Abstract:
The purpose of the present invention is to provide a medical needle with which, compared to a conventionally known suture thread guide needle, puncture, handling, and perforation are easy when guiding a suture thread along a hernia orifice beneath the skin, and therefore, the medical needle enables the execution of an LPEC method using simpler procedures. The purpose is accomplished by a medical needle comprising: a loop member provided with a loop needle the distal end of which has a loop-shaped structure, and a grip part the outer diameter of which is larger than the outer diameter of the loop needle; a threading member that is provided with a tubular threading needle and a tubular grip part the outer diameter of which is larger than the outer diameter of the threading needle, and that is configured so that the loop member can pass through the threading member from the distal end thereof; and a puncturing member that is provided with a tubular puncture needle the distal end of which has a sharp-angled structure and a tubular grip part the outer diameter of which is larger than the outer diameter of the puncture needle, and that is configured so that the threading member can pass through the puncturing member from the distal end thereof.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of priority to Japanese Patent Application No. 2014-184747, the disclosure of which is incorporated herein by reference in its entirety. 
       TECHNICAL FIELD 
       [0002]    The present invention relates to medical needles for use in laparoscopic surgery. 
       BACKGROUND ART 
       [0003]    Pediatric inguinal hernia is a congenital disease with about 20,000 cases reported in Japan each year, making it one of the most common diseases in pediatric surgery. In healthy boys, as the testes descend into the scrotum at birth, the peritoneum is drawn in along with the testes to forma sac within the scrotum. As the testes reach the scrotum, however, the sac formed by the peritoneum will be spontaneously closed. In the event that the sac-like peritoneum (i. e., hernia sac) is not closed and maintained, the intestine and other abdominal tissue may eventually enter the hernia sac. The condition is referred to as pediatric inguinal hernia. In girls, the round ligament of uterus extends from the upper lateral sides of uterus and follows the same path as the descending path of the testicles to hold the uterus in place. The ligament descends with a protrusion in the peritoneum, which, if not closed, forms a hernia sac. 
         [0004]    The pediatric inguinal hernia is typically treated by surgical procedures involving ligation of the hernia sac at its neck (i.e., hernia orifice) using a suture. Two types of surgical procedures are used to treat pediatric inguinal hernia: open surgery and laparoscopic surgery. An open surgery is performed by incising the skin in the groin to pull out the hernia sac, and ligating the sac in the proximity of the hernia orifice. Involving incision in the groin, the open surgery tends to leave scars and cause significant post-surgical pain. 
         [0005]    In contrast, a laparoscopic surgery, such as a technique known as laparoscopic percutaneous extraperitoneal closure (LPEC), is performed by inserting a laparoscope (i. e., camera) through a small opening formed in the umbilicus, and suture-ligating the vicinity of the hernia orifice using a surgical instrument while viewing the inside of the abdominal cavity on a monitor screen. As described, the LPEC technique is a less-invasive procedure that can eliminate the issues of scar formation and post-surgical pain associated with open surgery. 
         [0006]    Known surgical instruments used in LPEC include a suture guide needle called Lapa-Her Closure™ as described in Non-Patent Document 1 (the entire disclosure of which is incorporated herein by reference) listed below. 
       PRIOR ART DOCUMENTS 
     Non-Patent Document 
       [0007]    Non-Patent Document 1: Tamaki Iwade et al., The Shinshu Medical Journal, 61(3), pp. 139-147, 2013 
       DISCLOSURE OF THE INVENTION 
     Problems to Be Solved by the Invention 
       [0008]    The suture guide needle as described in Non-Patent Document 1 can be used to percutaneously guide a suture along a hernia orifice. The suture guide needle in Non-Patent Document 1, however, has to puncture the affected site while the suture is attached to the needle tip. Even after puncturing, the manipulation of the guide needle from the upper rim of the hernia orifice along the lateral rim to the lower rim also needs to be performed with the suture being attached to the needle tip. 
         [0009]    Thus, the LPEC procedure as described in Non-Patent Document 1 has been extremely difficult to perform since it requires the use of the needle with suture attached to its needle tip in the puncturing, manipulation and perforation steps during the percutaneous guidance of suture along the hernia orifice. 
