Surgical instrument and tissue dissecting unit

A surgical instrument includes an insertion section, a first jaw and a second jaw provided at a distal end portion of the insertion section, having predetermined curved shapes and configured to grasp tissue; a guide section formed along the predetermined curved shape and disposed in at least one of the first jaw and the second jaw; an actuation section which is movable by being guided by the guide section; a shaft body provided at the actuation section and configured to be rotatable about a rotation axis parallel to a center line of the shaft body; and a blade section connected to the shaft body at a position apart from the rotation axis in a direction across to the shaft body and configured to be directed to the shaft body, the blade section being rotatable about the rotation axis.

FIELD OF THE INVENTION

The present invention relates to a surgical instrument and a tissue dissecting unit.

DESCRIPTION OF RELATED ART

In the related art, a tool configured to simultaneously perform suture and dissection of living body tissue is known.

For example, in Published Japanese Translation No. 2013-542004 of PCT International Publication and Japanese Unexamined Patent Application, First Publication No. H08-289895, surgical instruments including a cartridge in which a plurality of staples are accommodated, a blade section configured to dissect living body tissue, and a manipulation unit for dissecting the tissue using the blade section and shooting staples into the tissue are disclosed.

In addition, in Japanese Unexamined Patent Application, First Publication No. H08-289895, a surgical instrument capable of moving a blade section along a cartridge having a curved shape is disclosed.

SUMMARY OF THE INVENTION

A surgical instrument according to a first aspect of the present invention includes an insertion section configured to be inserted into a body; a first jaw and a second jaw provided at a distal end portion of the insertion section, the first jaw and the second jaw having predetermined curved shapes and configured to grasp tissue; a guide section formed along the predetermined curved shape and disposed in at least one of the first jaw and the second jaw; an actuation section which is movable by being guided by the guide section; a shaft body provided at the actuation section and in which a center line of the shaft body extends from the first jaw toward the second jaw, the shaft body configured to be rotatable about a rotation axis parallel to the center line; and a blade section connected to the shaft body at a position apart from the rotation axis in a direction across to the shaft body and configured to be directed to the shaft body, the blade section being rotatable about the rotation axis.

According to a second aspect of the present invention, the surgical instrument according to the first aspect may further include a wire extending from a proximal end portion to a distal end portion of the guide section, being returned at the distal end portion of the guide section to extend toward the proximal end portion of the guide section, and being connected to the actuation section.

According to a third aspect of the present invention, the surgical instrument according to the second aspect may further include a suture unit configured to suture the tissue grasped by the first jaw and the second jaw.

According to a fourth aspect of the present invention, in the surgical instrument according to the second aspect, the actuation section may have a guided section having a disk-shape, the guided section being engaged with the guide section and in which the wire is wound on an outer periphery of the guided section, and the shaft body is fixed to the guided section such that the centerline of the shaft body passes through a center of the guided section.

According to a fifth aspect of the present invention, in the surgical instrument according to the fourth aspect, the guided section may have a sliding surface which forms a curved surface shape protruding toward the shaft body at a surface to which the shaft body is fixed among outer surfaces of the guided section, the sliding surface which comes in point contact with the guide section.

According to a sixth aspect of the present invention, in the surgical instrument according to the second aspect, the blade section may be inclined with respect to the centerline of the shaft body.

According to a seventh aspect of the present invention, in the surgical instrument according to the second aspect, the actuation section may have a guided section formed in a disk-shape, the guided section being engaged with the guide section and in which the wire is wound on an outer periphery of the guided section, and the shaft body may be fixed to the guided section such that the centerline of the shaft body extends in parallel to a centerline of the guided section at a position spaced apart from a center of the guided section.

According to a eighth aspect of the present invention, in the surgical instrument according to the second aspect, the actuation section may have a guided section formed in a disk-shape, the guided section being engaged with the guide section and in which the wire is wound on an outer periphery of the guided section, and the shaft body may be connected to the guided section such that the centerline of the shaft body passes through a center of the guided section and the shaft body is rotatable with respect to the guided section.

According to a nineth aspect of the present invention, in the surgical instrument according to the second aspect, the actuation section may have a stopper structure which is capable of abutting the guide section to restrict that the shaft body rotates 180° or more with respect to the guide section.

A tissue dissecting unit according to a tenth aspect of the present invention includes: an actuation section which is movable along a predetermined curved shape of a jaw having the predetermined curved shape; a shaft body provided at the actuation section; and a blade section connected to the shaft body, wherein the shaft body and the blade section are rotatable about a rotation axis parallel to a center line of the shaft body, and the blade section is disposed at a position apart from the rotation axis in a direction across to the shaft body, and connected to the shaft body so as to be directed to the shaft body.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A first embodiment of the present invention will be described.FIG. 1is an overall view of a surgical instrument1according to an embodiment.FIG. 2is a schematic view showing a cartridge unit of the surgical instrument1seen in an arrow A direction shown inFIG. 1.FIG. 3is a cross-sectional view taken along line III-III ofFIG. 2.FIG. 4is a partial cross-sectional view of the cartridge unit seen in an arrow B direction shown inFIG. 1.FIG. 5is a perspective view showing an actuation section installed at the cartridge unit.FIG. 6is a side view of the actuation section.FIG. 7is a perspective view showing a second jaw of the cartridge unit.FIG. 8is a cross-sectional view taken along line VIII-VIII ofFIG. 7.

