Endoscopic suturing system

• US 20050149067A1
• Filed: 10/05/2004
• Published: 07/07/2005
• Est. Priority Date: 01/30/2002
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation), Olympus Corporation
• Original Assignee: Olympus Corporation
• Inventors: Miyamoto, Satoshi, Yamamoto, Tetsuya, Mikkaichi, Takayasu, Iwasaka, Masayuki, Kawashima, Koichi, Takemoto, Shotaro, Chung, Sydney Sheung Chee, Matsui, Raifu
• Granted Patent: US 7,530,985 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/0493 Protective devices for suturing, i.e. for protecting the patient's organs or the operator
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/0034 adapted to be inserted through a working channel of an endoscope
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0448 Additional elements on or within the anchor
• CPC Class Codes: A61B 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 : with pre-tied sutures
• CPC Class Codes: A61B 2017/0488 : Instruments for applying suture clamps, clips or locks for applying suture anchors A61B2017/0409; for applying wound clamps A61B17/10; for applying ligaturing clamps or clips A61B17/128
• CPC Class Codes: A61B 2017/06019 : by means of a suture-receiving lateral eyelet machined in the needle lateral opening for attaching suture to suture anchor A61B2017/0414
• CPC Class Codes: A61B 2017/06028 : by means of a cylindrical longitudinal blind bore machined at the suture-receiving end of the needle, e.g. opposite to needle tip
• CPC Class Codes: A61B 2017/06042 : located close to needle tip
• CPC Class Codes: A61B 2017/06057 : Double-armed sutures, i.e. sutures having a needle attached to each end

Abstract

An endoscopic treatment device is used with an endoscope. This treatment device includes a transmission member with a flexible structure having a distal end portion to be inserted into a body and can be operated outside the body, a push rod coupled to the distal end portion, and first and second connecting members rotatably coupled to the push rod. The treatment device further includes first and second arm members rotatably coupled to the distal end portion of the connecting member, a holding member rotatably holding the respective arm at a predetermined interval therebetween, and first and second actuating members integrally formed with the arm members and can open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod. This device also includes a needle mounted on at least one of the first and second actuating members.

Claims

1. A treatment device which is used to perform treatment in a body by being operated outside the body, comprising:

a flexible member having a distal end portion which is capable of being inserted into the body;

a link mechanism which is arranged at the distal end portion of the flexible member and actuated by an operation outside the body; and

a curved needle which is actuated by the link mechanism and is able to move in a direction to puncture a tissue and a direction to be removed from the tissue.

2. A device according to claim 1, wherein the treatment device is capable of being inserted into the body along a guide member having an axis and is so held as to be movable with respect to the guide member in an axial direction of the guide member.

3. An endoscopic treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body and is capable of being operated outside the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portions of the first and second arm members at a predetermined interval therebetween;

first and second actuating members which are integrally formed with the distal end portions of the first and second arm members and is able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod; and

a needle which is mounted on at least one of the first and second actuating members and is used to puncture a tissue.

4. A device according to claim 3, wherein at least one of the first and second actuating members has at least one tissue fixing means.

5. A device according to claim 3, wherein the needle is a curved needle.

6. A device according to claim 3, further comprising protective means for protecting a tissue from the needle.

7. A device according to claim 3, further comprising a suture thread attached to the needle, and recovery means for recovering the thread inserted in the tissue from the needle.

8. A device according to claim 3, wherein the treatment device can be inserted into the body along a guide member having an axis and is so held as to be movable with respect to the guide member in an axial direction of the guide member.

9. An endoscopic treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion to be inserted into a body and is capable of being operated outside the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portions of the respective arm members at a predetermined interval therebetween;

first and second actuating members which are integrally formed with the distal end portions of the arm members and is able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod;

a needle which is mounted on at least one of the first and second actuating members and is used to puncture a tissue;

a thread attached to the needle; and

recovery means for recovering the thread inserted in the tissue from the needle,

wherein the recovery means has a lock member to remove the needle from one of the first and second actuating members.

