MEDICAL STAPLER AND SUTURING METHOD

A medical stapler includes a stapling head having a staple ejection portion and having a length in one direction, an anvil openably and closably coupled to the stapling head by a rotation shaft and having a length in one direction, a staple receiving portion provided in the anvil and provided at a position facing the staple ejection portion when the stapling head and the anvil are in a closed state, and a first guide portion configured to be displaced to a protruding orientation or a retracted orientation. In the protruding orientation, the first guide portion is capable of lifting a treatment tool.

TECHNICAL FIELD

The present disclosure relates to a medical stapler and a suturing method. This application is a continuation application of PCT International Application No. PCT/JP2021/033267, filed on Sep. 10, 2021. The content of the above-identified PCT International Applications is incorporated herein by reference.

BACKGROUND ART

In recent years, a medical stapler such as a stapler has been used in a surgery for suturing the digestive tract or the like. When an appropriate medical stapler is used, the surgery for suturing the digestive tract or the like can be made easier and a surgical time can be significantly reduced.

As a conventional medical stapler, for example, there is one including an endoscope and a stapling mechanism disposed around the endoscope disclosed in United States Patent Application, Publication No. 2018/0042603 (hereinafter, referred to as Patent Document). In the configuration of the Patent Document, a suturing treatment on a treatment target can be performed by the stapling mechanism while observing the treatment target using the endoscope.

However, when the medical stapler described in the Patent Document is used to suture a treatment target using the stapling mechanism, it has been difficult to ascertain a suture position and whether or not suturing can be performed in a state in which a diseased tissue is fully included.

In view showing the above circumstances, an objective of the present disclosure is to provide a medical stapler and a suturing method capable of causing a suture position to be easily ascertained and improving a treatment effect.

SUMMARY

In order to solve the above problems, the present disclosure proposes the following aspects.

A medical stapler according to a first aspect of the present disclosure includes a stapling head including a staple ejection portion and having a length in one direction, an anvil openably and closably coupled to the stapling head by a rotation shaft and having a length in one direction, a staple receiving portion provided in the anvil and provided at a position facing the staple ejection portion when the stapling head and the anvil are in a closed state, and a first guide portion configured to be displaced to a protruding orientation or a retracted orientation. In the protruding orientation, the first guide portion protrudes in a direction in which the anvil opens with respect to the stapling head when the anvil is in a closed state with respect to the stapling head. In the retracted orientation, the first guide portion does not protrude in the direction in which the anvil opens with respect to the stapling head when the anvil is in an open state with respect to the stapling head. In the protruding orientation, the first guide portion is capable of lifting a treatment tool.

A suturing method according to a second aspect of the present disclosure includes an insertion step of inserting a medical stapler and an endoscope into the body, a first advancing step of advancing a treatment tool from a distal-end portion of the endoscope, a grasping step of grasping a treatment target inside the body with the treatment tool, a retracting step of retracting the treatment tool relative to the medical stapler to draw in a tissue containing the treatment target to an endoscope side through a visual space of the medical stapler, an observation step of projecting the treatment target within a field of view showing the endoscope, and a suturing step of ejecting a staple from the stapling head to suture a circumference of the treatment target.

Advantageous Effects of Invention

The medical stapler and suturing method of the present disclosure can cause a suture position to be easily ascertained and improve a treatment effect.

DESCRIPTION OF EMBODIMENTS

First Embodiment

A first embodiment of the present disclosure will be described with reference toFIGS.1to18.

FIG.1is a view showing an overall configuration of a medical system300including a medical stapler100according to the present embodiment.

The medical system300is used for a surgery or the like in which the digestive tract or the like is sutured. The medical system300includes the medical stapler100, an endoscope200, an open-close operation unit250, an ejection operation unit270, and a wire sheath280. The open-close operation unit250is an operation unit that operates the medical stapler100using an open-close operation wire5. The ejection operation unit270is an operation unit that operates the medical stapler100using an ejection operation wire6.

The endoscope200is a known flexible endoscope, and includes a long insertion portion210that is inserted into the body from a distal end thereof, an operation unit220provided at a proximal-end portion of the insertion portion210, and a universal cord240.

A treatment tool channel230through which an endoscopic treatment tool is inserted is formed in the insertion portion210. A forceps port214, which is a distal end opening of the treatment tool channel230, is provided at a distal end212of the insertion portion210. The treatment tool channel230extends from the distal end212of the insertion portion210to the operation unit220.

A distal-end portion211of the insertion portion210includes an imaging unit (not shown in the drawings) including a CCD or the like. An objective lens215of the imaging unit is exposed at the distal end212of the insertion portion210.

A knob223that operates the insertion portion210and a switch224that operates the imaging unit or the like are provided on a proximal-end side of the operation unit220. An operator can bend the insertion portion210in a desired direction by operating the knob223.

A forceps insertion port222communicating with the treatment tool channel230is provided on a distal-end side of the operation unit220. The operator can insert the endoscopic treatment tool into the treatment tool channel230through the forceps insertion port222.

The universal cord240connects the operation unit220and an external peripheral device. The universal cord240outputs, for example, an image captured by the imaging unit to an external device. The image captured by the imaging unit is displayed on a display device such as a liquid crystal display via an image processing device.

The open-close operation unit250is an operation unit that opens and closes the medical stapler100by operating the open-close operation wire5. As shown inFIG.1, the open-close operation unit250includes an open-close operation unit main body252and an open-close operation slider253. A proximal end of the open-close operation wire5is coupled to the open-close operation slider253. The operator can advance and retract the open-close operation wire5by advancing and retracting the open-close operation slider253in a longitudinal axis direction with respect to the open-close operation unit main body252.