The surgical instrument1according to the embodiment shown inFIG. 1is a medical tool configured to suture tissue using staples27(seeFIG. 12) and to dissect the sutured area. The surgical instrument1includes an insertion section62which is capable of being inserted into a body, and a manipulation unit63connected to the insertion section62. The insertion section62includes a cartridge unit2and a flexible tube61. The cartridge unit2is filled with staples27. A flexible tube61is connected to the cartridge unit2.

The cartridge unit2has a root section3, an open-close link section8, a first jaw10and a second jaw50.

As shown inFIGS. 1 and 2, the root section3is a substantially tubular area configured to connect the cartridge unit2to the flexible tube61. A proximal end of the root section3is fixed to a distal end of the flexible tube61. A distal end of the root section3is connected to the open-close link section8and the second jaw50.

A connecting member5is inserted into the root section3. The connecting member5is operated by manipulation of a user with respect to the manipulation unit63.

The connecting member5has a first connecting member6and a second connecting member7(a wire). The first connecting member6is provided to open and close the first jaw10with respect to the second jaw50. The second connecting member7is provided to operate an actuation section31, which will be described below.

A proximal end of the first connecting member6extends to the manipulation unit63. A distal end of the first connecting member6is connected to the open-close link section8.

As shown inFIG. 4, the second connecting member7has a dissection connecting member7aand a returning connecting member7b. The dissection connecting member7ais wound on a pulley section25, which will be described below. The dissection connecting member7ais inserted into a first guide section24, which will be described below. A proximal end of the dissection connecting member7aextends to the manipulation unit63.

As shown inFIG. 5, a distal end of the returning connecting member7bis connected to the actuation section31. In the embodiment, the distal end of the returning connecting member7bis connected to a proximal end of a shaft body32, which will be described below. A proximal end of the returning connecting member7bextends to the manipulation unit63.

The open-close link section8is disposed at an inside of a distal portion of the root section3shown inFIG. 2. The open-close link section8has a link structure configured to convert movement of the first connecting member6in a center axis direction of the first connecting member6into open-close movement of the first jaw10.

The first jaw10shown inFIGS. 2, 3 and 4is provided at a distal end portion of the insertion section62(seeFIG. 1) to grasp tissue. As shown inFIG. 2, the first jaw10has a predetermined curved shape. The first jaw10has a base section11, a staple holder15, the staples27and the actuation section31.

As shown inFIG. 3, the base section11is a substantially rod-shaped or channel-shaped member having a longitudinal axis and a shape conforming to a curved shape of the first jaw10. The base section11has a concave section12, and a communication path13to the root section3. The concave section12is capable of accommodating the staple holder15and the actuation section31. The concave section12is opened toward a second grasping surface51of the second jaw50. A bottom is formed at the concave section12by a cover14. As shown inFIG. 4, the communication path13to the root section3is a passage through which the second connecting member7is inserted.

As shown inFIG. 3, the staple holder15has a holder main body16, the pulley section25and a driver26.

The holder main body16has a first grasping surface17, an accommodating section18and a groove section22. The first grasping surface17comes in contact with tissue when the tissue is grasped. The staples27are accommodated in the accommodating section18. The groove section22is opened at the first grasping surface17. The holder main body16is attached to the concave section12of the base section11in a direction in which the first grasping surface17is exposed from the base section11.

The staple holder15is detachably attached to the base section11. For example, after suture by using the staples27, the staple holder15after use is capable of being removed from the base section11. A suturation by using the surgical instrument1according to the embodiment is performed a plurality of times by attaching the staple holder15to the base section11in place of the used staple holders after suture by using the staples27.

The first grasping surface17is a surface directed toward the second grasping surface51(seeFIG. 1) of the second jaw50in a state in which the holder main body16is attached to the concave section12of the base section11.

The staples27is capable of being accommodated in the accommodating section18in a state in which insertion ends of the staples27are directed toward the second grasping surface51.

As shown inFIG. 3, in the first grasping surface17, an inner region of an envelope curve that surrounds the plurality of accommodating sections18defines a suture area SA in which tissue is sutured by the staples27. In a state in which the staples27are accommodated in the accommodating section18, staple arrays19(a first staple array20, a second staple array21) are provided in two regions of the holder main body16divided by the groove section22.

The first staple array20is constituted by the plurality of staples27arranged in an extending direction of the groove section22. In the embodiment, the first staple array20is installed on the first grasping surface17in two or more rows at an interval.

The second staple array21is constituted by the plurality of staples27arranged in the extending direction of the groove section22. In the embodiment, the second staple array21is installed on the first grasping surface17in two or more rows at an interval.

Accordingly, the staple array19has the plurality of staples27, which is capable of being shot from the first jaw10toward the second jaw50, around the groove section22.

