A fastening device includes a shaft having a longitudinal axis, a fixing member configured to fix the shaft to an endoscope by being attached to the endoscope, a staple unit attached to a distal end of the shaft and rotatable around the longitudinal axis, an operation unit provided at a proximal-end portion of the shaft, and a rotation restriction mechanism configured to restrict rotation of the staple unit around the longitudinal axis with respect to the endoscope due to an operation of the operation unit.

TECHNICAL FIELD

The present disclosure relates to a fastening device, an endoscope system, and a suturing method. This application is a continuation application of PCT International Application No. PCT/JP2021/033265, filed on Sep. 10, 2021. The content of the above-identified PCT International Applications is incorporated herein by reference.

BACKGROUND ART

In recent years, in a surgery to suture the gastrointestinal tract or the like, a fastening device such as a medical stapler (hereinafter, may be referred to as a stapler) and an endoscope system including such a fastening device have been used to suture a tissue. When an appropriate stapler is used, a surgery to suture the gastrointestinal tract or the like can be easily performed and a surgical time can be significantly reduced.

In an endoscopic suturing system disclosed in United States Patent Application, Publication No. 2018/0042603, a tissue retractor is advanceable with respect to a suturing device, and the suturing target tissues are retracted to the suturing device to be sutured by the advanced tissue retractor.

In a surgery to perform a treatment on a tissue inside the body using an endoscope system including a fastening device, a relative positional relationship between the fastening device and the endoscope may be adjusted. For example, when the fastening device is inserted to the position close to a tissue inside the body to be treated to perform a treatment by inserting the endoscope into the body, a direction of a stapler may be adjusted to be aligned with a direction in which the tissue is sutured. For example, in the process of treating the tissue, the tissue grasped by the fastening device may be observed from the fastening device side. In such a case, it is necessary to adjust a relative positional relationship between the endoscope and the fastening device attached to a distal end side of the endoscope. More specifically, the fastening device may be rotated with respect to the endoscope in a circumferential direction around a longitudinal axis of the endoscope.

On the other hand, in the process of inserting the endoscope into the body, it is necessary to prevent the fastening device attached to a distal end side of the endoscope from unintentionally coming into contact with tissues inside the body, prevent the fastening device from blocking a field of view of the endoscope, or the like.

In view of the above circumstances, an objective of the present disclosure is to provide a fastening device in which a relative positional relationship in a circumferential direction between an endoscope and a fastening device attached to a distal end side of the endoscope can be suitably adjusted in the process of performing a treatment on a tissue inside the body, an endoscope system including such a fastening device, and a suturing method of a tissue inside the body using the endoscope system.

SUMMARY

According to one aspect of the present disclosure, a fastening device includes a shaft having a longitudinal axis, a fixing member configured to fix the shaft to an endoscope by being attached to the endoscope, a staple unit attached to a distal end of the shaft and rotatable around the longitudinal axis, an operation unit provided at a proximal-end portion of the shaft, and a rotation restriction mechanism configured to restrict rotation of the staple unit around the longitudinal axis with respect to the endoscope due to an operation of the operation unit.

According to another aspect of the present disclosure, an endoscope system includes an endoscope, a shaft having a longitudinal axis along the endoscope, a staple unit attached to a distal end of the shaft and rotatable around the longitudinal axis, an operation unit provided at a proximal-end portion of the shaft, and a rotation restriction mechanism configured to restrict rotation of the staple unit around the longitudinal axis with respect to the endoscope due to an operation of the operation unit.

According to a yet another aspect of the present disclosure, a suturing method of a tissue using a fastening device including a shaft having a longitudinal axis, a fixing member configured to fix the shaft to an endoscope by being attached to the endoscope, a staple unit attached to a distal end of the shaft and rotatable around the longitudinal axis, an operation unit provided at a proximal-end portion of the shaft, and a rotation restriction mechanism configured to restrict rotation of the staple unit around the longitudinal axis with respect to the endoscope due to an operation of the operation unit, includes a step of inserting the staple unit and the endoscope, which are in a state in which the rotation thereof around the longitudinal axis is restricted, into a body, a step of grasping at least a part of the tissue with forceps, a step of pulling a part of the tissue relatively to a proximal end side of the endoscope and positioning a part of the tissue grasped by the forceps within a sutureable range of the fastening device, a step of releasing a state in which the rotation of the staple unit around the longitudinal axis is restricted, and a step of ejecting a staple and suturing the tissue using the staple unit.

Advantageous Effects of Invention

According to the fastening device, the endoscope system, and the suturing method according to the above-described aspects of the present disclosure, a state in which the fastening device attached to a distal end side of the endoscope is rotatable around a longitudinal axis direction and a state in which rotation of the fastening device around the longitudinal axis is restricted can be suitably switched between in the process of performing a treatment on a tissue inside the body.

DESCRIPTION OF EMBODIMENTS

First Embodiment

Hereinafter, a first embodiment of the present disclosure will be described with reference toFIGS.1to8.FIG.1is a view showing an overall configuration of an endoscope system300including a fastening device100according to the present embodiment.