The ejection operation unit270is an operation unit that ejects a staple S (FIG.10) from the medical stapler100by operating the ejection operation wire6. As shown inFIG.1, the ejection operation unit270includes an ejection operation unit main body272and an ejection operation slider273. A proximal end of the ejection operation wire6is coupled to the ejection operation slider273. The operator can advance and retract the ejection operation wire6by advancing and retracting the ejection operation slider273in a longitudinal axis direction with respect to the ejection operation unit main body272.

The wire sheath280is a sheath through which the open-close operation wire5and the ejection operation wire6are inserted. As shown inFIG.1, a distal-end side of the wire sheath280is coupled to the insertion portion210of the endoscope200by a plurality of bands281.

FIG.2is a perspective view showing the medical stapler100.

The medical stapler100includes a cap (attachment member)1, a grasping portion2, a staple ejection portion3, a staple receiving portion4, an open-close operation wire5, and an ejection operation wire (power transmission member)6. The medical stapler100is attachable to and detachable from the distal-end portion211of the insertion portion210shown inFIG.1.

FIG.3is a front view showing the cap1. InFIG.3, the grasping portion2is displayed by a two-dotted line.

The cap (attachment member)1is a member that is attachable to the distal-end portion211of the endoscope200. The cap1is formed in a substantially columnar shape and has a first through hole11penetrating in an axial direction A (FIG.2) and a second through hole12penetrating in the axial direction A.

The first through hole11is a hole into which the distal-end portion211of the insertion portion210shown inFIG.1is inserted. A shape of the first through hole11is formed to follow an outer shape of the distal-end portion211of the insertion portion210. Therefore, when the distal-end portion211of the endoscope200is inserted into the first through hole11, the cap1can be attached to the distal-end portion211of the endoscope200.

A central axis O1of the first through hole11in the axial direction A is eccentric with respect to a central axis O of the cap1in the axial direction A. A direction in which the central axis O1is eccentric with respect to the central axis O is defined as an “upward side B1”.

The second through hole12is a hole into which the wire sheath280, through which the open-close operation wire5and the ejection operation wire6shown inFIG.1are inserted, is inserted. An inner diameter of the second through hole12is substantially coincident with an outer diameter of the wire sheath280.

A distal-end portion of the wire sheath280is inserted through the second through hole12to be fixed. The open-close operation wire5and the ejection operation wire6which are inserted through the wire sheath280pass through the second through hole12and extend to a distal-end side thereof.

The central axis O2of the second through hole12in the axial direction A is eccentric with respect to the central axis O of the cap1in the axial direction A as shown inFIG.3. A direction in which the central axis O2is eccentric with respect to the central axis O is opposite to the direction (the upward side B1) in which the central axis O1is eccentric with respect to the central axis O. A direction in which the central axis O2is eccentric with respect to the central axis O is defined as a “downward side B2”. In the present embodiment, the upward side B1and the downward side B2are directions extending in a vertical direction B.

FIG.4is a perspective view showing the medical stapler100with the grasping portion2in a closed state.FIG.5is a front view showing the medical stapler100with the grasping portion2in a closed state.

When the cap1is attached to the distal-end portion211of the endoscope200, as shown inFIGS.4and5, the objective lens215and the forceps port214are exposed from an opening13on a distal-end side of the first through hole11of the cap1. The operator can observe a treatment target through the objective lens215even when the medical stapler100is attached to the distal-end portion211of the endoscope200.

FIG.6is a perspective view showing the medical stapler100with the grasping portion2in an open state.FIG.7is a front view showing the medical stapler100with the grasping portion2in an open state. Further,FIG.8is a side view showing the medical stapler100with the grasping portion2in a closed state.FIG.9is a side view showing the medical stapler100with the grasping portion2in an open state.

As shown inFIG.6, the grasping portion2includes a stapling head (first grasping member)21, an anvil (second grasping member)22, an open-close rotation shaft23, a movable pin27, and an extended portion24.

As shown inFIG.6, the stapling head21and the anvil22are coupled to be openable and closable by the open-close rotation shaft23. The open-close rotation shaft23is provided on the distal-end side with respect to the cap1. An axial direction C of the open-close rotation shaft23is perpendicular to the axial direction A and the vertical direction B of the cap1. As shown inFIG.7, the grasping portion2is symmetrically formed with respect to the central axis O3in the vertical direction B.

The stapling head21is non-rotatably fixed to the distal-end side of the cap1. The stapling head21is fixed to the cap1at a position on the downward side B2with respect to the central axis O of the cap1. As shown inFIG.3, the stapling head21is disposed at a position overlapping the second through hole12of the cap1in a front view. On the other hand, as shown inFIG.7, the stapling head21is disposed at a position not overlapping the objective lens215and the forceps port214of the endoscope200in a front view.

As shown inFIG.6, the stapling head21includes a first distal-end portion21aand a first main body portion21b,and is formed in a substantially T shape in a plan view. The first distal-end portion21ais disposed on the distal-end side with respect to the first main body portion21b.

The first distal-end portion21ais formed in a substantially rectangular parallelepiped shape. The first distal-end portion21ais formed in a rectangular shape extending in the axial direction C of the open-close rotation shaft23in a plan view. The staple ejection portion3is provided at the first distal-end portion21a.An opening31aof the staple ejection portion3is provided on a surface (upper surface21e) of the first distal-end portion21aon the upward side B1.

The first main body portion21bis an elongated member extending in the axial direction A. A distal end of the first main body portion21bis fixed to the first distal-end portion21a.A proximal end of the first main body portion21bis fixed to the cap1via the extended portion24.