10. A device according to claim 9, wherein the recovery means can move along a direction in which the endoscopic treatment device extends.

11. A device according to claim 9, wherein the thread attached to the needle has at least one large loop and at least one small loop wound around a thread that forms the large loop.

12. An endoscopic treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a needle which is used to puncture a tissue and to which a thread for suturing the tissue is fixed; and

recovery means for recovering the needle inserted in the tissue,

wherein the recovery means has a needle lock member which can lock the needle and a thread lock member which can lock the thread, thereby forming needle/thread fixing means capable of clamping the tissue between the needle locked to the needle lock member and the thread lock member.

13. A device according to claim 12, wherein the needle/thread fixing means has a space in which the thread is exposed to the outside and is able to be cut.

14. An endoscopic treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body and a proximal end portion arranged outside the body;

a push rod coupled to the distal end portion of the transmission member;

an operating section coupled to the proximal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members,

a holding member which rotatably holds the distal end portions of the arm members;

first and second actuating members which are integrally formed with the distal end portions of the arm members and is movable in opening and closing directions when the operating section moves the first and second connecting members and the first and second arm members with respect to the coupling member through the transmission member and the push rod; and

a restricting mechanism which is mounted on one of the first and second actuating members to restrict a movement range of said one actuating member.

15. A device according to claim 14, wherein the restricting mechanism has a force charging member pivotally mounted on said one actuating member and one of the arm members, and a spring which biases said one actuating member in one of the opening and closing directions with respect to the force charging member.

16. An endoscopic treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body and can be operated outside the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portions of the respective arm members at a predetermined interval therebetween;

first and second actuating members which are integrally formed with the distal end portions of the arm members and is able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod;

a third actuating member which is pivotally attached to the first actuating member;

a third connecting member which is pivotally coupled to the holding member and the third actuating member and moves together with the first and second actuating members; and

a needle which is mounted on at least one of the first and second actuating members and is used to puncture a tissue.

17. A treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a needle which is used to puncture a living tissue and to which a thread for suturing the tissue is fixed;

a recovery member capable of recovering the needle inserted into the tissue, the recovery member having an outer periphery portion at which a groove is provided, and an inner hole;

a guide formed in an elongated shape and capable of guiding the recover member;

an elongated circular member capable of being inserted into the guide; and

at least one arm provided at a distal end of the elongated circular member,

the recovery member being engaged with the elongated circular member when the arm and the groove are located in the guide.

18. A treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a recovery member capable of recovering a needle punctured into a tissue, the recovery member having an outer periphery portion at which a protrusion is formed;

a guide formed in an elongated shape and having an inner hole, the guide being capable of guiding the recovery member;

circular members, having a distal end portion at which a groove has been provided, capable of being inserted into the guide; and

another elongated circular member capable of being inserted into the circular member,

wherein, when the protrusion and the groove are engaged with each other, the recovery member and the circular members can be integrally advanced and retracted, and

the elongated circular member and the circular members can be separated from each other.

19. A treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body and is capable of being operated outside of the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portions of the first and second arm members;

first and second actuating members which are integrally formed with the distal end portions of the first and second arm members and are able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod;

a needle which is mounted at least at one of the first and second actuating members and is used to puncture a tissue;

a thread mounted on the needle; and

a recovery member capable of recovering the needle,

wherein one of the first and second actuating members has a loop portion, and the recovery member can pass through the loop.

20. A treatment device which is used together with an endoscope to perform treatment in a body by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body and is capable of being operated outside of the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portions of the first and second arm members;

first and second actuating members which are integrally formed with the distal end portions of the first and second arm members and are able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod;

a needle which is mounted at least at one of the first and second actuating members and is used to puncture a tissue;

a thread mounted on the needle;

a recovery member capable of recovering the needle; and

an operating member having a cylindrical outer periphery portion at which a groove has been formed and a central axis,

wherein the operating member can operate the recovery member via the groove when the operating member rotates around the central axis.