         [0010]    In view of the above-described problems, it is an objective of the present invention to provide a medical needle that makes easier the puncturing, manipulation and perforation steps during the percutaneous guidance of suture along the hernia orifice as compared to the suture guide needle described in Non-Patent Document 1 and thus can facilitate the LPEC procedure. 
       Means of Solving the Problems 
       [0011]    In an effort to solve the above-described problems, the present inventors have succeeded in facilitating the puncturing, manipulation and perforation steps during the percutaneous guidance of suture along the hernia orifice by separately providing a puncturing member for puncturing and a loop member for capturing the suture. Surprisingly, the present inventors have succeeded in facilitating the grasping of suture at the distal end of the puncturing needle after the perforation step by further separately providing a threading member for threading the needle from inside and using the loop member, the threading member and the puncturing member, inserted one member into the next, in combination. Thus, the present inventors have succeeded in producing a medical needle that can facilitate the LPEC procedure. These successful examples ultimately led to the present invention. 
         [0012]    According to the present invention, there is provided a medical needle, comprising a loop member including a loop needle with a loop-like distal end portion and a handle with an outer diameter larger than that of the loop needle; a threading member including a tubular threading needle and a tubular handle with an outer diameter larger than that of the threading needle, wherein the loop member can be inserted from a proximal end of the threading member; and a puncturing member including a tubular puncturing needle with a distal end portion having a sharp angle structure and a tubular handle with an outer diameter larger than that of the puncturing needle, wherein the threading member can be inserted from a proximal end of the puncturing member, wherein the medical needle is configured such that the length of the loop needle is greater than the length of the threading needle so that when the loop member is inserted into the threading member to the farthest point, the distal end portion of the loop needle protrudes from the distal end portion of the threading needle, and the length of the threading needle is greater than the length of the puncturing needle so that when the threading member is inserted into the puncturing member to the farthest point, the distal end portion of the threading needle protrudes from the distal end portion of the puncturing needle. Preferably, the threading member includes a tubular threading needle and a tubular handle with an outer diameter larger than that of the threading needle, wherein the loop member can be inserted from the proximal end of the threading member, wherein the threading member has a distal end portion that has a non-loop-like structure. 
         [0013]    In the medical needle of the present invention, preferably, a radial projection is provided on the handle of the loop member and first and second cutouts are provided in the handle of the threading member that each extend longitudinally from the proximal end, such that the projection of the loop member can engage with the first and second cutouts of the threading member. The depth of the first cutout of the threading member is such that when the projection of the loop member engages with the first cutout of the threading member, the distal end portion of the loop needle does not protrude from the distal end portion of the threading needle. The depth of the second cutout of the threading member is such that when the projection of the loop member engages with the second cutout of the threading member, the distal end portion of the loop needle protrudes from the distal end portion of the threading needle. 
         [0014]    In the medical needle of the present invention, preferably, a radial projection is provided on the handle of the threading member and first and second cutouts are provided in the handle of the puncturing member that each extend longitudinally from the proximal end, such that the projection of the threading member can engage with the first and second cutouts of the puncturing member. The depth of the first cutout of the puncturing member is such that when the projection of the threading member engages with the first cutout of the puncturing member, the distal end portion of the threading needle does not protrude from the distal end portion of the puncturing needle. The depth of the second cutout of the puncturing member is such that when the projection of the threading member engages with the second cutout of the puncturing member, the distal end portion of the threading needle protrudes from the distal end portion of the puncturing needle. 
         [0015]    In the medical needle of the present invention, the threading member preferably includes an attachment that can be removably fitted to the proximal end of the threading member. 
         [0016]    In the medical needle of the present invention, a third cutout is preferably provided in the puncturing member that is larger than the diameter of the suture and extends longitudinally from the distal end portion of the puncturing needle to the proximal end of the handle of the puncturing member. 
         [0017]    Preferably, the medical needle of the present invention is a needle for treating pediatric inguinal hernia. 
       Advantageous Effects of Invention 
       [0018]    The medical needle of the present invention employs so called a three-stage rocket format. In other words, the diameters of the needles and handles (or grips) of the loop member, the threading member and the puncturing member that compose the medical needle of the present invention may be varied such that the threading member and the loop member can be successively nested in the puncturing member to form a single unit that can be used for puncturing and retrieving of the suture. 