The endoscope system300according to the present embodiment is used for surgery or the like in which the gastrointestinal tract or the like is sutured. The endoscope system300includes the fastening device100(medical stapler, staple unit), an endoscope200, an open-close operation unit250, a needle ejection operation unit270, a wire sheath (shaft)280, a resin sheath290, and a wire sheath fixing portion260. The open-close operation unit250is an operation unit that operates the fastening device100using an open-close operation wire5. The open-close operation wire5is constituted by a wire and a coil sheath provided to cover the wire. The needle ejection operation unit270is an operation unit that operates the fastening device100using a needle ejection wire6. Similarly to the open-close operation wire5, the needle ejection wire6is also constituted by a wire and a coil sheath provided to cover the wire. In the present embodiment, the fastening device100is configured as, for example, a medical stapler.

The endoscope200has a configuration of a known flexible endoscope. The endoscope200includes a long insertion portion210that is inserted into a 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-end portion212of the insertion portion210. The treatment tool channel230extends from the distal-end portion212of the insertion portion210to the operation unit220.

A distal-end portion211of the insertion portion210includes an imaging unit (not shown) including a CCD or the like. An objective lens215of the imaging unit is exposed at the distal-end portion212of the insertion portion210. The distal-end portion211of the insertion portion210has a rigid portion on a distal end side.

A knob223for operating the insertion portion210and a switch224for operating the imaging unit and 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 code240outputs, 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 configured to open and close the fastening device100by 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 needle ejection operation unit270is configured to eject a staple S (seeFIG.25) from the fastening device100and suture a tissue inside the body to be treated by operating the needle ejection wire6. As shown inFIG.1, the needle ejection operation unit270includes a needle ejection operation unit main body272and an ejection operation slider273. A proximal end of the needle ejection wire6is coupled to the ejection operation slider273. The operator can advance and retract the needle ejection wire6by advancing and retracting the ejection operation slider273in the longitudinal axis direction with respect to the needle ejection operation unit main body272.

The wire sheath280is a sheath through which the open-close operation wire5and the needle ejection wire6are inserted. As shown inFIG.8, the wire sheath280is formed to include a cover layer281formed on an outer circumference and a coil sheath282formed on an inner side of the cover layer281. The cover layer281is formed of, for example, a tube containing a blade, a three-layer coil, or the like, and can be rotated following a rotation operation by the operator. The coil sheath282has flexibility, and in which an inner lumen through which two inner sheaths283to be described later can be inserted is formed. In the present embodiment, an example in which the cover layer281is formed on an outer side of the coil sheath282in a radial direction of the wire sheath280will be described, but the present embodiment is not limited to this configuration. For example, the cover layer281may be formed on an inner side of the coil sheath282in the radial direction of the wire sheath280.

The two inner sheaths283are inserted through the inner lumen formed in the wire sheath280. The two inner sheaths283are formed of a resin material and have flexibility. The open-close operation wire5and the needle ejection wire6are inserted into the two inner sheaths283, respectively. The wire sheath280may have a multi-lumen tube having two lumens instead of the two inner sheaths283.

As shown inFIG.1, the resin sheath290is a sheath through which the wire sheath280is insertable to be advanceable and retractable therein. The resin sheath290is formed of resin material. As shown inFIG.1, a distal end side of the resin sheath290is coupled to the insertion portion210of the endoscope200by a band291. In the resin sheath290, a distal end thereof is fixed to a cap1of the fastening device100and a proximal end thereof is fixed to the wire sheath fixing portion260.

FIG.2is a perspective view of the wire sheath fixing portion260. The wire sheath fixing portion260is a fixing portion that restricts unintended advance and retraction or unintended rotation of the wire sheath280with respect to the resin sheath290. The wire sheath fixing portion260includes a wire sheath fixing portion main body261and a band attachment portion264.

The wire sheath fixing portion main body261is formed in a cylindrical shape and includes a distal end opening262and a proximal end opening263. A proximal end of the resin sheath290is fixed to the distal end opening262. From the proximal end opening263, the wire sheath280is formed to extend to the proximal end side.

The band attachment portion264is a member attached to the operation unit main body261and has a band insertion hole265. When a band (not shown) that has been passed through the band insertion hole265is attached to the endoscope200, the operation unit main body261can be easily fixed to the endoscope200. When the operation unit main body261is fixed to the endoscope200, the wire sheath280and the resin sheath290can be prevented from separating from the insertion portion210of the endoscope200.

A rubber stopper266that is in contact with the wire sheath280is provided in the proximal end opening263of the wire sheath280. A frictional force generated between the wire sheath280and the rubber stopper266can suppress an unintended advance and retraction operation and rotational operation of the wire sheath280during a treatment.

FIG.3is a perspective view of the fastening device100according to the present embodiment. The fastening device100includes the cap (fixing member)1, a grasping portion (staple unit)2, a staple ejection portion3, a staple receiving portion4, the open-close operation wire5, and the ejection operation wire6. The grasping portion2includes a first grasping member (first jaw, staple head)21, a second grasping member (second jaw, anvil)22, an open-close rotation shaft23, and a movable pin (not shown). The first grasping member21and the second grasping member22are coupled to be openable and closable by the open-close rotation shaft23. The first grasping member21and the second grasping member22rotate relatively to grasp a target tissue. The open-close rotation shaft23is provided on a distal end side with respect to the cap1. An axial direction C of the open-close rotation shaft23is perpendicular to an axial direction A of the cap1and a vertical direction B. The fastening device100is attachable to and detachable from the distal-end portion211of the insertion portion210of the endoscope200.

The cap1is formed in a substantially columnar shape. The cap1has a first through hole11penetrating in the axial direction A and a second through hole12(seeFIG.6) penetrating in the axial direction A. The first through hole11is a hole into which the distal-end portion211of the insertion portion210is 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. In the present embodiment, a central axis of the first through hole11in the axial direction A is eccentric with respect to a central axis of the cap1in the axial direction A.