In the present embodiment, the extended portion24for securing a distance from the endoscope200is provided on a proximal-end side of the grasping portion2, but the present embodiment is not limited to this configuration. Presence or absence, a length, or the like of the extended portion24can be appropriately selected and changed according to a configuration of the grasping portion2and other factors such as a size of grasping forceps (treatment tool) G.

A communication hole24acommunicating with the second through hole12formed in the cap1is formed in the extended portion24, and through which the open-close operation wire5and the ejection operation wire6are inserted.

Further, in the present embodiment, the extended portion24is provided in the grasping portion2, but the extended portion24May be configured to be provided in the cap1.

The first main body portion21bincludes a contact pin21c(FIG.8). The contact pin21cis provided at the proximal end of the first main body portion21band comes into contact with the anvil22in a closed state to restrict a movable range of the anvil22.

As shown inFIG.8, a first engagement groove21dis a groove penetrating in the axial direction C of the open-close rotation shaft23in the first main body portion21b.The first engagement groove21dextends in the axial direction A.

The anvil22is attached to the stapling head21to be rotatable by the open-close rotation shaft23. As shown inFIGS.6and7, the anvil22includes a U-shaped member22aformed in a substantially U shape, and a second main body portion22bsupporting the U-shaped member22ato be rotatable.

The U-shaped member22ais formed in a substantially U-shape, and both end parts thereof are coupled to the second main body portion22b.In a closed state, a central portion of the U-shaped member22ais disposed on a distal-end side of the stapling head21. The central portion includes a second distal-end portion22c.The second distal-end portion22cis formed in a substantially rectangular parallelepiped shape. The second distal-end portion22cextends in the axial direction C of the open-close rotation shaft23. The staple receiving portion4is provided at the second distal-end portion22c.

The second main body portion22bis attached to the first main body portion21bof the stapling head21to be rotatable by the open-close rotation shaft23. A guide groove22dinto which the first main body portion21bis inserted is formed in the second main body portion22b.A second engagement groove22eis formed in each of a pair of side plate portions22gfacing each other in the axial direction C with the guide groove22dof the second main body portion22binterposed therebetween.

The second engagement grooves22eare grooves each penetrating in the axial direction C. As shown inFIG.7, the second engagement grooves22eare symmetrical with respect to the central axis O3of the anvil22. As shown inFIG.8, the second engagement grooves22eare each inclined toward the downward side B2from the distal-end side to the proximal-end side in the axial direction A in a side view in a closed state.

As shown inFIGS.2and4, the anvil22includes a pair of first guide portions22hhaving a cubic shape. The pair of first guide portions22hare displaced around an axis of the open-close rotation shaft23into a protruding orientation (FIG.8) or a retracted orientation (FIG.9) in accordance with opening and closing of the anvil22.

As shown inFIG.7, the pair of first guide portions22hare positioned inside the pair of second main body portions22bto which both end parts of the U-shaped member22aare connected. As shown inFIG.8, a part of the first guide portion22hon the proximal-end side is coupled to the side plate portion22gin which the second engagement groove22eis formed. In a side view shown inFIG.8, a first end surface22h1of the first guide portion22his coplanar with a first end surface22g1of the side plate portion22g.

A width W1of the first guide portion22hin the axial direction C is smaller than the width W2of the side plate portion22gin the axial direction C (W1<W2). A second end surface22h3of the first guide portion22his coupled to a second end surface22g2of the side plate portion22gvia a third end surface22h4orthogonal to the second end surface22h3. A notch portion22kthat enables the first guide portion22hto avoid coming into contact with the contact pin21cwhen the anvil22is opened or closed is formed between the first guide portion22hand the side plate portion22g.

Further, a shape of the first guide portion22his not limited to a cubic shape and can be changed as appropriate. Also, a protrusion height H and the width W1of the first guide portion22hare not limited to the height dimension shown inFIG.8, and can be changed as appropriate.

As shown inFIG.8, when the anvil22is in a closed state, the upper surface22h2of the first guide portion22hprotrudes in a direction in which the anvil22opens (to the upward side B1) with respect to an upper surface22fof the stapling head21(protruding orientation). Also, when the first guide portion22his in the protruding orientation, the upper surface22h2thereof is positioned on the downward side B2with respect to an upper surface22jof the anvil22.

Although it has been described that, when the first guide portion22his in the protruding orientation, the upper surface22h2thereof is positioned on the downward side B2with respect to the upper surface22jof the anvil22, the upper surface22h2may be on the upward side B1with respect to the upper surface22jof the anvil22. However, the upper surface22h2needs to be on the downward side B2with respect to an optical axis A1not to hinder a visual field of the endoscope200.

As shown inFIG.9, when the anvil22is in an open state, the first guide portion22hdoes not protrude in the direction in which the anvil22opens (to the upward side B1) with respect to the stapling head21(retracted orientation). When the first guide portion22his in the retracted orientation, it is positioned at the same height as the upper surface21fof the first main body portion21bof the stapling head21. Here, when the first guide portion22his in the retracted orientation, the first end surface22h1is coplanar with the upper surface21fof the first main body portion21bof the stapling head21.

The pair of guide portions22hare provided in the anvil22, and one of the first guide portions22his present on a movement path of grasping forceps G.

When the first guide portion22his in the retracted orientation, the first end surface22h1may be on the downward side B2with respect to the upper surface21fof the first main body portion21bof the stapling head21.

As shown inFIG.6, the anvil22has a visual space (pass-through space)25that passes through in an open-close direction R between the staple receiving portion4on the distal-end side and the open-close rotation shaft23on the proximal-end side. In the present embodiment, the visual space25is a space surrounded by sides of the U-shaped member22aformed in a substantially U shape.