As shown inFIG. 3, the groove section22is a linear groove in which a blade section39(to be described below) of the actuation section31is accommodated to be capable of advancing and retracting. In the embodiment, the groove section22is formed in a curved shape. The groove section22defines a dissection line L (seeFIGS. 9 and 12) in dissection of tissue.

The groove section22has a through-hole23and the first guide section24. The through-hole23is opened at the first grasping surface17. The first guide section24is continuous with the through-hole23and is formed in the holder main body16.

The through-hole23has a first wall surface23aand a second wall surface23bthat are apart from each other, and a bottom surface that connects the first wall surface23aand the second wall surface23b. In the embodiment, a bottom surface of the groove section22is constituted by a part of an inner surface of the base section11. Further, in the embodiment, in an intermediate region of the first jaw10in the extending direction of the groove section22, gaps between the first wall surface23aand the bottom surface and between the second wall surface23band the bottom surface are formed at an intermediate region of the first jaw10in the extending direction of the groove section22for allowing the actuation section31to pass through the intermediate region.

As shown inFIG. 3, the first wall surface23ahas a surface crossing the first grasping surface17in the holder main body16. The first wall surface23aextends from the first grasping surface17of the holder main body16toward a bottom section of the concave section12of the base section11. The first wall surface23aextends in a longitudinal axis direction of the base section11.

As shown inFIG. 3, the second wall surface23bis a surface formed in parallel to the first wall surface23a(including substantially in parallel) at a position apart from the first wall surface23aby a distance at which the blade section39of the actuation section31is capable of passing therethrough. The second wall surface23bis a surface crossing the first grasping surface17in the holder main body16. The second wall surface23bextends from the first grasping surface17of the holder main body16toward the bottom section of the concave section12of the base section11. The second wall surface23bextends in the longitudinal axis direction of the base section11.

As shown inFIGS. 3 and 4, the first guide section24has a groove shape wider than an interval between the first wall surface23aand the second wall surface23b. The first guide section24extends to conform to a curved shape of the groove section22. A first guided section34of a pair of guided sections33formed at the actuation section31is capable of coming in contact with the first guide section24.

The dissection connecting member7ais inserted into the first guide section24. In the inside of the first guide section24, the dissection connecting member7aextends from a proximal end portion toward a distal end portion of the first guide section24along the first guide section24, turns at the pulley section25of the distal end portion of the first guide section24to extend to the proximal end portion of the first guide section24, and is connected to the actuation section31. In the embodiment, a distal end of the dissection connecting member7ais wound on an outer periphery of the first guided section34, which will be described below.

The pulley section25shown inFIG. 4, on which the dissection connecting member7ais wound, is rotatably connected to the base section11.

The driver26shown inFIG. 3is disposed in the accommodating section18. The driver26is capable of being moved inside the accommodating section18by a cam section37of the actuation section31. That is, when the driver26is moved toward an opening of the first grasping surface17side of the accommodating section18by the cam section37(seeFIG. 5), the driver26pushes a connecting section30(seeFIG. 12) of each of the staples27toward the opening of the first grasping surface17side to push out the staple27from the accommodating section18.

The staple27has a pair of leg sections28and29(seeFIG. 12) having insertion ends inserted into tissue, and the connecting section30that connects the pair of leg sections28and29. The staple27is formed in a U shape (a U shape in which all angles are right angles) by bending deformable strands having high biocompatibility. A known structure may be selected and employed as the shape of the staple27.

The actuation section31shown inFIGS. 3, 5 and 6is disposed inside the base section11. The actuation section31is configured to move the driver26to push out the staples27from the accommodating section18and also dissect the tissue after the staples27are pushed out.

As shown inFIGS. 3, 5 and 6, the actuation section31has the shaft body32, the pair of guided sections33, the cam section37and the blade section39.

The shaft body32is connected to the distal end of the second connecting member7of the connecting member5. The shaft body32is capable of being guided and moved to a second guide section53(seeFIG. 7) formed at the first guide section24and the second grasping surface51, which will be described below, by moving the second connecting member7in a center axis direction of the second connecting member. A centerline C1(seeFIG. 6) of the shaft body32is a rotational center of the actuation section31in the embodiment. That is, in the embodiment, the actuation section31is rotatable within a predetermined range about the centerline C1of the shaft body32serving as a rotational center while being supported by the first guide section24and the second guide section53. The allowable range of rotation of the actuation section31in the embodiment is between a state in which the blade section39comes in contact with the first wall surface23aand a state in which the blade section39comes in contact with the second wall surface23b. The pair of guided sections33, the cam section37and the blade section39are attached to the shaft body32.

The pair of guided sections33are members engaged with the first guide section24and the second guide section53. In the embodiment, the pair of guided sections33have the first guided section34engaged with the first guide section24and a second guided section35engaged with the second guide section53.

