claims 1 to 7, further comprising an operating member. 9. The transfer body includes a swing member that transfers the holding unit to an object to be gripped by the grip member, and a conversion mechanism that converts movement of the operation member into rotation of the swing member. The ligator according to claim 8, 10. The thread tensioning means is constituted by thread winding means for winding the thread and pulling it in the proximal direction.
The ligator according to any one of 1 to 9. 11. The yarn winding means comprises a winding shaft and a regulating means for regulating a rotation direction of the winding shaft, and is configured so that a once-wound yarn can maintain a tension state without being loosened. The ligator according to claim 10, which is provided. 12. The ligator according to claim 1, wherein two or more knots can be formed in the thread.