The second through hole12(seeFIG.6) is a hole into which the resin sheath290is inserted. An inner diameter of the second through hole12substantially coincides with an outer diameter of the resin sheath290. A distal-end portion of the resin sheath290is inserted through the second through hole12and fixed. The wire sheath280, the open-close operation wire5, and the ejection operation wire6, which are inserted through the resin sheath290, are inserted through the second through hole12and extend to the distal end side.

A central axis of the second through hole12in the axial direction A is eccentric with respect to the central axis of the cap1in the axial direction A. A direction in which the central axis of the second through hole12is eccentric with respect to the central axis of the cap1is opposite to a direction in which the central axis of the first through hole11is eccentric with respect to the central axis of the cap1. In other words, in the present embodiment, the central axis of the first through hole11and the central axis of the second through hole12are disposed on both sides of the central axis of the cap1in the vertical direction B.

FIG.4is a perspective view showing a state in which the fastening device100according to the present embodiment is attached to the distal-end portion of the insertion portion210of the endoscope200. The first grasping member21includes a first distal-end portion21aand a proximal-end portion21b, and is formed in substantially a T shape in a plan view. The first distal-end portion21ais disposed on a distal end side with respect to the proximal-end 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 opening of the staple ejection portion3is provided on an upper surface of the first distal-end portion21a. The proximal-end portion21bis formed to be accommodated in a recessed portion1aof the cap1to be described later. As shown inFIG.5, the first grasping member21further includes a contact pin21cand a first engagement groove21d. The contact pin21cis provided at a proximal end of the first main body portion21b, and comes into contact with the second grasping member22that is in a closed state to restrict a movable range of the second grasping member22. The first engagement groove21dis a groove in the first grasping member21penetrating in the axial direction C of the open-close rotation shaft23. The first engagement groove21dextends in the axial direction A.

The second grasping member22includes a U-shaped member22aformed in substantially a U shape, and a second main body portion22bsupporting the U-shaped member22ato be rotatable. The U-shaped member22ais formed in substantially a U shape, and both end parts thereof are coupled to the second main body portion22b, and a center part thereof is disposed on a distal end side. A distal end side of the center part of the U-shaped member22ais formed in a substantially rectangular parallelepiped shape, and the staple receiving portion4is provided thereon. The second main body portion22bis rotatably attached to the first main body portion21bof the first grasping member21by the open-close rotation shaft23. A guide groove22d(seeFIG.6) into which the first main body portion21bis inserted is formed in the second main body portion22b. As shown inFIGS.5and6, a second engagement groove22eis formed on both side portions of the guide groove22dof the second main body portion22b.

When the fastening device100is inserted into the body while being attached to the distal-end portion of the insertion portion210of the endoscope200, the fastening device100is in contact with the cap1with the first grasping member21and the second grasping member22closed in the grasping portion2. More specifically, as shown inFIG.4, the proximal-end portion21bof the first grasping member21is fitted into the recessed portion1a(seeFIG.6) formed on a distal end side of the cap1.

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 the treatment target through the objective lens215even when the fastening device100is attached to the distal-end portion211of the endoscope200.

As shown inFIG.4, when the grasping portion2is in a closed state, the staple ejection portion3and the staple receiving portion4face each other. When the grasping portion2is in the closed state, a slight gap is formed between the staple ejection portion3and the staple receiving portion4. When the grasping portion2is in the closed state, an optical axis of the objective lens215passes outside the first grasping member21and the second grasping member22. When the grasping portion2is in the closed state, a central axis of the forceps port214is at a position not overlapping the first grasping member21, but overlapping the second grasping member22.

As shown inFIG.5, when the grasping portion2is in an open state, the staple receiving portion4is disposed on a proximal end side with respect to the open-close rotation shaft23. When the grasping portion2is in the open state, the staple ejection portion3and the staple receiving portion4are disposed on both sides with the optical axis of the objective lens215interposed therebetween. When the grasping portion2is in the open state, the optical axis of the objective lens215passes through a visual space25. When the grasping portion2is in the open state, the central axis of the forceps port214passes through the visual space25.

FIG.6is a view showing a state (first state) in which an engagement between the grasping portion2and the cap1is released. As shown inFIG.6, the recessed portion1ahaving a dimension that allows at least a part of the proximal-end portion21bof the first grasping member21to be fitted therein is formed at a distal-end portion of the cap1. The proximal-end portion21bof the first grasping member21is formed in a shape corresponding to a shape of the recessed portion1aof the cap1. Therefore, when the grasping portion2and the cap1are engaged with each other with at least a part of the proximal-end portion21bof the first grasping member21accommodated in the recessed portion1a, rotation of the grasping portion2with respect to the cap1is restricted (second state). In the present embodiment, the proximal-end portion21bof the first grasping member21and the recessed portion1aof the cap1constitute a rotation restriction mechanism of the fastening device100.

FIG.7is a bottom view showing a state in which the wire sheath280is disengaged from the cap1. As shown inFIGS.6and7, an inclined surface1bis formed in a circumferential direction of the recessed portion1aof the cap1. An inclined surface21fcorresponding to the inclined surface1bis formed in a circumferential direction of the proximal-end portion21bof the first grasping member21. As described above, the grasping portion2and the cap1can be engaged in a state in which the inclined surface21fof the first grasping member21and the inclined surface1bof the cap1are in contact with each other. Therefore, as shown inFIG.4, in a state in which the grasping portion2and the cap1are engaged, even if the operator attempts to rotate the wire sheath280by operating the wire sheath fixing portion260, the rotation of the grasping portion2coupled to the wire sheath280with respect to the longitudinal axis is restricted.