The first guided section34is fixed to an end disposed at the first jaw10side, in both ends of the shaft body32. The first guided section34has a disk shape having a centerline in a thickness direction of the first guided section. A groove to which a distal end of the dissection connecting member7ais hooked is formed to extend in the circumferential direction at an outer periphery of the first guided section34. A distal end portion of the dissection connecting member7ais annularly hooked to the first guided section34. The first guided section34is rotatable with respect to the distal portion of the dissection connecting member7a. In the embodiment, a centerline of the first guided section34is coaxial with the centerline C1of the shaft body32. The first guided section34is rotatable in the first guide section24together with the shaft body32. The first guided section34is attached to the shaft body32by a screw34a. The first guided section34and the shaft body32may be integrally formed.

The second guided section35is fixed to an end disposed at the second jaw50side, in both ends of the shaft body32. The second guided section35has a disk shape having a centerline in a thickness direction the second guided section. In the embodiment, the centerline of the second guided section35is coaxial with the centerline C1of the shaft body32. The second guided section35is rotatable in the second guide section53together with the shaft body32. The second guided section35is attached to the shaft body32by a screw35a. The second guided section35and the shaft body32may be integrally formed.

As shown inFIGS. 3 and 5, the cam section37is connected to the shaft body32to be rotatable with respect to the shaft body32. The cam section37has an inclined surface38inclined with respect to a longitudinal axis of the base section11. The inclined surface38of the cam section37comes in contact with the driver26to move the driver26when the cam section37is moved in the longitudinal axis direction of the base section11. The moving direction of the cam section37is an extending direction of the groove section22.

As shown inFIG. 6, the blade section39is disposed at a position apart from the shaft body32in a direction crossing the direction in which the centerline C1of the shaft body32extends. The blade section39is connected to the shaft body32at a position between the ends of the shaft body32. The blade section39has a blade edge39aextending in parallel to the centerline C1of the shaft body32. The blade edge39ahas a sharp shape that is capable of dissecting tissue of a living body. As shown inFIG. 3, the blade section39is disposed at the groove section22so as to protrude from the first grasping surface17toward the second jaw50. The blade section39is positioned closer to the proximal side than the cam section37when the blade section39is positioned closest to the groove section22by rotation of the actuation section31, which will be described below.

The blade edge39ais in a position apart from the centerline C1of the shaft body32and directed toward the shaft body32. For this reason, the blade section39is capable of dissecting tissue while being pressed to a proximal side in a dissection direction of the tissue by the blade section39by which the blade edge39acomes in contact with the tissue of the living body. When the blade section39is pushed by the tissue of the living body, the blade section39is rotated about the centerline C1of the shaft body32(serving as a rotational center of the actuation section31in the embodiment).

In the embodiment, when the first jaw10and the second jaw50are in a closed state, the blade edge39ais formed in at least a gap portion between the first grasping surface17and the second grasping surface51.

The second jaw50shown inFIGS. 1 and 7is provides at a distal end portion of the insertion section62to grasp the tissue, and have a predetermined curved shape same as the first jaw10. The second jaw50has the second grasping surface51in which a plurality of forming pockets52is formed.

The second grasping surface51is a surface directed toward the first grasping surface17of the first jaw10. When the first jaw10is closed with respect to the second jaw50, a distance between the first grasping surface17of the first jaw10and the second grasping surface51of the second jaw50is previously set according to a thickness of tissue serving as a suture target. The distance between the first grasping surface17of the first jaw10and the second grasping surface51of the second jaw50is set to a distance at which adhesion of the tissue serving as a suture target occurs after suture by using the staples27and excessive debridement of the tissue serving as the suture target is hard to occur.

The forming pockets52and the second guide section53are formed at the second grasping surface51. The second guide section53is formed such that the second guided section35is capable of entering and to extend in the longitudinal axis direction of the second jaw50.

Each of the forming pockets52shown inFIG. 7has an inclined surface or a curved surface configured to guide the leg sections28and29to plastically deform the leg sections28and29of the staple27to form a shape in which the tissue is sutured as shown inFIG. 12.

As shown inFIG. 8, the second guide section53has an opening section53athrough which the shaft body32shown inFIG. 6is capable of being inserted, and a groove section53bwider than the opening section53aand in which the second guided section35is slidable. As shown inFIG. 7, the second guide section53has a linear shape along a curved shape of the groove section22(seeFIGS. 2 and 3). A shape of the groove section53bis appropriately set according to the shape of the second guided section35.

An inlet53cconfigured to allow the second guided section35to enter the second guide section53is formed at a proximal portion of the second guide section53. For this reason, when the actuation section31is positioned closest to the proximal side with respect to the groove section22, the second guided section35is removed from the second guide section53. Accordingly, when the actuation section31is positioned closest to the proximal side with respect to the groove section22, the first jaw10and the second jaw50is capable of being freely opened and closed in a state in which they are not connected by the actuation section31.

In the embodiment, a suture unit54in which the tissue is sutured (seeFIG. 3) is constituted by the staple holder15, the staples27, the cam section37and the second jaw50.

As shown inFIG. 1, the flexible tube61is a tubular elongated member. The connecting member5(the first connecting member6, the dissection connecting member7aand the returning connecting member7b) is inserted through the flexible tube61.