As shown inFIG.8, the movable pin27is engaged with the first engagement groove21dand the second engagement groove22e,and advances and retracts in the axial direction A along the first engagement groove21d.A distal end of the open-close operation wire5is attached to the movable pin27. The movable pin27advances and retracts in the axial direction A due to an operation of the open-close operation wire5, and in conjunction with this, the anvil22opens and closes as shown inFIGS.8and9.

When the open-close operation wire5advances toward the distal-end side, as shown inFIG.9, the movable pin27rotates the anvil22in an opening direction (R1) with the open-close rotation shaft23as a center to bring the grasping portion2into an open state. When the open-close operation wire5retracts toward the proximal-end side, as shown inFIG.8, the movable pin27rotates the anvil22in a closing direction (R2) with the open-close rotation shaft23as a center to bring the grasping portion2into a closed state.

When the grasping portion2is in a closed state, the staple ejection portion3and the staple receiving portion4face each other in the vertical direction B as shown inFIG.8. When the grasping portion2is in the closed state, a slight gap P is formed between the staple ejection portion3and the staple receiving portion4. When the grasping portion2is in the closed state, an optical axis A1of the objective lens215passes outside (the upward side B1of) the stapling head21and the anvil22. Also, when the grasping portion2is in the closed state, a central axis A2of the forceps port214is at a position not overlapping the stapling head21but overlapping the anvil22in a front view.

As shown inFIG.9, when the grasping portion2is in an open state, the staple receiving portion4is disposed on the proximal-end side with respect to the open-close rotation shaft23. When the grasping portion2is in the open state, the staple receiving portion4is disposed on the proximal-end side with respect to the staple ejection portion3. When the grasping portion2is in the open state, the optical axis A1of the objective lens215passes through the visual space25. Also, when the grasping portion2is in the open state, the central axis A2of the forceps port214passes through the visual space25.

FIG.10is a cross-sectional view showing the grasping portion2including the staple ejection portion3.FIG.10shows a state before the ejection operation wire6is pulled.

The staple ejection portion3is provided at the first distal-end portion21aof the stapling head21, and can store and eject the staple S. The staple ejection portion3includes a staple storage portion31, a linear movement member32, and a rotation member33.

The staple storage portion31is a space that stores the staple S provided at the first distal-end portion21aof the stapling head21. As shown inFIGS.6and7, the stapling head21includes two staple storage portions31formed to be aligned in the axial direction C and capable of storing two U-shaped staples S.

The staple storage portion31opens in the vertical direction B at the opening31aprovided on the upper surface21eof the first distal-end portion21a.The staple S is stored in the staple storage portion31through the opening31a.The staple S is stored in the staple storage portion31with needle tips S1of the staple S facing the upward side B1.

The staple storage portion31is formed in a rectangular shape with short sides extending in the axial direction A and long sides extending in the axial direction C in a plan view. In the staple S stored in the staple storage portion31, the needle tips S1at both ends are disposed in the axial direction C.

The linear movement member32is a member accommodated in a bottom part of the staple storage portion31and is movable in the vertical direction B in an internal space of the staple storage portion31. The linear movement member32includes a recessed portion32athat supports the staple S to the upward side B1. The staple S stored in the staple storage portion31is fitted into the recessed portion32a.

A first pulley34and a second pulley36as the rotation member33are rotatably attached inside the stapling head21. The first pulley34and the second pulley36rotate to move the linear movement member32in the vertical direction B. A distal end of the ejection operation wire6is coupled to the first pulley34. When the ejection operation wire6is pulled in an arrow direction inFIG.10, the first pulley34can be made to rotate.

The second pulley36is rotatably attached inside the stapling head21, and the first pulley34is disposed on a distal-end side with respect to the second pulley36. A rotation shaft35of the first pulley34and a rotation shaft37of the second pulley36extend in the axial direction C and are substantially parallel to the open-close rotation shaft23of the grasping portion2. The first pulley34has a protruding portion38, which supports the linear movement member32from the downward side B2, on the distal-end side.

The distal end of the ejection operation wire6is coupled to the upward side B1above the rotation shaft35at the first pulley34. The ejection operation wire6extends from the first pulley34to the ejection operation unit270shown inFIG.1via the second pulley36and passing through the second through hole12. The reason for providing the second pulley36is to adjust a position of the ejection operation wire6for smoothly guiding it into the second through hole12, and to reduce frictional resistance when the ejection operation wire6is guided into the second through hole12. Therefore, the same effect can be obtained even when only the first pulley34is used as the rotation member33and a member having an R shape with a high degree of slidability and having reduced friction is provided in place of the second pulley36.

FIG.11is a cross-sectional view showing the grasping portion2in which the ejection operation wire6is pulled.

When the ejection operation wire6is pulled, a part of the first pulley34on the upward side B1rotates to the proximal-end side, and a part of the first pulley34on the downward side B2rotates to the distal-end side. As a result, the protruding portion38of the first pulley34pushes up the linear movement member32to the upward side B1, and the stored staple S is ejected from the opening31ato the upward side B1.

The staple receiving portion4is provided on a lower surface of the second distal-end portion22cof the anvil22. A plurality of pockets41that can receive the staples S (FIG.10) ejected from the staple ejection portion3are provided in the staple receiving portion4. In the present embodiment, two U-shaped staples are ejected from the staple ejection portion3. Therefore, four pockets41(FIG.7) are provided in the staple receiving portion4. When the grasping portion2is in the closed state, the opening31athrough which the staples S (FIG.10) are ejected and the pockets41of the staple ejection portion3face each other in the vertical direction B.

Operation of Medical Stapler100

Next, an operation of the medical stapler100will be described.FIG.12is a flowchart showing a manipulation procedure performed by the operator using the medical stapler100.FIGS.13to18are views showing an operation of the medical stapler100.