As shown inFIGS.6and7, when the operator operates the wire sheath fixing portion260to cause the wire sheath280to protrude to the distal end side with respect to the cap1, the grasping portion2coupled to the wire sheath280is also moved to the distal end side. Through such an operation, the engagement between the grasping portion2and the cap1is released. In other words, when the operator operates the wire sheath fixing portion260to cause the wire sheath280to protrude to the distal end side with respect to the cap1, a state in which rotation around the longitudinal axis of the grasping portion2is restricted can be released. At this time, the grasping portion2enters a rotatable state (first state) around the longitudinal axis.

In this state, the operator can rotate the grasping portion2around the longitudinal axis by operating the wire sheath280to rotate. Through such an operation, for example, a direction of the grasping portion2can be adjusted to be aligned with the tissue. Thereafter, the operator can perform a treatment on the tissue of the treatment target using the same operation as that in a conventional fastening device. In the process of the treatment, when the operator rotates the wire sheath280, the operator can observe the tissue of the treatment target grasped by the grasping portion2at a desired angle using the imaging unit of the endoscope200. For example, when the operator rotates the wire sheath280, the tissue can be observed from the first grasping member21side.

When the fastening device100is removed from the inside of the body after the treatment on the tissue to be treated using the fastening device100is completed, in order to facilitate the removal operation and avoid unintended contact with the tissue inside the body, it is preferable to re-engage the grasping portion2and the cap1to remove them as an integrated structure. Therefore, the operator operates to rotate the wire sheath280to align the proximal-end portion21bof the first grasping member21with the recessed portion1aof the cap1, and then retracts the wire sheath280to the proximal end side. More specifically, for example, when the operator rotates the wire sheath280while observing a posture of the grasping portion2with the imaging unit of the endoscope200, the inclined surface21fof the proximal-end portion21bof the first grasping member21can be aligned with the inclined surface1bformed in the recessed portion1aof the cap1. In this state, when the operator retracts the wire sheath280to the proximal end side, the grasping portion2and the cap1are engaged with each other with the proximal-end portion21bof the first grasping member21accommodated in the recessed portion1aof the cap1. Thereafter, the operator can remove the grasping portion2and the cap1, which have been engaged and integrated, from the inside of the body.

According to the fastening device100according to the present embodiment, a state of the engagement between the cap1and the grasping portion2can be switched as appropriate. In a state in which the cap1and the grasping portion2are engaged, the rotation of the grasping portion2around the longitudinal axis is restricted even if the operator rotates the wire sheath280. In other words, in this state, the rotation of the grasping portion2around the axis with respect to the endoscope200is restricted. When the fastening device100according to the present embodiment is attached to the endoscope200and inserted into the body, it is possible to avoid obstructing a field of view of the imaging unit of the endoscope200, unintentionally contacting the tissue inside the body, or the like.

When the operator moves the wire sheath280to the distal end side to cause the grasping portion2to protrude further to the distal end side than the cap1, the engagement between the cap1and the grasping portion2is released. In this state, the operator can rotate the wire sheath280and the grasping portion2coupled to the wire sheath280around the longitudinal axis. When the fastening device100according to the present embodiment is inserted into the body and a treatment on the tissue is performed, aligning a direction of the grasping portion2with a direction in which the tissue is sutured, observing the tissue from a desired direction, or the like is possible.

As described above, according to the fastening device100and the endoscope system300including the fastening device100according to the present embodiment, the operator can appropriately switch the fastening device100between the rotatable state and the rotation restriction state with respect to the endoscope200only by operating the wire sheath280.

Next, an operation of the fastening device100according to the present embodiment described above will be described with reference toFIGS.9to14as an example.FIG.9is a flowchart showing surgery procedures using the fastening device100performed by the operator.FIGS.10to14are views showing an operation of the fastening device100.

As shown inFIG.9, the operator attaches the fastening device100to the distal-end portion211of the endoscope200(attachment step S11). The operator inserts the fastening device100and the endoscope200into the body (insertion step S12).

The operator brings the distal-end portion211of the endoscope200to which the fastening device100is attached closer to a treatment target T (an example of the target tissue). The operator transitions the grasping portion2to the open state by operating the open-close operation unit250to advance the open-close operation wire5. Since the optical axis of the objective lens215passes through the visual space25, the operator can observe the treatment target T through the imaging unit of the endoscope200. Since the central axis of the forceps port214passes through the visual space25, as shown inFIG.10, the operator causes grasping forceps (treatment tool) G to protrude from the forceps port214(protrusion step S13), operates the grasping forceps G to bring a distal end of the grasping forceps G closer to the treatment target (advancing step S14), and then grasps the treatment target T (grasping step S15).

The operator retracts the grasping forceps G while grasping the treatment target T with the grasping forceps G. The operator retracts the treatment target T so that the treatment target T is positioned at least in the visual space25by retracting the grasping forceps G (retracting step S16). In the present embodiment, the operator may retract in the treatment target T until the treatment target T passes through the visual space25by retracting the grasping forceps G until the distal end of the grasping forceps G passes through the visual space25.