         [0019]    In comparison to the suture guide needle described in Non-Patent Document 1, the medical needle of the present invention makes it possible to easily guide a suture percutaneously along a hernia orifice and thus facilitates the LPEC procedure since it can achieve puncturing, manipulation and perforation steps by using a puncturing member with a threading member inserted therethrough and with the suture not extending from the tip of the puncturing needle. Further, the puncturing member can serve as an outer casing that an operator can hold to handle the needle. This facilitates the puncturing. Accordingly, the LPEC procedure when performed using the medical needle of the present invention can save time as compared to the conventional LPEC procedure and is thus expected to reduce the burden for both the operators and the patients. 
     
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         [0020]      FIG. 1  is a cross-sectional plan view of one embodiment of a medical needle of the present invention. 
           [0021]      FIG. 2  is an external view of one embodiment of the medical needle of the present invention. 
           [0022]      FIG. 3  is a cross-sectional plan view of a loop member according to one embodiment of the medical needle of the present invention. 
           [0023]      FIG. 4  is a perspective view of the loop member according to one embodiment of the medical needle of the present invention. 
           [0024]      FIG. 5  is a cross-sectional plan view of a threading member according to one embodiment of the medical needle of the present invention. 
           [0025]      FIG. 6  is a perspective view of the threading member according to one embodiment of the medical needle of the present invention, in which (a) is a perspective view of the threading member with its proximal end open and (b) is a perspective view of the threading member with its proximal end closed with an attachment  29  fitted thereto. 
           [0026]      FIG. 7  is a cross-sectional plan view of a puncturing member according to one embodiment of the medical needle of the present invention, in which (a) is a cross-sectional plan view of the puncturing member without a puncturing member entire cutout  39  and (b) is a cross-sectional plan view of the puncturing member with the puncturing member entire cutout  39 . 
           [0027]      FIG. 8  is a perspective view of the puncturing member according to one embodiment of the medical needle of the present invention. 
           [0028]      FIG. 9  shows (a) a cross-sectional plan view and (b) an external view of one embodiment of the medical needle of the present invention. 
           [0029]      FIG. 10  shows (a) a cross-sectional plan view and (b) an external view of one embodiment of the medical needle of the present invention. 
           [0030]      FIG. 11  is a schematic diagram illustrating a method of using one embodiment of the medical needle of the present invention. 
           [0031]      FIG. 12  is a schematic diagram illustrating a method of using one embodiment of the medical needle of the present invention. 
           [0032]      FIG. 13  is a schematic diagram illustrating a method of using one embodiment of the medical needle of the present invention. 
           [0033]      FIG. 14  is a schematic diagram illustrating a method of using one embodiment of the medical needle of the present invention. 
       
    
    
     DESCRIPTION OF EMBODIMENTS 
       [0034]    While a medical needle  1  according to one embodiment of the present invention comprising a loop member  10 , a threading member  20 , and a puncturing member  30  will specifically be described in the following with reference to  FIGS. 1 to 10 , it is to be understood that the present invention is not limited to what is embodied in these drawings. 
         [0035]    As depicted in  FIGS. 1 and 2 , the medical needle  1  consists of the loop member  10 , the threading member  20 , and the puncturing member  30 . The loop member  10 , the threading member  20 , and the puncturing member  30  are shown in  FIG. 3  through  FIG. 8  in respective cross-sectional views and perspective views. These members will now be described with reference to  FIGS. 3, 5, and 7 , each by way of a cross-sectional view. 
         [0036]    The loop member  10  includes a loop needle  11  and a loop handle  12 . The loop needle  11  has a loop structure at its distal end portion  13 . The size of the loop is not particularly limited as long as a suture can be inserted therethrough. The body of the loop needle  11  may or may not have a hollow tubular structure. The loop needle  11  and the loop handle  12  are connected and held together via a loop needle joint  14  (i. e., needle hub). The loop handle  12  has a cylindrical structure having a larger outer diameter than that of the loop needle  11 . The loop handle  12  may or may not have a tubular structure. The loop handle  12  has a loop handle proximal end portion  16  that is opposite the loop needle joint  14  connected to the loop needle  11 . The loop handle proximal end portion  16  preferably has a disc structure having a cross-section larger than the inner diameter of a threading handle  22  described below. 