21. A suturing method using an endoscopic suturing device, comprising:

(1) retaining an insert assisting device into a body;

(2) inserting a suturing device incorporated in the endoscope into the insert assisting device and inserting the suturing device into the body;

(3) opening a curved needle of the suturing device;

(4) pushing the curved needle against a sutured region;

(5) puncturing the curved needle into a tissue;

(6) recovering the needle by using a recovery member;

(7) removing the curved needle from the tissue;

(8) moving the recovery member close to the sutured region; and

(9) returning the recovery member to a predetermined position, and removing the suturing device to the outside of the body by closing the curved needle.

22. A treatment device which is used together with an endoscope to perform treatment in a body cavity by being operated outside the body, comprising:

driving means which is inserted into the body cavity together with the endoscope and operated outside the body;

an arm member which is placed in the body cavity and operated by the driving means;

a connecting member which is detachably mounted on the arm member; and

a needle which is used to punctuate a living tissue and to which a thread for suturing the tissue is fixed, the needle being detachably mounted on the connecting member.

23. A treatment device which is used together with an endoscope to perform treatment in a body cavity by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body cavity and is capable of being operated outside the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portion of each of the arm members;

first and second actuating members which are integrally formed with the distal end portions of the first and second arm members and are able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod;

a needle which is mounted on at least one of the first and second actuating members and is used to puncture a living tissue;

a thread attached to the needle;

recovery means for recovering the needle; and

an engaging member which engages the recovery means,

wherein the needle and the thread are fixed to a case in advance, and

the thread can be attached to one of the first and second actuating members, and the recovery means can be amounted on the engaging member.

24. A treatment device which is used together with an endoscope to perform treatment in a body cavity by being operated outside the body, comprising:

driving means which is inserted into the body cavity together with the endoscope and operated outside the body;

an arm member which is placed in the body cavity and operated by the driving means;

a connecting member which is mounted on the arm member;

a needle which includes a fixing portion being able to be attached and detached to and from the connecting member and is used to puncture a living tissue and to which a thread for suturing the living tissue is fixed; and

an elastic member placed near the fixing portion,

the connecting member and the needle being fixed through the elastic member.

25. A treatment device which is used together with an endoscope to perform treatment in a body cavity by being operated outside the body, comprising:

a transmission member with a flexible structure which has a distal end portion inserted into a body cavity and is capable of being operated outside the body;

a push rod coupled to the distal end portion of the transmission member;

first and second connecting members coupled to the push rod, each of the first and second connecting members having a distal end portion and a proximal end portion rotatably coupled to the push rod;

first and second arm members each having a distal end portion and a proximal end portion rotatably coupled to the distal end portion of a corresponding one of the first and second connecting members;

a holding member which rotatably holds the distal end portion of each of the arm members;

first and second actuating members which are integrally formed with the distal end portions of the first and second arm members and are able to open/close when the transmission member actuates the first and second connecting members and the first and second arm members through the push rod;

a needle which is mounted on at least one of the first and second actuating members and is used to puncture a living tissue; and

a thread attached to the needle,

wherein the thread extends from a portion at which the thread is fixed to the needle in a direction different from the needle, and a notch through which the thread is to pass is formed in an end portion of at least one of the first and second actuating members.

26. A method of contracting a stomach by using an endoscopic treatment device, comprising steps of:

placing a thread for contracting the stomach between first and second actuating members of the treatment device;

inserting the treatment device combined with an endoscope into a body;

fixing the thread to portions of a stomach wall by using the treatment device; and

pulling the thread to contract the stomach.

27. A method according to claim 26, further comprising steps:

passing the thread pulled to contract the stomach through a tube; and

fixing the tube to the stomach wall in the form of a loop near the contracted thread by using the treatment device.