Hereinafter, an operation of the medical stapler100will be described along the flowchart ofFIG.12while referring toFIGS.13to18.

First, the operator attaches the medical stapler100to the distal-end portion211of the endoscope200(attachment step S11). The operator inserts the endoscope200to which the medical stapler100is attached into the body (insertion step S12).

Next, as shown inFIG.13, the operator brings the distal-end portion211of the endoscope200to which the medical stapler100is attached closer to a treatment target T. The treatment target T is, for example, a part of a tissue inside the body.

The operator operates the open-close operation unit250shown inFIG.1to advance the open-close operation wire5, thereby opening the anvil22to bring the grasping portion2into an open state and placing the first guide portion22hin the retracted orientation (first open-close step S13).

When the medical stapler100is inserted into the body for the first time, since the treatment target T is not grasped by the grasping forceps G (grasp ascertaining step S14: No), an advancing step S15is subsequently performed.

After the grasping portion2is brought into the open state, the operator causes the grasping forceps G to protrude (advance) from the forceps port214and approach the treatment target T (first advancing step S15). The operator can advance the grasping forceps G while ascertaining a position of the treatment target T via the visual space25using the imaging unit of the endoscope200. Since the first guide portion22his in the retracted orientation when the grasping portion2is in an open state, there is no protruding object on the stapling head21side and there is no obstacle to hinder observation. Therefore, the operator can satisfactorily observe the treatment target T via the visual space25. The operator grasps the treatment target T with the grasping forceps G (grasping step S16).

Next, as shown inFIG.13, the operator retracts the grasping forceps G with the treatment target T grasped by the grasping forceps G (retracting step S17). The operator retracts the grasping forceps G so that a distal end of the grasping forceps G is disposed on the proximal-end side with respect to the first guide portion22h.

Next, as shown inFIG.14, the operator brings the grasping portion2into a closed state by operating the open-close operation unit250shown inFIG.1to retract the open-close operation wire5, thereby placing the first guide portion22hin the protruding orientation (second open-close step S18). The first guide portion22hassumes the protruding orientation at the same time as the grasping portion2is brought into a closed state, and protrudes to the upward side B1with respect to the stapling head21within the visual space25of the anvil22in the closed state. A tissue V containing the treatment target T grasped by the grasping forceps G is sandwiched between the staple ejection portion3of the stapling head21and the staple receiving portion4of the anvil22.

When the grasping portion2is in the closed state, since a part of the tissue V of the treatment target T grasped by the grasping forceps G can be accommodated in the visual space25formed inside the anvil22, there is an effect that the treatment target T sandwiched between the staple ejection portion3and the staple receiving portion4is less likely to lose.

When the grasping portion2is in the closed state, the optical axis A1of the objective lens215of the imaging unit passes outside (the upward side B1) of the stapling head21and the anvil22. Therefore, even when the grasping portion2is in the closed state, the operator can observe the tissue V containing the treatment target T via the imaging unit of the endoscope200. At this time, the operator can observe a surface Va (a surface on a side opposite to the stapling head21) of the tissue V containing the treatment target T using the imaging unit.

Next, as shown inFIG.15, the operator advances the grasping forceps G again to move the grasping forceps G to the distal-end side with respect to the first guide portion22hwhile keeping the grasping portion2in the closed state (second advancing step S19). At this time, when the grasping forceps G advance until the grasping forceps G ride on the first guide portion22hin the protruding orientation, the distal-end side of the grasping forceps G is lifted to the upward side B1. As shown inFIG.16, the grasping forceps G are lifted by the first guide portion22hin the protruding orientation, which is present on an advance-retraction path. The grasping forceps G are lifted by one of the pair of first guide portions22h.As shown inFIG.15, when the grasping forceps G are lifted by the first guide portion22h,the tissue V containing the treatment target T grasped by the grasping forceps G is lifted to the upward side B1with respect to the anvil22in the closed state. At this time, it is preferable to lift the tissue V so that it is placed on the second distal-end portion22cof the anvil22. Therefore, the tissue V grasped by the grasping forceps G can be turned up.

A back surface Vb (surface facing the stapling head21) side of the tissue V containing the treatment target T lifted by the grasping forceps G faces the objective lens215in a direction of the optical axis A1. The operator can observe the back surface Vb of the tissue V containing the treatment target T lifted by the grasping forceps G using the imaging unit of the endoscope200(observation step S20). The operator can ascertain whether or not the entire treatment target T has been drawn into the visual space25using the grasping forceps G. That is, it can be ascertained whether or not the treatment target T is present at a suture position at which the staple ejection portion3and the staple receiving portion4face each other. The operator performs the next suturing step S21after ascertaining that the treatment target T is not contained in a portion sandwiched between the staple ejection portion3and the staple receiving portion4.

In the observation step20described above, if it is ascertained that the treatment target T is insufficiently drawn in and the treatment target T is present at the suture position, the processing returns to the first open-close step S13to bring the grasping portion2into an open state. The operator determines in grasp ascertaining step S14to proceed to retracting step S17due to the state in which the treatment target T is grasped by the grasping forceps G (grasp ascertaining step S14: Yes), and further retracts the grasping forceps G (retracting step S17) while grasping the treatment target T to further draw the tissue V containing the treatment target T into the grasping portion2. Thereafter, the grasping portion2is brought into a closed state (second open-close step S18), the treatment target T is lifted by advancing the grasping forceps G until the grasping forceps G ride on the first guide portion22hthat has protruded (second advancing step S19), and the back surface side of the treatment target T is observed again (observation step S20). The operator performs steps S13to S20until it is ascertained that the treatment target T is not contained in the portion sandwiched between the staple ejection portion3and the staple receiving portion4. At this time, steps S15and S16are skipped.