A proximal end of the root section3of the cartridge unit2is fixed to a distal end of the flexible tube61. The proximal end of the flexible tube61is fixed to the manipulation unit63.

In addition, a pipe line configured to guide a known observation apparatus (for example, an endoscope) for observing a suture area from the manipulation unit63toward the cartridge unit2may be installed at the flexible tube61.

The manipulation unit63is provided at the proximal end of the flexible tube61. The manipulation unit63is provided to allow a user to perform manipulation of opening and closing the first jaw10and the second jaw50, to staple the staples27to the tissue, and to dissect the tissue. The manipulation unit63has substantially a rod shape such that an operator is capable of gripping the manipulation unit63with her or his hands.

The manipulation unit63has a housing64, a curved knob65, an open-close knob66, a lever67, and a transmission mechanism (not shown). The housing64has substantially a rod shape and is formed a space inside the housing The curved knob65is provided to bend the flexible tube61. The open-close knob66and the lever67are disposed to be exposed to the outside of the housing64to operate the connecting member5. The transmission mechanism is connected to the connecting member5in the housing64.

The curved knob65is a member configured to bend the flexible tube61by pulling an angle wire (not shown) extending from the distal end of the flexible tube61to the manipulation unit63. The curved knob65is rotatable with respect to the housing64of the manipulation unit63, and is capable of being fixed not to be rotated with respect to the housing64at an arbitrary position.

The open-close knob66is a member configured to advance and retract the first connecting member6in the centerline direction. The open-close knob66is rotatable with respect to the housing64of the manipulation unit63, and is capable of being fixed not to be rotated with respect to the housing64at an arbitrary position.

As an operator operates the open-close knob66, the transmission mechanism (not shown) transmits an amount of manipulation of the open-close knob66to the first connecting member6as an amount of force to advance and retract the first connecting member6in the centerline direction.

The lever67is a member configured to advance and retract the second connecting member7in the centerline direction. The lever67is swingable with respect to the housing64of the manipulation unit63, and in capable of being fixed not to be swung with respect to the housing64at an arbitrary position.

As the operator operates the lever67, the transmission mechanism (not shown) transmits an amount of manipulation of the lever67to the second connecting member7as an amount of force to advance and retract the second connecting member7in the centerline direction. In the embodiment, the dissection connecting member7ais pulled to the proximal side when the lever67is swung in a first predetermined direction, and the returning connecting member7bis pulled to the proximal side when the lever67is swung in a direction opposite to the first predetermined direction.

In addition, the dissection connecting member7aand the returning connecting member7bare connected via the actuation section31in the cartridge unit2. For this reason, the returning connecting member7bis moved to the distal side when the dissection connecting member7ais pulled to the proximal side by the lever67, and the dissection connecting member7ais moved to the distal side when the returning connecting member7bis pulled to the proximal side by the lever67.

Next, an action of the surgical instrument according to the embodiment will be described.FIGS. 9 to 12are views showing the action of the surgical instrument1according to the embodiment.

As shown inFIG. 3, the surgical instrument1is prepared in a state in which the staples27are accommodated in the accommodating section18and the cam section37and the blade section39are disposed in the vicinity of the proximal end of the base section11. At this time, the pair of guided sections33of the actuation section31are disposed in the vicinity of the proximal ends of the first guide section24and the second guide section53.

The surgical instrument1is guided to a treatment target area through a natural opening of a patient such as the mouth or the like of the patient, a small incision portion formed in an abdominal wall or the like of the patient by a known technology.

As shown inFIG. 9, the first jaw10and the second jaw50provided at the distal end portion of the insertion section62of the surgical instrument1grasp the tissue serving as the dissection target in accordance with a manipulation of the open-close knob66(seeFIG. 1) of the manipulation unit63under observation of a laparoscope (not shown).

As the tissue serving as the dissection target is grasped by the first jaw10and the second jaw50as shown inFIG. 9, the dissection line L with respect to the dissection target tissue is defined. As a user fixes the open-close knob66shown inFIG. 1to the housing64, as shown inFIG. 9, a position of the first jaw10with respect to the second jaw50is fixed in a state in which the first jaw10and the second jaw50grasp the tissue.

The user operates the lever67to move the dissection connecting member7ato the proximal side after fixing the open-close knob66shown inFIG. 1to the housing64. The dissection connecting member7amoved to the proximal side moves the actuation section31to the distal side as a pulling direction is reversed by the pulley section25shown inFIG. 4. The actuation section31moves both of the cam section37and the blade section39shown inFIGS. 3 and 5to the distal side. The driver26shown inFIG. 3is pushed up by the inclined surface38of the cam section37which is moved to the distal side. The driver26shown inFIG. 3pushes out the staples27from the accommodating section18such that insertion ends of the staples27pierce into the tissue as the driver26is pushed up to the inclined surface38of the actuation section31.