         [0037]    The threading member  20  includes a threading needle  21  and a threading handle  22 . The threading needle  21  has a hollow tubular structure. The distal end portion  23  of the threading needle  21  is not particularly limited and may have any structure such as a right angle and a sharp angle. The threading needle  21  and the threading handle  22  are connected and held together via a threading needle joint  24  (i. e., needle hub). The threading handle  22  has a circular tube structure having a larger outer diameter than that of the threading needle  21 . The threading handle  22  has a threading handle proximal end portion  26  that is opposite the threading needle joint  24  connected to the threading needle  21  and through which the loop member  10  can be inserted. Thus, the inner diameter of the threading needle  21  is larger than the outer diameter of the loop needle  11  and the inner diameter of the threading handle  22  is larger than the outer diameter of the loop handle  12 . The threading handle proximal end portion  26  may be an open end or alternatively, may have a removable attachment  29  fitted in the open end. 
         [0038]    The puncturing member  30  includes a puncturing needle  31  and a puncturing handle  32 . The puncturing needle  31  has a hollow tubular structure. The distal end portion  33  of the puncturing needle  31  is not particularly limited as long as it has a sufficiently sharp angle structure to puncture the skin of the subject. The puncturing needle  31  and the puncturing handle  32  are connected and held together via a puncturing needle joint  34  (i. e., needle hub). The puncturing handle  32  has a circular tube structure having a larger outer diameter than that of the puncturing needle  31 . The puncturing handle  32  has a puncturing handle proximal end portion  36  that is opposite the puncturing needle joint  34  connected to the puncturing needle  31  and through which the threading member  20  can be inserted. Thus, the inner diameter of the puncturing needle  31  is larger than the outer diameter of the threading needle  21  and the inner diameter of the puncturing handle  32  is larger than the outer diameter of the threading handle  22 . 
         [0039]    The loop needle  11 , the threading needle  21  and the puncturing needle  31  have decreasing lengths in this order. In other words, the loop needle  11  is formed to have a greater length than the threading needle  21 . Specifically, the loop needle  11  is formed to have a greater length than the threading needle  21  such that when the loop member  10  is inserted into the threading member  20  to the farthest point, the distal end portion  13  of the loop needle  11  extends from the distal end portion  23  of the threading needle  21 . The threading needle  21  is formed to have a greater length than the puncturing needle  31 . Specifically, the threading needle  21  is formed to have a greater length than the puncturing needle  31  such that when the threading member  20  is inserted into the puncturing member  30  to the farthest point, the distal end portion of the threading needle  21  extends from the distal end portion  33  of the puncturing needle  31 . While the length of the puncturing needle  31  is not particularly limited, the length needs to be greater than the expected maximum diameter of the hernia orifice. The term “needle length” as used herein refers to the entire length of a needle extending from its distal end portion to its needle joint. 
         [0040]    While the medical needle of the present invention may take any form as long as it includes a loop member, a threading member and a puncturing member having respective structures as described above, it may include projections and cutouts as shown in  FIGS. 1 to 10 . 
         [0041]    Accordingly, the loop handle  12  has a loop handle projection  15  that projects in the direction of height, or radially, and extends distally from the loop handle proximal end portion  16 . The threading handle  22  has first and second cutouts, in particular a threading handle short cutout  27  and a threading handle long cutout  28 , that each extend distally from the threading handle proximal end portion  26 . The loop handle projection  15  can engage with each of the threading handle short cutout  27  and the threading handle long cutout  28 . Specifically, the radial depth of each of the threading handle short cutout  27  and the threading handle long cutout  28  is greater than the height of the loop handle projection  15 . The depth (i. e., width) of the threading handle short cutout  27  is such that the distal end portion  13  of the loop needle  11  does not extend from the distal end portion  23  of the threading needle  21  when the loop handle projection  15  is engaged with the threading handle short cutout  27 . The depth of the threading handle long cutout  28  is such that the distal end portion  13  of the loop needle  11  extends from the distal end portion  23  of the threading needle  21  when the loop handle projection  15  is engaged with the threading handle long cutout  28 . 