Next, in a state in which a tissue V1around the treatment target T at a portion that does not contain the treatment target T among the tissue V pulled by the grasping forceps G is sandwiched between the staple ejection portion3and the staple receiving portion4, the operator operates the ejection operation unit270to pull the ejection operation wire6, and thereby, the staple S stored in the staple ejection portion3is ejected toward the staple receiving portion4. At this time, the staple S may be ejected from the stapling head21a plurality of times. The needle tips S1of the staple S penetrate the tissue V1around the treatment target T and are bent by coming into contact with the pockets41of the staple receiving portion4. As a result, the tissue V containing the treatment target T is sutured. Therefore, the entire treatment target T is sutured (suturing step S21).

Next, as shown inFIG.17, the operator operates the open-close operation unit250shown inFIG.1to bring the grasping portion2into an open state again. The operator opens the grasping forceps G to release the grasp on the treatment target T, thereby completing the suturing treatment. Thereafter, the operator removes the medical stapler100and endoscope200from the inside of the body.

According to the medical stapler100of the present embodiment, when the treatment target T grasped by the grasping forceps G is lifted to the upward side B1by the first guide portion22h,a state of the back surface (surface facing the stapling head21) of the treatment target T can be visually observed using the imaging unit. Therefore, the treatment target T can be sufficiently drawn into the grasping portion2by the grasping forceps G while ascertaining the suture position. That is, the operator can perform suturing on the tissue V1around the treatment target T in a state of containing the entire treatment target T. Therefore, the treatment target T can be completely excised, and a treatment effect can be improved.

Also, according to the medical stapler100of the present embodiment, since the first guide portion22his provided in the anvil22, and the anvil22with the first guide portion22hof the present embodiment can be employed in an existing structure, the costs can be suppressed to be low.

According to the medical stapler100of the present embodiment, since an insertion diameter of the medical stapler100with the grasping portion2in a closed state is substantially the same as that of the distal-end portion211of the endoscope200, it can be easily inserted into the body such as the digestive tract. Also, even if the grasping portion2of the medical stapler100is in an open state, the operator can observe the treatment target T via the imaging unit of the endoscope200and can treat the treatment target T by causing the grasping forceps G to protrude from the forceps port214.

While the first embodiment of the present disclosure has been described in detail as above with reference to the drawings, the specific configurations are not limited to the embodiment and may include design changes or the like within a range not departing from the gist of the present invention. Also, the components shown in the embodiment and modified examples described above can be configured by appropriately combining them.

For example, a shape of the grasping portion2is not limited to the aspect of the first embodiment. Hereinafter, modified examples of the grasping portion2will be described. Further, in the following description, components that are common to those already described will be denoted by the same reference signs and duplicate description will be omitted.

Modified Example 1

For example, in the embodiment described above, the pair of first guide portions22hhave been formed in a cubic shape, but a shape of the first guide portions22his not limited thereto.

FIGS.19A and19Bare perspective views showing a grasping portion2A in modified example 1.

Modified example 1 of the first embodiment will be described with reference toFIGS.19A and19B.

As shown inFIGS.19A and19B, an anvil22A of the grasping portion2A includes a first guide portion22hA having a triangular shape in a side view. As shown inFIG.19A, the first guide portion22hA includes a side surface22rorthogonal to a length direction (axial direction A) of the anvil22A and extending to the upward side B1, and a first inclined surface22pinclined in a direction away from the side surface22rfrom a distal end to a proximal-end side of the side surface22r.

As shown inFIG.19A, an inclination angle θ1of the first inclined surface22pwith respect to a horizontal direction is appropriately set according to types of treatment tool or the like.

As shown inFIG.19A, when the grasping portion2A is in a closed state, the pair of first guide portions22hA protrude to the upward side B1with respect to the stapling head21and are in a protruding orientation. The first inclined surface22pin each of the first guide portions22hA faces the distal-end portion211of the endoscope200.

As shown inFIG.19B, when the grasping portion2A is in an open state, the pair of first guide portions22hA are both in a retracted orientation. The pair of first guide portions22hA are displaced in conjunction with rotation of the anvil22A in a closing direction, and when the grasping portion2A is in an open state, a portion thereof protruding to the upward side B1from the stapling head21disappears completely, and the pair of first guide portions22hA are placed in a retracted orientation completely hidden by the stapling head21.

In modified example 1, it is the same as the first embodiment in that the pair of first guide portions22hA protrude to the upward side B1with respect to the stapling head21when the grasping portion2A is in a closed state. The first inclined surfaces22pof the pair of first guide portions22hA in the protruding orientation coincide with each other in the axial direction A. Each of the first inclined surfaces22pis inclined to the upward side B1with distance away from the endoscope200. Therefore, the grasping forceps G (FIG.16) that have advanced from the forceps port214are lifted to the upward side B1along the first inclined surface22pof either one of the first guide portions22hA.

According to the configuration of modified example 1, since the grasping forceps G are smoothly lifted to the upward side B1by the first inclined surface22pof the first guide portion22hA, the operation by the operator is facilitated.

Modified Example 2

For example, in the first embodiment, the pair of first guide portions22hare provided only on the anvil22side, but they may be provided on other components. A grasping portion2B according to modified example 2 has a different shape of the stapling head compared to the grasping portion2A according to modified example 1.

FIGS.20A and20Bare perspective views showing the grasping portion2B of modified example 2.

Hereinafter, modified example 2 will be described with reference toFIGS.20A and20B.

As shown inFIGS.20A and20B, the stapling head21B of the grasping portion2B has one second guide portion22hB on the proximal-end side. The second guide portion22hB on the stapling head21side has a triangular shape in a side view similarly to the pair of first guide portions22hA provided on the anvil22A, and is formed to protrude from the upper surface21fof the first main body portion21b.