In this state, when the operator moves the wire sheath280to the distal end side, the engagement between the cap1and the grasping portion2is released (rotation restriction release step S17). Therefore, when the operator operates the wire sheath280to rotate, the grasping portion2can be rotated around the longitudinal axis. Therefore, a direction and posture of the grasping portion2can be adjusted to be aligned with a direction in which the operator wants to suture the treatment target T.

In the retracting step S16, the operator may retract in the treatment target T by advancing the grasping portion2with respect to the grasping forceps G. That is, in the retracting step S16, the operator retracts the treatment target T by retracting the grasping forceps G relative to the grasping portion2. As shown inFIG.11, since the first grasping member21presses down a peripheral part of the treatment target T, the operator easily retracts the treatment target T with the grasping forceps G.

When the grasping portion is retracted while the treatment target T is grasped by the grasping forceps G, a large amount of tissue can be taken into the grasping portion. Also, even in a case of being unable to approach the treatment target T, it is possible to approach the treatment target T by advancing the grasping portion.

When the treatment target T is retracted by advancing the grasping portion2with respect to the grasping forceps G, the rotation restriction release step is substantially performed before the retracting step S16. In the present embodiment, the rotation restriction release step S17may be carried out before the retracting step S16or after the retracting step S16.

As shown inFIG.12, the operator transitions the grasping portion2to a closed state by operating the open-close operation unit250to retract the open-close operation wire5. The treatment target T is sandwiched between the staple ejection portion3of the first grasping member21and the staple receiving portion4of the second grasping member22.

When the grasping portion2is in the closed state, a part of the treatment target T grasped by the grasping forceps G can be accommodated in a space (the visual space25) formed by the U-shaped member22aof the second grasping member22and the second main body portion22b. Therefore, the treatment target T sandwiched between the staple ejection portion3and the staple receiving portion4is less likely to lose. In this state, since the restriction on the rotation of the grasping portion2around the longitudinal axis is released, the operator can observe the treatment target T from a desired angle by rotating the wire sheath280.

When the operator operates the ejection operation unit270to pull the ejection operation wire6with the treatment target T sandwiched between the staple ejection portion3and the staple receiving portion4, the stored staple S is ejected toward the staple receiving portion4. A needle tip S1of the staple S penetrates through the treatment target T and is bent by coming into contact with a pocket41(seeFIG.5) of the staple receiving portion4. As a result, as shown inFIG.12, the treatment target T is sutured (suture step S18).

As shown inFIG.13, the operator operates the open-close operation unit250to bring the grasping portion2into the open state again. The operator separates the grasping forceps G from the treatment target T and completes the suturing treatment. As shown inFIG.14, the operator may remove the grasping forceps G through the forceps port214, and then cause the treatment tool such as a snare wire or a high-frequency knife to protrude from the forceps port214to excise the sutured treatment target T.

Thereafter, the operator rotates the wire sheath280to align the proximal-end portion21bof the first grasping member21with the recessed portion1aof the cap1, and then retracts the wire sheath280toward the proximal end side. In this state, when the operator retracts the wire sheath280to the proximal end side, the grasping portion2and the cap1are engaged with each other with the proximal-end portion21bof the first grasping member21accommodated in the recessed portion1aof the cap1. Therefore, the rotation of the grasping portion2around the longitudinal axis is restricted (rotation restriction step S19).

The fastening device100and the endoscope200, whose rotation is restricted by the engagement of the cap1and the grasping portion2, are removed from the inside of the body (removal step S20). Thereafter, the operator ends the suturing method for the treatment target T through necessary steps (end S21).

A suturing method for the treatment target T according to the present embodiment has been described using the flowchart shown inFIG.9, but a suturing method is not limited thereto. As described above, the rotation restriction release step S17may be carried out before the retracting step S16or after the retracting step S16. The operator can adjust each step as appropriate by taking into consideration an actual treatment situation.

Modified Example

Hereinafter, a configuration of a fastening device100A according to a modified example of the present embodiment will be described usingFIGS.15to19. For the fastening device100A according to the present modified example, components common to those in the fastening device100according to the first embodiment described above will be denoted by the same reference signs, and description thereof will be omitted. Only different points between the fastening device100A according to the present modified example and the fastening device100according to the first embodiment will be described.

FIG.15is a view showing a configuration of the fastening device100A according to the present modified example.FIG.16is a front view for explaining an operation using the fastening device100A according to the present modified example.FIG.17is a view for explaining an operation using the fastening device100A according to the present modified example.FIG.18is an enlarged cross-sectional view of a partial configuration of the fastening device100A according to the present modified example.FIG.19is a view for explaining an operation using the fastening device100A according to the present modified example.

As shown inFIG.15, in the fastening device100A according to the present modified example, an inclined surface inclined with respect to a longitudinal axis of the wire sheath280is formed in each of the proximal-end portion21bof the first grasping member21and the recessed portion1aof the cap1. The proximal-end portion21bof the first grasping member21includes an inclined surface21gformed to be inclined with respect to the longitudinal axis of the wire sheath280. The recessed portion1aof the cap1includes an inclined surface1ccorresponding to the inclined surface21gand formed to be inclined with respect to the longitudinal axis of the wire sheath280. Other configurations of the fastening device100A according to the present modified example are the same as the configurations of the fastening device100according to the first embodiment described above.