         [0042]    Similar to the loop handle projection  15 , the threading handle  22  has a threading handle projection  25  that projects radially and extends distally from the threading handle proximal end portion  26 . The puncturing handle  32  has first and second cutouts, in particular a puncturing handle short cutout  37  and a puncturing handle long cutout  38 , that each extend distally from the puncturing handle proximal end portion  36 . The threading handle projection  25  can engage with each of the puncturing handle short cutout  37  and the puncturing handle long cutout  38 . Specifically, the radial depth of each of the puncturing handle short cutout  37  and the puncturing handle long cutout  38  is greater than the height of the threading handle projection  25 . The depth (i. e., width) of the puncturing handle short cutout  37  is such that the distal end portion  23  of the threading needle  21  does not extend from the distal end portion  33  of the puncturing needle  31  when the threading handle projection  25  is engaged with the puncturing handle short cutout  37 . The depth of the puncturing handle long cutout  38  is such that the distal end portion  23  of the threading needle  21  extends from the distal end portion  33  of the puncturing needle  31  when the threading handle projection  25  is engaged with the puncturing handle long cutout  38 . 
         [0043]    In addition to the puncturing handle short cutout  37  and the puncturing handle long cutout  38 , the puncturing member preferably has a third cutout, in particular a puncturing member entire cutout  39 , that is larger than the suture diameter and extends longitudinally from the puncturing needle distal end portion  33  to the puncturing handle proximal end portion  36 . In other words, the puncturing member entire cutout  39  is a cutout provided over the entire length of the puncturing member. As shown in  FIG. 13 , since the puncturing member  30  has the puncturing member entire cutout  39 , the suture  40  can be displaced out of the puncturing member  30  from the puncturing member entire cutout  39  by inserting the threading member  20  into the puncturing member  30  with the suture  40  remaining within the lumen of the puncturing member  30 . Thus, when the puncturing needle  31  is punctured into the body of the subject, the suture  40  within the puncturing member  30  can be placed and left within the body of the subject without removing the puncturing needle  31  from the body. This significantly facilitates the subsequent procedures and is thus advantageous. 
         [0044]      FIGS. 9 and 10  each show a cross-sectional plan view and an external view of the loop member  10 , the threading member  20  and the puncturing member  30 , inserted one member into the next, to form a single unit. In  FIG. 9 , the loop handle projection  15  is engaged with the threading handle short cutout  27  and the threading handle projection  25  is engaged with the puncturing handle short cutout  37 . In this configuration, neither the loop needle distal end portion  13  nor the threading needle distal end portion  23  extends out from the puncturing needle distal end portion  33 . In  FIG. 10 , the loop handle projection  15  is engaged with the threading handle long cutout  28  and the threading handle projection  25  is engaged with the puncturing handle long cutout  38 . In this configuration, the loop needle distal end portion  13  and the threading needle distal end portion  23  extend from the puncturing needle distal end portion  33 . 
         [0045]    The medical needle of the present invention is not particularly limited as long as it has the above-described structure and various modifications can be made to the extent that the objectives of the present invention are achieved. For example, surface features may be provided on the surface of the handles of the loop member, the threading member and the puncturing member in order to provide a better grip when holding the medical needle of the present invention. Also, as shown in  FIG. 7 , a circumferential puncturing finger stop  35  is preferably provided on the handle  32  of the puncturing member  30 , which serves as an outer casing when the members are assembled into a single unit, in order to facilitate engagement with fingers. 
         [0046]    The medical needle of the present invention can be used in surgical procedures to treat, for example, pediatric inguinal hernia. As described, a preferred embodiment of the medical needle of the present invention is a needle for treating pediatric inguinal hernia. It should be noted, however, that the medical needle of the present invention can be applicable to laparoscopic surgery not only in children, but also in adult patients, as it can serve to allow a surgeon to introduce suture into the abdominal cavity, form a loop within the abdominal cavity, and then draw the other end of the suture out of the abdominal cavity, without leaving scars, as well as to allow him to manipulate the needle from outside of the abdominal cavity to pass the suture through an internal organ to ligate it. Other examples of surgical procedures to which the medical needle of the present invention is applicable include ligature resection in the testicular vein ligation for testicular vein varicosis, retention of the testicular artery and vein and ductus deference in the abdominal cavity during orchiopexy, retention of the intestine during appendectomy, retention of the colon during colectomy, retention of the gall bladder during cholecystectomy, retention of the ureter during hydronephrosis and hydroureter surgery, suture closure of the absent diaphragm in diaphragmatic hernia, gastric fundplication in esophageal hiatal hernia, fixation of the anterior wall of stomach in stomach volvulus, laparoscopic gastrostomy, and resection of Meckel diverticulum. Steps of using one embodiment of the medical needle of the present invention in pediatric inguinal hernia surgery will now be described with reference to  FIGS. 11 to 14 . 