Further, when the staples27are pushed out from the accommodating section18, the leg sections28and29of the staples27abut the forming pockets52(seeFIG. 7). The forming pockets52deform the leg sections28and29of the staples27into a predetermined shape for suturing the tissue as shown inFIG. 12. The staples27are sequentially shot from the accommodating section18from the proximal side toward the distal side of the first jaw10in accordance with a movement of the cam section37. In this way, the suture unit54shown inFIG. 3sutures the tissue grasped by the first jaw10and the second jaw50via the staples27.

The actuation section31is capable of being moved along the groove section22by the second connecting member7. The blade section39(seeFIGS. 5 and 6) disposed at the proximal side of the cam section37moves along the groove section22between the first staple array20and the second staple array21serving as the dissection line L (seeFIGS. 9 and 12) as the blade section39is pulled by the dissection connecting member7a. In a process in which the actuation section31is pulled by the dissection connecting member7aand dissects the tissue of the living body, the blade edge39ais pressed against the tissue, and the actuation section31rotates about a centerline of each of the pair of guided sections33serving as a rotational center. Here, as shown inFIGS. 10 and 11, the blade edge39aof the blade section39comes in contact with neither the first wall surface23anor the second wall surface23bof the groove section22, the shaft body32rotates about the centerline of each of the pair of guided sections33serving as a rotational center due to rotation of the actuation section31, and the blade section39rotates about the shaft body32. The blade section39is moved to a hand side (a proximal side of the groove section22) in a moving direction of the actuation section31by rotation of the blade section39, and a direction of the blade edge39ais a pulling direction of the actuation section31by the dissection connecting member7a. That is, in a process in which the actuation section31is pulled by the dissection connecting member7ato dissect the tissue, the blade edge39ais directed in the pulling direction of the actuation section31by the dissection connecting member7a. Here, the blade edge39ais directed in a tangential direction of the curved groove section22.

In a process in which the actuation section31is pulled by the dissection connecting member7a, since the blade edge39ais moved so as to be dragged by the shaft body32in a direction away from the first wall surface23aor the second wall surface23bshown inFIG. 3the blade edge39ais hard to bite into the first wall surface23aor the second wall surface23b.

The tissue is sequentially dissected by the blade section39from an area sutured by the staples27. The blade section39dissects the tissue in the suture area SA, in the tissue grasped by the first jaw10and the second jaw50.

After completion of suture by the staples27and dissection by the blade section39, the user releases fixing of a lever69by a fixing section70and opens the first jaw10with respect to the second jaw50. Accordingly, grasping of the tissue by the first jaw10and the second jaw50is released.

According to necessity, the actuation section31is capable of moving to the proximal end side of the groove section22by which the returning connecting member7bis moved to the proximal side by operating the lever67. When the actuation section31is positioned at the proximal end portion of the groove section22, the empty staple holder15after shooting of the staples27is capable of replacing with a new staple holder15.

When treatment is performed a plurality of times by using the surgical instrument1according to the embodiment, suture and dissection are capable of continuously performing by replacing the staple holder15with a new one after shooting the staples27to continue suture and dissection.

In the related art, in the tool for dissecting the tissue by biting into the tissue using the blade edge of the blade section by pushing the blade section for dissecitng the tissue of the living body, the blade section may unsteadily move when the tissue is pushed out from the proximal side of the blade section. In particular, when the blade section is pushed out along the curved dissection line, in order to prevent unsteadily moving of the blade section, a direction in which a compressive force is applied to the blade section should be adjusted in an advance direction of the blade section.

On the other hand, according to the surgical instrument1of the embodiment, since the blade edge39aof the blade section39is directed toward the distal side of the groove section22in the tangential direction of the groove section22by which the actuation section31having the blade section39is pulled by the dissection connecting member7a, unsteadily movement of the blade section39is hard to occur, movement of the blade section39is smoothly performed, and dissection of the tissue is stabilized.

Next, a second embodiment of the present invention will be described. In the embodiments described below, the same components as the components in description of the first embodiment are designated by the same reference numerals as in the first embodiment, and overlapping description will be omitted.FIG. 13is a side view showing an actuation section of a surgical instrument1A according to the embodiment.

As shown inFIG. 13, the surgical instrument1A according to the embodiment is different from the first embodiment in that a blade section39A has a blade edge39aA extending to be inclined with respect to the centerline C1of the shaft body32.

The blade edge39aA is formed along a straight line crossing the centerline C1of the shaft body32. In the blade edge39aA, half or more of the entire length of the blade edge39aA is directed toward the centerline C1of the shaft body32.

In the embodiment, the blade edge39aA extends in a direction inclined with respect to an advance direction of the blade edge39aA. For this reason, the tissue of the living body is capable of being dissected with a force smaller than that of the blade edge39adescribed in the first embodiment.

Next, a third embodiment of the present invention will be described.FIG. 14is a side view showing an actuation section of a surgical instrument1B according to the embodiment.

As shown inFIG. 14, in the surgical instrument1B according to the embodiment, an actuation section31B having a different configuration different from the actuation section31described in the first embodiment is provided instead of the actuation section31described in the first embodiment.