The inclined surface21gand the inclined surface1cmay be inclined at substantially the same angle with respect to the longitudinal axis of the wire sheath280. When the operator retracts the wire sheath280to the proximal end side from the state shown inFIG.9, that is, from a state in which the engagement between the grasping portion2and the cap1is released, the distal-end portion21bof the first grasping member21is similarly pulled to the distal end side. Due to this operation, the proximal-end portion21bof the first grasping member21engages with the recessed portion1aof the cap1with the inclined surface21gand the inclined surface1cin contact with each other.

When the operator engages the grasping portion2and the cap1again after performing a treatment on the tissue using the fastening device100according to the first embodiment described above, it is necessary to operate the wire sheath280to adjust a posture of the grasping portion2so that the inclined surface21fformed on the proximal-end portion21bof the grasping portion2and the inclined surface1bformed in the recessed portion1aof the cap1face each other. As shown inFIG.10, when a relative positional relationship in a circumferential direction between the grasping portion2and the cap1deviates, it is necessary for the operator to adjust a position of the grasping portion2while observing the state and posture of the grasping portion2to engage it with the cap1.

On the other hand, according to the fastening device100A according to the present modified example, also in the state shown inFIG.16, when the operator simply operates to retract the wire sheath280, the inclined surface21gformed on the proximal-end portion21bof the grasping portion2comes into contact with the inclined surface1cformed on the distal end side of the recessed portion1aof the cap1as shown inFIG.18, and thereby the distal-end portion21bof the first grasping member21slides into the recessed portion1ato be accommodated therein. As a result, as shown inFIGS.17and19, the grasping portion2and the cap1are engaged. According to the fastening device100A according to the present modified example, the operator does not need to observe a state and posture of the grasping portion2in an operation of engaging the grasping portion2and the cap1.

The fastening device100A according to the present modified example has the same effects as those of the fastening device100according to the first embodiment because the other configurations are the same. An endoscope system having the fastening device100A according to the present modified example has the same effects as those of the endoscope system300according to the first embodiment.

Second Embodiment

Hereinafter, a configuration of a fastening device100B according to a second embodiment of the present disclosure will be described usingFIGS.20to22. For the fastening device100B according to the present embodiment, components common to those in the fastening device100according to the first embodiment described above will be denoted by the same reference signs, and description thereof will be omitted. Only different points between the fastening device100B according to the present embodiment and the fastening device100according to the first embodiment will be described.

FIG.20is a bottom view of the fastening device100B according to the present embodiment.FIGS.21and22are views showing an operation using the fastening device100B according to the present embodiment. The fastening device100B according to the present embodiment differs from the fastening device100according to the first embodiment described above in that one rotation adjustment wire292is coupled to a proximal-end portion21bof a first grasping member21.

As shown inFIG.20, the rotation adjustment wire292having flexibility is coupled to the proximal-end portion21bof the first grasping member21. The rotation adjustment wire292may be coupled to the proximal-end portion21bof the first grasping member21by various known methods such as, for example, welding and adhesion. Although not shown, the rotation adjustment wire292is formed to be inserted through a resin sheath293disposed parallel to a resin sheath290and extend to a wire sheath fixing portion260on a proximal end side. In the present embodiment, although not shown, the resin sheath293may be attached to a rubber stopper266on the proximal end side.

The rotation adjustment wire292may be configured to be operated by the wire sheath fixing portion260, or an operation unit for adjusting only the rotation adjustment wire292may be configured.

As shown inFIG.20, in a state in which the grasping portion2protrudes further to a distal end side than the cap1, the rotation adjustment wire292is coupled to the proximal-end portion21bof the first grasping member21of the grasping portion2in a loosened state. In this state, since an engagement between the grasping portion2and the cap1is released, when an operator operates the wire sheath280to rotate, the grasping portion2can be rotated around a longitudinal axis of the wire sheath280. That is, in the fastening device100B according to the present embodiment, when the grasping portion2is moved to the distal end side with respect to the cap1, and the operator operates the rotation adjustment wire292to enter a loosened state, a restriction on rotation of the grasping portion2around a longitudinal axis direction is released.

At this time, the operator can perform a treatment on a tissue using the grasping portion2. When the operator removes the fastening device100B from the inside of the body after performing a treatment on the tissue, the grasping portion2and the cap1are engaged again. For example, as shown inFIG.21, if a relative positional relationship between the grasping portion2and the cap1in a circumferential direction deviates, when the operator pulls the position adjustment wire292to the proximal end side, a tension force (traction force) acting on the position adjustment wire292is transmitted to the grasping portion2. The tension force with which the operator pulls the position adjustment wire292to the distal end side causes the position adjustment wire292to transition from a loosened state to a substantially straight state as shown inFIG.16. At the same time, the tension force acting on the position adjustment wire292acts on the grasping portion2, and a moment rotating the grasping portion2around the longitudinal axis direction is generated. As a result, as shown inFIG.22, relative positions of the proximal-end portion21bof the grasping portion2and the recessed portion1aformed in the cap1in the circumferential direction coincide with each other. In this state, when the operator retracts the wire sheath280to the proximal end side, the proximal-end portion21bof the grasping portion2is accommodated in the recessed portion1aformed in the cap1to engage the grasping portion2and the cap1.

According to the fastening device100B according to the present embodiment, the traction force to the proximal end side acting on the position adjustment wire292acts as a rotational moment on the grasping portion2on the distal end side, causing the grasping portion2to rotate around the longitudinal axis. Therefore, in an operation in which the operator engages the grasping portion2and the cap1, the operation of aligning relative positions of the proximal-end portion21bof the grasping portion2and the recessed portion1aof the cap1becomes simpler.