         [0047]    First, the attachment  29  fitted to the threading handle proximal end portion  26  of the threading member  20  is removed and the loop member  10  is inserted into the threading member  20  to the farthest point (Step  1  in  FIG. 11 ). Next, once the loop needle distal end portion  13  protrudes from the threading needle distal end portion  23 , suture  40  is passed through the loop needle distal end portion  13  (Step  2  in  FIG. 11 ). In this state, the loop member  10  is pulled out from the threading member  20  to pull the suture  40  through the lumen of the threading member  20 . With about one centimeter of one end of the suture protruding from the threading needle distal end portion  23  and the other end of the suture coming out from the threading handle proximal end portion  26 , the attachment  29  is fitted to the threading handle proximal end portion  26  to secure the suture  40  (Step  3  in  FIG. 11 ). The threading member  20  with the suture  40  extending therethrough is then inserted into the puncturing member  30 . Specifically, the threading handle projection  25  is engaged with the puncturing handle short cutout  37  such that the threading needle distal end portion  23  and the suture  40  do not protrude from the puncturing needle distal end portion  33 . In this state, the puncturing member  30  and the threading member  20  are secured to one another as a single unit (Step  4  in  FIG. 11 ). 
         [0048]    Next, the puncturing needle  31  is punctured through the skin of the subject (Step  5  in  FIG. 12 ),then advanced through the subcutaneous tissue and muscles. Specifically, the puncturing needle  31  is manipulated in the extraperitoneal space from the hernia orifice upper rim  51  along the hernia orifice lateral rim  53  toward the hernia orifice lower rim  52  where it is advanced to perforate into the abdominal cavity (Step  6  in  FIG. 12 ). Next, the threading handle projection  25  is disengaged from the puncturing handle short cutout  37  and the threading member  20  is moved circumferentially within the puncturing member  30  until the threading handle projection  25  engages with the puncturing handle long cutout  38 . This engagement causes the threading needle distal end portion  23  and the suture  40  to protrude from the puncturing needle distal end portion  33 . In this state, the puncturing member  30  and the threading member  20  are secured to one another as a single unit. The part of the suture  40  protruding from the threading needle distal end portion  23  is then grasped by a grasper  60  and the attachment  29  fitted to the threading handle proximal end portion  26  is removed (Step  7  in  FIG. 12 ). Next, the threading member  20  is removed from the puncturing member  30 , leaving the suture  40  within the lumen of the puncturing member  30  with one end of the suture  40  extending from the hernia orifice lower rim  52  (Step  8  in  FIG. 12 ). 
         [0049]    Next, the loop member  10  is inserted into the threading member  20  so that the loop handle projection  15  engages with the threading handle short cutout  27  to secure the loop member  10  to the threading member  20  (Step  9  in  FIG. 13 ). Subsequently, the threading member  20  with the loop member  10  inserted therethrough is inserted into the puncturing member  30  so that the threading handle projection  25  engages with the puncturing handle short cutout  37  to secure the threading member  20  to the puncturing member  30  (Step  10  in  FIG. 12 ). Upon this, neither the threading needle distal end portion  23  nor the loop needle distal end portion  13  extends out from the puncturing needle distal end portion  33 . When the puncturing member entire cutout  39  is provided on the puncturing member  30 , the suture  40  residing within the lumen of the puncturing member  30  can be fully displaced through the puncturing member entire cutout  39  into the extraperitoneal space of the subject. Then, the puncturing needle  31  is retracted, leaving the suture  40  within the extraperitoneal space of the subject (Step  11  in  FIG. 13 ). 