The actuation section31B is different from the first embodiment in that a shaft body32B is fixed to a position offset with respect to a centerline of each of the pair of guided sections33, instead of the shaft body32described in the first embodiment.

In the embodiment, the actuation section31B rotates about a centerline C2of each of the pair of guided sections33. The shaft body32B rotates about the centerline C2each of the pair of guided sections33serving as a rotational center due to rotation of the actuation section31B about the centerline C2of each of the pair of guided sections33serving as a rotational center.

A blade section39B configured to dissect the tissue of the living body like the first embodiment is provided at the shaft body32B. The blade section39B has a blade edge39aB directed to a centerline of each of the pair of guided sections33extending parallel to a centerline of each of the pair of guided sections33.

In this embodiment as well, the actuation section31B is movable along the groove section22by the second connecting member7. In a process in which the actuation section31B is pulled by the dissection connecting member7aand dissects the tissue of the living body, the tissue pushes the blade edge39aB like the first embodiment, and the actuation section31B rotates about the center line of each of the pair of guided sections33serving as a rotational center. Then, the shaft body32B rotates about a centerline of each of the pair of guided sections33, and the blade section39B rotates about a centerline of each of the pair of guided sections33. The blade section39moves to a hand side in the moving direction of the actuation section31B (a proximal side of the groove section22).

In a process in which the actuation section31B is pulled by the dissection connecting member7aand dissects the tissue, the blade edge39aB is directed in a pulling direction of the actuation section31B by the dissection connecting member7a. At this time, the blade edge39aB is directed in a tangential direction of the curved groove section22.

Accordingly, in this embodiment, like the first embodiment, since the blade section39B is guided by the first guide section24and the second guide section53while being held with no contact with the groove section22, movement of the blade section39B in a dissection process of the tissue is smooth.

Next, a fourth embodiment of the present invention will be described.FIG. 15is a cross-sectional view showing an actuation section31C of a surgical instrument according to the embodiment.

As shown inFIG. 15, in the embodiment, the actuation section31C having a different configuration from the actuation section31described in the first embodiment is provided instead of the actuation section31described in the first embodiment.

The actuation section31C is different from the first embodiment in that the shaft body32is connected to the pair of guided sections33such that the shaft body32is rotatable with respect to the pair of guided sections33.

That is, in the embodiment, a bearing34cinterposed between the first guided section34and the shaft body32and a bearing35cinterposed between the second guided section35and the shaft body32are provided.

In the embodiment, in addition to rotation of the actuation section31C as a whole, the blade section39is rotatable when the shaft body32is rotated with respect to the first guided section34and the second guided section35as well. In the embodiment, the blade section39is rotatable with a force smaller than that in the first embodiment.

Next, a fifth embodiment of the present invention will be described.FIG. 16is a side view showing an actuation section31D of a surgical instrument according to the embodiment.FIG. 17is a cross-sectional view showing configurations of the first guide section24and the second guide section53of the surgical instrument according to the embodiment, and showing the same cross section taken along line III-III ofFIG. 2.

As shown inFIGS. 16 and 17, in the embodiment, the actuation section31D having a different configuration from the actuation section31described in the first embodiment is provided instead of the actuation section31described in the first embodiment.

The actuation section31D has a pair of guided sections33D (a first guided section34D, a second guided section35D) of which a surface directed to the shaft body32forms a curved surface, instead of the pair of guided sections33of the first embodiment.

In the first guided section34D, the surface directed toward the shaft body32is formed in a curved surface protruding toward the shaft body32(a hemispherical shape in the embodiment), and the surface directed toward the shaft body32is a sliding surface that comes in point contact with the first guide section24.

In the second guided section35D, the surface directed toward the shaft body32is formed in a curved surface shape protruding toward the shaft body32(a hemispherical shape in the embodiment), and the surface directed toward the shaft body32is a sliding surface in point contact with the second guide section53.

In addition, in the embodiment, the first guide section24and the second guide section53have inclined surfaces24D and53D that are inclined in a V shape respectively. The first guided section34D and the second guided section35D come in point contact with the inclined surface24D and the inclined surface53D.

Even when a rotational center of the actuation section31D is inclined, the first guided section34D or the second guided section35D respectively comes in point contact with the first guide section24or the second guide section53. For this reason, in comparison with the actuation section31of the first embodiment, in the actuation section31D including the pair of guided sections33D of the embodiment, sliding resistance when the actuation section31D is pulled in a state in which a rotational center is inclined is reduced, and the tissue of the living body is capable of being dissected with a small force.

Next, a sixth embodiment of the present invention will be described.FIG. 18is a schematic view showing an actuation section31E and a first guide section24of a surgical instrument according to the embodiment.

As shown inFIG. 18, in the embodiment, the actuation section31E having a different configuration from the actuation section31described in the first embodiment is provided instead of the actuation section31described in the first embodiment.

The actuation section31E has a first guided section34E having an elliptical disk shape, instead of the first guided section34of the first embodiment.

The first guided section34E has a longitudinal axis larger than a width wl of the first guide section24and a short axis slightly smaller than the width w1of the first guide section24.