The fastening device100B according to the present embodiment has the same effects as those of the fastening device100according to the first embodiment because the other configurations are the same. An endoscope system having the fastening device100B according to the present embodiment has the same effects as those of the endoscope system300according to the first embodiment.

Modified Example 1

Hereinafter, a configuration of a fastening device100C according to modified example 1 of the present embodiment will be described usingFIGS.23to25. For the fastening device100C according to the present modified example, components common to those in the fastening device100B according to the second embodiment described above will be denoted by the same reference signs, and description thereof will be omitted. Only different points between the fastening device100B according to the present modified example and the fastening device100B according to the second embodiment will be described.

FIG.23is a bottom view showing a state in which the grasping portion2and the cap1are engaged in the fastening device100C according to the present modified example.FIG.24is a bottom view of the fastening device100C according to the present modified example showing a state in which an engagement between the grasping portion2and the cap1is released and the rotation of the grasping portion2around the longitudinal axis is restricted when the grasping portion2is moved further to the distal end side than the cap1.FIG.25is a bottom view of the fastening device100C according to the present modified example showing a state in which the engagement between the grasping portion2and the cap1is released and the restriction on the rotation of the grasping portion2around the longitudinal axis is released.

As shown inFIG.23, the fastening device100C according to the present modified example differs from the fastening device100B of the second embodiment described above in that a rotation restriction wire294with a higher strength is inserted through the resin sheath293instead of the rotation adjustment wire292. Then, the fastening device100C according to the present modified example has a port295, that opens toward the proximal end side and into which the rotation restriction wire294can be inserted, in the proximal-end portion21bof the grasping portion2.

The rotation restriction wire294according to the present modified example preferably has flexibility so that it can smoothly pass through a curved lumen when the fastening device100C is inserted into the body. On the other hand, the rotation restriction wire294preferably has a predetermined rigidity so that it can be moved to the distal end side with respect to the cap1and inserted into the port295as shown inFIG.19to be described later. The rotation restriction wire294is formed to be inserted through a through hole formed in the cap1and the resin sheath293and extend to the wire sheath fixing portion260on the proximal end side. In the present modified example, although not shown, the rotation restriction wire294may be configured to be operated by the wire sheath fixing portion260, or an operation unit for adjusting only the rotation restriction wire294may be configured.

When the fastening device100C according to the present modified example is inserted into the body, as shown inFIG.23, the engagement between the grasping portion2and the cap1is maintained in a state in which the rotation restriction wire294is inserted into the port295formed in the proximal-end portion21bof the grasping portion2. In this state, the rotation of the grasping portion2around the longitudinal axis direction is restricted. The fastening device100C according to the present modified example is inserted to the position close to the tissue, which is a treatment target, inside the body in a state in which the grasping portion2and the cap1are engaged and integrated.

As shown inFIG.24, in the fastening device100C according to the present modified example, when the operator pushes the wire sheath280to the distal end side while the fastening device100C is inserted to the position close to the tissue, the grasping portion2coupled to the wire sheath280moves to the distal end side together. Therefore, the engagement between the grasping portion2and the cap1is released. However, since the rotation restriction wire294is inserted into the port295formed in the proximal-end portion21bof the grasping portion2, the restriction on the rotation of the grasping portion2around the longitudinal axis direction is maintained.

As shown inFIG.25, when the operator moves the rotation restriction wire294to the proximal end side, the rotation restriction wire294is pulled out from the port295. Therefore, the restriction on the rotation of the grasping portion2in the longitudinal axis direction is released. As a result, when the operator operates the wire sheath280to rotate, the grasping portion2can rotate around the longitudinal axis. Then, similarly to the above-described embodiments and modified examples, the operator can perform a treatment on a tissue inside the body using the fastening device100C.

Although not shown, when the fastening device100C is removed out of the body after the treatment on the tissue inside the body is completed using the fastening device100C, the operator engages the cap1and the grasping portion2again. When the operator engages the cap1and the grasping portion2, for example, the operator can operate the wire sheath280to rotate, align a position of the port295formed at the distal-end portion21bof the grasping portion2with a position of the rotation restriction wire294, and then push the rotation restriction wire294toward the port295. Then, when the operator moves the wire sheath280to the proximal end side with the rotation restriction wire294inserted into the port295, that is, with the rotation of the grasping portion2around the longitudinal axis restricted, the proximal-end portion21bof the grasping portion2is accommodated in the recessed portion1aof the cap1to engage the grasping portion2and the cap1. The operator can remove the fastening device100C, in which the grasping portion2and the cap1are engaged, out of the body.

The fastening device100C according to the present modified example has the same effects as those of the fastening device100B according to the present embodiment because the other configurations are the same. An endoscope system having the fastening device100C according to the present modified example has the same effects as those of the endoscope system according to the present embodiment.

Modified Example 2

Hereinafter, a configuration of a fastening device100D according to modified example 2 of the present embodiment will be described usingFIGS.26and27. For the fastening device100D according to the present modified example, components common to those in the fastening device100C according to modified example 1 described above will be denoted by the same reference signs, and description thereof will be omitted. Only different points between the fastening device100D according to the present modified example and the fastening device100C according to modified example 1 will be described.