         [0050]    When the puncturing member entire cutout  39  is not provided on the puncturing member  30 , the puncturing member  30  after Step  8  in  FIG. 12  is removed from the abdominal cavity so that one end of the suture  40  extends from the hernia orifice lower rim  52  with the rest of the suture  40  remaining within the abdominal cavity along the hernia orifice lateral rim  53  and the other end of the suture  40  extending from the hernia orifice upper rim  51 . Next, the loop member  10  is inserted into the threading member  20  so that the loop handle projection  15  engages with the threading handle short cutout  27  to secure the loop member  10  to the threading member  20  and then the threading member  20  with the loop member  10  inserted therethrough is inserted into the puncturing member  30  so that threading handle projection  25  engages with the puncturing handle short cutout  37  to secure the threading member  20  to the puncturing member  30 . Upon this, neither the threading needle distal end portion  23  nor the loop needle distal end portion  13  extends out from the puncturing needle distal end portion  33 . With the needle assembly held in this state, the puncturing needle  31  is punctured through the skin of the subject from the same perforation site as in the above-described Step  5  to reach the state after the above-described Step  11  is implemented. 
         [0051]    Next, the puncturing needle  31  is advanced through the subcutaneous tissue and muscles. Specifically, the puncturing needle  31  is manipulated in the extraperitoneal space from the hernia orifice upper rim  51  along the hernia orifice medial rim  54  toward the hernia orifice lower rim  52  where it is advanced to perforate again into the abdominal cavity from the original perforation site (Step  12  in  FIG. 14 ). Next, the threading handle projection  25  is disengaged from the puncturing handle short cutout  37  and the threading member  20  is moved circumferentially within the puncturing member  30  until the threading handle projection  25  engages with the puncturing handle long cutout  38 . Similarly, the loop handle projection  15  is disengaged from the threading handle short cutout  27  and the loop member  10  is moved circumferentially within the threading member  20  until the loop handle projection  25  engages with the threading handle long cutout  28 . These engagements cause the threading needle distal end portion  23  and the loop needle distal end portion  13  to protrude from the puncturing needle distal end portion  33 . In this state, the puncturing member  30 , the threading member  20  and the loop member  10  are secured to one another as a single unit. Next, using the grasper  60 , the end of the suture  40  extending from the hernia orifice lower rim  52  is guided through the loop needle distal end portion  13  (Step  13  in  FIG. 14 ). 
         [0052]    Next, the threading handle projection  25  is disengaged from the puncturing handle long cutout  38  and the threading member  20  is moved circumferentially within the puncturing member  30  until the threading handle projection  25  engages with the puncturing handle short cutout  37 . Similarly, the loop handle projection  15  is disengaged from the threading handle long cutout  28  and the loop member  10  is moved circumferentially within the threading member  20  until the loop handle projection  15  engages with the threading handle short cutout  27 . These engagements secure the suture  40  guided through the loop needle distal end portion  13  (Step  14  in  FIG. 14 ). With the needle assembly held in this state, the puncturing needle  31  is removed such that the both ends of the suture  40  extend from the hernia orifice upper rim  51 . Next, the ends of the suture  40  are tied together to ligate the hernia orifice  50  (Step  15  in  FIG. 14 ). The ligature of the suture  40  is embedded subcutaneously. 
       REFERENCE SIGNS LIST 
       [0053]      1 : medical needle
   10 : loop member
   11 : loop needle
   12 : loop handle
   13 : loop needle distal end portion
   14 : loop needle joint
   15 : loop handle projection
   16 : loop handle proximal end portion
   20 : threading member
   21 : threading needle
   22 : threading handle
   23 : threading needle distal end portion
   24 : threading needle joint
   25 : threading handle projection
   26 : threading handle proximal end portion
   27 : threading handle short cutout
   28 : threading handle long cutout
   29 : attachment
   30 : puncturing member
   31 : puncturing needle
   32 : puncturing handle
   33 : puncturing needle distal end portion
   34 : puncturing needle joint
   35 : puncturing finger stop
   36 : puncturing handle proximal end portion
   37 : puncturing handle short cutout
   38 : puncturing handle long cutout
   39 : puncturing member entire cutout
   40 : suture
   50 : hernia orifice
   51 : hernia orifice upper rim
   52 : hernia orifice lower rim
   53 : hernia orifice lateral rim
   54 : hernia orifice medial rim
   60 : grasper