The second guide portion22hB includes a side surface22sorthogonal to a length direction (axial direction A) of the stapling head21and extending to the upward side B1, and a second inclined surface22tthat is inclined toward the downward side B2from an upper end of the side surface22sas it goes to a proximal-end side of the stapling head21C. A position of the second inclined surface22tof the second guide portion22hB in the axial direction A substantially coincides with that of the first inclined surface22pof each of the pair of first guide portions22hA on the anvil22A side.

As shown inFIG.20A, when the grasping portion2B is in a closed state, the pair of first guide portions22hA of the anvil22A are disposed on both sides of the second guide portion22hB of the stapling head21.

As shown inFIG.20B, when the grasping portion2B is in an open state, only the pair of first guide portions22hA on the anvil22side are in a retracted orientation while the second guide portion22hB on the stapling head21side remains in a protruding orientation.

According to the configuration of modified example 2, when the grasping portion2B is in a closed state, since the second guide portion22hB on the stapling head21side is present between the pair of first guide portions22hA on the anvil22A side, when the above-described first advancing step S15(FIG.12) is performed with the grasping portion2B in the closed state, it is possible to prevent the grasping forceps G from passing between the pair of first guide portions22hA and advancing along the upper surface21fof the first main body portion21bof the stapling head21.

Also, it is possible to prevent the grasping forceps G, which have once been lifted by one of the first guide portions22hA, from falling between the pair of first guide portions22hA. Due to these pair of first guide portions22hA and second guide portion22hB, it is possible to reliably lift the grasping forceps G that have grasped the treatment target T to the upward side B1to ascertain the suture position.

Also, since the grasping forceps G are lifted by one of these three guide portions22hA,22hB, and22hA, even an operator who is not accustomed to the operation can easily ascertain the suture position simply by advancing the grasping forceps G. Also, positioning when the cap1is attached to the distal-end portion211of the endoscope200is facilitated, and work efficiency is improved.

Modified Example 3

For example, in the first embodiment, the pair of first guide portions22hare configured to be provided on the anvil22side, but the present disclosure is not limited to the configuration. A grasping portion2C of modified example 3 differs from the first embodiment in that the pair of first guide portions22hare integrated.

FIGS.21A and21Bare perspective views showing the grasping portion2C in modified example 3.

Hereinafter, modified example 3 of the first embodiment will be described with reference toFIGS.21A and21B.

As shown inFIGS.21A and21B, the grasping portion2C includes an anvil22C including a third guide portion22hC, and a stapling head21C including a stepped portion26capable of accommodating the third guide portion22hC.

The third guide portion22hC formed on the anvil22C side has a shape in which the pair of first guide portions22hA in modified example 2 are connected and integrated. The third guide portion22hC includes a pair of guide portions22hA and a connecting portion22hb that connects them. The connecting portion22hb connects upper parts of the pair of guide portions22hA facing each other via the stapling head21. A groove portion22mfor preventing interference with the stapling head21is formed in a region surrounded by the pair of guide portions22hA and the connecting portion22hb. The groove portion22mis formed in a dimension slightly larger than a thickness in a width direction of the stapling head21.

The third guide portion22hC includes a side surface22uorthogonal to a length direction (axial direction A) of the anvil22C and extending in the vertical direction B when the grasping portion2C is in a closed state, and a third inclined surface22vinclined from an upper end of the side surface22utoward the downward side B2toward a proximal-end side of the grasping portion2C. The groove portion22mopens at the side surface22uand the third inclined surface22v.

The stepped portion26formed on the stapling head21C side is formed on a proximal-end side of the stapling head21. The stepped portion26is formed throughout in the width direction of the stapling head21. The stepped portion26can accommodate the entire connecting portion22hb of the third guide portion22hC when the anvil22is in an open state.

Further, the stepped portion26is not limited to being formed at the proximal end of the stapling head21. For example, it may be formed in the middle of the stapling head21in a length direction. Also, a groove portion may be used instead of the stepped portion26.

As shown inFIG.21A, when the grasping portion2C is in a closed state, the third guide portion22hC of the anvil22C protrudes to the upward side B1of the stapling head21C.

As shown inFIG.21B, when the grasping portion2C is in an open state, the third guide portion22hC of the anvil22C is in a retracted orientation, and the connecting portion22hbthereof is accommodated in the stepped portion26of the stapling head21C. In the third guide portion22hC positioned in the retracted orientation, the side surface22uthereof and an upper surface21fof a first main body portion21bof the stapling head21C are substantially coplanar with each other.

According to the configuration of the modified example 3, when the grasping portion2C is in a closed state, the third guide portion22hC provided between second main body portions22bon both left and right sides of the anvil22C assumes a protruding orientation. When the third guide portion22hC integrated throughout in the width direction of the anvil22C is provided, the third guide portion22hC also appears on the upward side B1of the stapling head21when the grasping portion2C is in a closed state. Therefore, since a groove or step is not formed in the width direction, the grasping forceps G can reliably ride on the third guide portion22hC in the first advancing step S15described above, and the grasping forceps G can be reliably lifted to the upward side B1of the anvil22C (second distal-end portion22c).

Modified Example 4

For example, in the first embodiment, as shown inFIG.10, the second distal- end portion22cof the U-shaped member22aof the anvil22in which the staple receiving portion4is provided has a substantially rectangular parallelepiped shape, but the present disclosure is not limited thereto.

An anvil22D according to modified example 4 has a different cross-sectional shape on the second distal-end portion22cside of U-shaped member22a.

FIG.22is a cross-sectional view showing a grasping portion2D in modified example 4.

Hereinafter, modified example 4 of the first embodiment will be described with reference toFIG.22.