FIG.26is a bottom view of the fastening device100D according to the present modified example showing a state in which an engagement between the grasping portion2and the cap1is released, and the rotation of the grasping portion2around the longitudinal axis is restricted by moving the grasping portion2further to the distal end side than the cap1.FIG.27is a bottom view of the fastening device100D according to the present modified example showing a state in which the restriction on the rotation of the grasping portion2around the longitudinal axis is released.

The fastening device100D according to the present modified example differs from modified example 1 described above in a form in which the rotation of the grasping portion2around the longitudinal axis is restricted. More specifically, the fastening device100D according to the present modified example includes a protrusion297formed on the proximal-end portion21bof the grasping portion2, and forceps (rotation restriction member)296that can grasp the protrusion297.

In the fastening device100D according to the present modified example, the protrusion297protruding in a direction intersecting the longitudinal axis of the wire sheath280, that is, outward in a radial direction, is formed on the proximal-end portion21bof the grasping member2. On the other hand, the forceps296are inserted through a through hole formed in the cap1and the resin sheath293, and formed to penetrate through the through hole formed in the cap1and the resin sheath293and extend to the wire sheath fixing portion260on the proximal end side. In the present modified example, although not shown, the forceps296may be configured to be operated by the wire sheath fixing portion260, or an operation unit for operating only the forceps296may be configured. The forceps296according to the present modified example may be configured by, for example, providing a pair of forceps capable of grasping the protrusion297at a distal end of the rotation restriction wire294according to modified example1of the present embodiment described above. However, the forceps296according to the present modified example is not limited to this configuration. For example, a hook that can be caught on the protrusion297may be provided at a distal end of a wire having flexibility and a predetermined strength.

The fastening device100D according to the present modified example is inserted to the position close to the tissue inside the body, which is a treatment target, in a state in which the grasping portion2and the cap1are engaged and integrated. When the fastening device100D according to the present modified example is inserted into the body, it becomes a state in which the proximal-end portion21bof the grasping portion2is accommodated in the recessed portion1aformed in the cap1, and the forceps296grasps the protrusion297. Therefore, the rotation of the grasping portion2around the longitudinal axis is restricted.

When the fastening device100D according to the present modified example is inserted to the position close to the tissue, as shown inFIG.26, when the operator pushes the wire sheath280to the distal end side, the grasping portion2coupled to the wire sheath280moves to the distal end side together. Therefore, the engagement between the grasping portion2and the cap1is released. However, since a state in which the forceps296grasps the protrusion297is maintained, the restriction on the rotation of the grasping portion2around the longitudinal axis direction is maintained.

As shown inFIG.27, the operator can release the state in which the forceps296grasps the protrusion297by operating the forceps296. This operation releases the restriction on the rotation of the grasping portion2in the longitudinal axis direction. As a result, when the operator operates the wire sheath280to rotate, the grasping portion2can rotate around the longitudinal axis. Then, similarly to the above-described embodiments and modified examples, the operator can perform a treatment on a tissue inside the body using the fastening device100D.

When the fastening device100D is removed out of the body after the treatment on the tissue inside the body is completed using the fastening device100D, the operator engages the cap1and the grasping portion2again. When the operator engages the cap1and the grasping portion2again, for example, the operator can operate the wire sheath280to rotate, align a position of the protrusion297formed on the distal-end portion21bof the grasping portion2with a position of the forceps296, and then move the forceps296toward the distal-end portion21bof the grasping portion2to grasp the protrusion297. Then, when the operator moves the wire sheath280to the proximal end side with the forceps296grasping the protrusion297, that is, with the rotation of the grasping portion2around the longitudinal axis restricted, the proximal-end portion21bof the grasping portion2is accommodated in the recessed portion1aof the cap1to engage the grasping portion2and the cap1. The operator can remove the fastening device100D, in which the grasping portion2and the cap1are engaged, out of the body.

The fastening device100D according to the present modified example has the same effects as those of the fastening device100B according to the present embodiment because the other configurations are the same. An endoscope system having the fastening device100D according to the present modified example has the same effects as those of the endoscope system according to the present embodiment.

While the embodiments of the present disclosure and modified examples corresponding to the embodiments have been described in detail as above with reference to the drawings, the specific configurations are not limited to the embodiments 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 above-described embodiments and modified examples can be configured by appropriately combining them.

For example, the configuration of the fastening device100B according to the modified example of the first embodiment of the present disclosure can be applied to the second embodiment and the modified examples. More specifically, an inclined surface inclined with respect to the longitudinal axis of the wire sheath280may be formed in each of the proximal-end portion21bof the first grasping member21and the recessed portion1aof the cap1of the fastening devices100B,100C, and100D according to the second embodiment and the modified examples of the present disclosure. Therefore, in the operation of engaging the cap1and the grasping portion2, there is no need for the operator to operate the wire sheath280to rotate to align positions of the cap1and the grasping portion2in the circumferential direction. As a result, an operation by the operator becomes easier.

A suturing method for the treatment target T according to the present disclosure has been described using an operation of the fastening device100according to the first embodiment as an example, but a suturing method is not limited thereto. For example, it can be applied to the embodiments and the corresponding modified examples of the present disclosure by appropriately changing the step of restricting the rotation of the grasping portion2around the longitudinal axis and the step of releasing the restriction on the rotation of the grasping portion2around the longitudinal axis also for the fastening devices according to the modified example of the first embodiment, the second embodiment, and the modified examples of the second embodiment of the present disclosure.

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.