In the embodiment, the actuation section31E is assembled upon assembly of the first jaw10such that the blade section39is disposed closer to a proximal side than the shaft body32when the first guided section34E enters the first guide section24. For this reason, a rotatable range of the actuation section31E is limited to a range in which the first guided section34E is rotatable in the first guide section24. A stopper structure constituted by the first guided section34E abuts onto the first guide section24to restrict that the shaft body32rotates 180° or more with respect to the first guide section24.

In the embodiment, movement of the blade section39to the distal side farther than the shaft body32is prevented by the first guided section34E. For this reason, the blade edge39aof the blade section39is always substantially directed toward the distal side. For this reason, when the actuation section31E is pulled using the dissection connecting member7a, it is prevented that the tissue is not dissected as a result from abutting a side of the blade section39opposite to the blade edge39awith the tissue.

In the embodiment, a second guided section (not shown) having an elliptical disk shape may be provided instead of the second guided section35of the first embodiment.

Next, a seventh embodiment of the present invention will be described.FIG. 19is a cross-sectional view showing configurations of an actuation section31F, a first guide section24F and a second guide section53F of a surgical instrument according to the embodiment, and showing the same cross section taken along line III-III ofFIG. 2.

As shown inFIG. 10, in the embodiment, the first guide section24F and the second guide section53F having different configurations from the first guide section24and the second guide section53described in the first embodiment are provided instead of the first guide section24and the second guide section53described in the first embodiment. In addition, in the embodiment, the actuation section31F having a different configuration from the actuation section31described in the first embodiment is provided instead of the actuation section31described in the first embodiment.

The first guide section24F has a wall section24Fa and a wall section24Fb having different heights at an inner periphery side and an outer periphery side of the curved shape of the groove section22.

The second guide section53F has a wall section53Fa and a wall section53Fb having different heights at an inner periphery side and an outer periphery side of the curved shape of the groove section22.

The actuation section31F has a pair of guided sections33F constituted by a first guided section34F and a second guided section35F, instead of the pair of guided sections33described in the first embodiment.

The first guided section34F has a first inner rotation member40rotatable with respect to the shaft body32, a first outer rotation member41coaxial with the first inner rotation member40and connected to the first inner rotation member40, and a pulley plate42connected to the dissection connecting member7alike the first embodiment.

The first inner rotation member40and the first outer rotation member41are relatively rotatable about the centerline C1of the shaft body32serving as a rotational center.

The first inner rotation member40is capable of abutting the wall section24Fa at the inner periphery side of the curved shape of the groove section22, in the wall section24Fa and the wall section24Fb.

The first outer rotation member41is capable of abutting the wall section24Fb at the outer periphery side of the curved shape of the groove section22, in the wall section24Fa and the wall section24Fb.

The second guided section35F has a second inner rotation member43that is rotatable with respect to the shaft body32, and a second outer rotation member44coaxial with the second inner rotation member43and connected to the second inner rotation member43.

The second inner rotation member43and the second outer rotation member44are relatively rotatable about the centerline C1of the shaft body32serving as a rotational center.

The second inner rotation member43is capable of abutting the wall section53Fa at the inner periphery side of the curved shape of the groove section22, in the wall section53Fa and the wall section53Fb.

The second outer rotation member44is capable of abutting the wall section53Fb at the outer periphery side of the curved shape of the groove section22, in the wall section53Fa and the wall section53Fb.

In the embodiment, when the actuation section31F is guided by the first guide section24F and the second guide section53F, the first inner rotation member40and the first outer rotation member41is capable of being rotated in opposite directions, and the second inner rotation member43and the second outer rotation member44is capable of being rotated in opposite directions.

For this reason, the pair of guided sections33F are rolled with respect to the first guide section24F and the second guide section53F, and a resistance at this time is rolling friction smaller than sliding friction. As a result, the actuation section31F and the blade section39thereof smoothly advance along the groove section22.

While embodiments of the present invention have been described in detail above with reference to the accompanying drawings, the specific configurations are not limited to the embodiment but may include design changes without departing from the spirit of the present invention.

For example, while the flexible surgical instrument1including the flexible tube61has been exemplarily described in the embodiments, a hard shaft may be provided instead of the flexible tube61.

While an example in which the first jaw10and the second jaw50are opened and closed by using the open-close knob66has been described in the above-mentioned embodiments, the jaws may be configured such that an open-close operation in the cartridge unit2and dissection of the tissue by the blade section39of the actuation section31are performed as one operation. For example, when the actuation section31is moved to the distal side of the cartridge unit2by using the lever67, the actuation section31may be configured to connect the first jaw10and the second jaw50to move the first jaw10toward the second jaw50. In this case, the open-close operation in the cartridge unit2and dissection of the tissue by the blade section39of the actuation section31may be performed as one operation using the lever67.

While embodiments of the present invention have been described above, the technical scope of the present invention is not limited to the embodiments, but combination of the components in the embodiments can be varied, and various modifications of the components can be added or deleted without departing from the spirit of the present invention. The present invention is not limited to the above-mentioned description.