As shown inFIG.22, the anvil22D of the grasping portion2D has an inclined surface22wat the second distal-end portion22cof the U-shaped member22a.The inclined surface22wis provided to be continuous with an outer surface22Db of the anvil22D on a side opposite to the staple receiving portion4. When the grasping portion2D is in a closed state, the inclined surface22wis inclined from the outer surface22Db toward the downward side B2as it goes from the distal end to the proximal-end side. That is, the inclined surface22wis inclined toward the first guide portion22hA side that is positioned on the proximal-end side with respect to the inclined surface22w.

The inclined surface22wis preferably formed throughout in a width direction of the second distal-end portion22cof the anvil22, but the present disclosure is not limited thereto, and may be formed partially in the width direction of the second distal-end portion22c.Also, an inclination angle θ2of the inclined surface22wwith respect to a horizontal direction can be changed as appropriate.

According to the configuration of the modified example 4, when the inclined surface22wis provided on a side opposite to the staple receiving portion4in the anvil22D, when the grasping portion2D is in a closed state, the operator advances the grasping forceps G that has been lifted by the first guide portion22hA toward the distal-end side, and thereby the tissue V containing the treatment target T grasped by the grasping forceps G is made easier to ride on the inclined surface22wof the anvil22D. Therefore, turning up is easily achieved even with thick tissue V, and the operator can easily ascertain the suture position.

While the first embodiment and modified examples 1 to 4 of the present disclosure have been described in detail as above with reference to the drawings, the specific configurations are not limited to the embodiment and modified examples and may include design changes or the like within a range not departing from the gist of the present invention. Also, the components shown in the first embodiment and modified examples 1 to 4 described above can be configured by appropriately combining them.

Second Embodiment

Next, a medical stapler102of a second embodiment will be described with reference toFIG.23. In the following description, components that are common to those already described will be denoted by the same reference signs and duplicate description will be omitted.

The medical stapler102according to the second embodiment has a different aspect of the anvil compared to the medical stapler100according to the first embodiment. In the first embodiment described above, as shown inFIGS.6,7, or the like, the visual space25surrounded by the U-shaped member22aformed in a substantially U shape has been formed in the anvil22, but an aspect of the anvil22is not limited thereto.

FIG.23is a perspective view showing a configuration of the medical stapler102(grasping portion2E) of the second embodiment.

The grasping portion2E in the medical stapler102of the present embodiment includes an L-shaped member22Ea formed in a substantially L shape, and a second main body portion22Eb supporting the L-shaped member22Ea to be rotatable. A staple receiving portion4is provided at a distal end of the L-shaped member22Ea. A proximal end of the L-shaped member22Ea is attached to the second main body portion22Eb. In this case, a visual space25is a space sandwiched between sides of the L-shaped member22Ea formed in a substantially L shape.

According to the medical stapler102of the second embodiment, as shown inFIG.23, even when an anvil22E is in an open state, the operator can observe a treatment target T via an imaging unit of an endoscope200and can treat the treatment target T by causing grasping forceps G to protrude from a forceps port214.

While the second embodiment of the present disclosure has been described in detail with reference to the drawings, the specific configurations are not limited to the embodiment and may include design changes or the like within a range not departing from the gist of the present invention. Also, it is possible to configure the second embodiment by appropriately combining the components shown in the modified examples 1 to 4 of the first embodiment described above.

Third Embodiment

Next, a medical stapler103according to a third embodiment will be described with reference toFIGS.24A and24B. In the following description, components that are common to those already described will be denoted by the same reference signs and duplicate description will be omitted.

The medical stapler103according to the third embodiment differs from the medical staplers100and102according to the first and second embodiments in that a stapling head21F varies. The first embodiment and second embodiment described above have had an aspect in which the stapling head21is fixed.

FIGS.24A and24Bare cross-sectional views showing a configuration of the medical stapler103(grasping portion2F) of the third embodiment.

The grasping portion2F in the medical stapler103of the present embodiment has a configuration in which the stapling head21F tilts with respect to an extended portion24provided on a proximal-end side of the stapling head21F. As the stapling head21F tilts, an anvil22coupled to the stapling head21F also tilts at the same time. Regarding a tilting mechanism, it is possible to employ various existing technologies.

As shown inFIG.24A, if a tissue V drawn into a visual space25by grasping forceps G is a thick tissue, since a surface Va of the tissue V tends to bulge, it is difficult to ascertain a suture site.

Therefore, as shown inFIG.24B, when a distal-end side of the stapling head21F is tilted in a state in which the tissue V drawn in by the grasping forceps G is sandwiched between the anvil22and the stapling head21F, a grasped portion (suture position) can be ascertained from the surface Va side.

Thereafter, the grasped portion (suture position) may be ascertained from a back surface Vb side of the tissue V by advancing the grasping forceps G and lifting the grasping forceps G to the upward side B1due to a first guide portion22hA.

While the third embodiment of the present disclosure has been described in detail with reference to the drawings, the specific configurations are not limited to the embodiment and may include design changes or the like within a range not departing from the gist of the present invention. Also, it is possible to configure the third embodiment by appropriately combining the components shown in the first embodiment, modified examples 1 to 4, and the second embodiment described above.

Although the respective embodiments and modifications of the present disclosure have been described above, the technical scope of the present disclosure is not limited to the above-described embodiments, and configurations in the respective embodiments and modifications within the scope not departing from the spirit of the present disclosure. It is possible to change the combination of elements, make various changes to each configuration element, or delete each configuration element. For example, the configuration according to any one of above-described embodiments and modifications of the present disclosure may be appropriately combined with each modification of the operation section. The present disclosure is not limited by the above description, but only by the appended claims.