Abstract:
A medical treatment device includes a suturing-ligating member, a stopper, a fixing member and a suturing-ligation releasing member. The suturing-ligating member has a distal end portion, that carries out one of suturing and ligation of biological tissue by puncturing. The stopper is provided to be movable forward or backward on the suturing-ligating member, and stoppable by friction on the suturing-ligating member to maintain the biological tissue in a sutured or ligated state by the suturing-ligating member. The fixing member is provided on the distal end side of the suturing-ligating member to fix the distal end side of the suturing-ligating member to the biological tissue. The releasing member is provided on the distal end side of the suturing-ligating member to release the ligation state maintained by frictional stopping between the suturing-ligating member and the stopper by moving the suturing-ligating member to the distal end portion side with respect to the stopper.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This application claims the benefit of U.S. Provisional Application No. 60/572,967, filed May 20, 2004. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     1. Field of the Invention  
         [0003]     The present invention relates to a treatment system for living tissues, which is used to perform endoscopic treatment, such as suturing or ligating an internal living tissue, in combination with an endoscope and other instruments.  
         [0004]     2. Description of the Related Art  
         [0005]     A device that sutures or ligates an internal tissue under endoscopic observation, that is, a ligation treatment device used for endoscopic treatment, is disclosed in U.S. Pat. Appln. Publication Specification No. 2003/0236535A1 (hereinafter referred to as publication). The device disclosed in this publication can suture or ligate the tissue by penetrating a ligature having a fixing member through the tissue. In order to release a sutured or ligated state of the tissue, the ligature is cut or removed from the tissue with a fixing member grasped. If a desired region fails to be sutured or ligated, for example, the ligature is cut to release the sutured or ligated state. For example, a scissor forceps or the like is endoscopically used to cut the ligature. Besides, the fixing member is grasped and removed from the tissue by endoscopically using a grasping forceps or the like.  
       BRIEF SUMMARY OF THE INVENTION  
       [0006]     According to an aspect of this invention, there is provided a medical treatment device includes a suturing-ligating member, a stopper, a fixing member and a suturing-ligation releasing member. The suturing-ligating member has a distal end portion, that carries out one of suturing and ligation of biological tissue by puncturing. The stopper is provided to be movable forward or backward on the suturing-ligating member, and stoppable by friction on the suturing-ligating member to maintain the biological tissue in a sutured or ligated state by the suturing-ligating member. The fixing member is provided on the distal end side of the suturing-ligating member to fix the distal end side of the suturing-ligating member to the biological tissue. The releasing member is provided on the distal end side of the suturing-ligating member to release the ligation state maintained by frictional stopping between the suturing-ligating member and the stopper by moving the suturing-ligating member to the distal end portion side with respect to the stopper.  
         [0007]     Advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. Advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter. 
     
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING  
       [0008]     The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention, and together with the general description given above and the detailed description of the preferred embodiments given below, serve to explain the principles of the invention.  
         [0009]      FIG. 1  is a schematic sectional view of a treatment system for living tissues according to a first embodiment of this invention, showing a state in which a ligation treatment device, ligation instrument, and puncture needle are combined;  
         [0010]      FIG. 2  is a schematic perspective view showing the ligation treatment device of the treatment system according to the first embodiment;  
         [0011]      FIG. 3  is a schematic sectional view showing a state in which the puncture needle of the treatment system for living tissues according to the first embodiment is located close to a target tissue;  
         [0012]      FIG. 4  is a schematic sectional view showing a state in which the puncture needle of the treatment system for living tissues according to the first embodiment is inserted through the target tissue;  
         [0013]      FIG. 5  is a schematic sectional view showing a state in which a cylindrical member and a flexible wire of the ligation treatment device is disengaged from the puncture needle of the treatment system for living tissues according to the first embodiment;  
         [0014]      FIG. 6  is a schematic sectional view showing the way the target tissue is ligated by means of the ligation treatment device of the treatment for living tissues according to the first embodiment;  
         [0015]      FIG. 7  is a schematic perspective view showing a state in which a ligature on the proximal end side of a silicone tube is cut after the target tissue is ligated by means of the ligation treatment device of the treatment system for living tissues according to the first embodiment;  
         [0016]      FIG. 8  is a schematic perspective view showing a state in which the flexible wire is grasped with a grasping forceps to release the ligation after the target tissue is ligated with the ligation treatment device of the treatment system for living tissues according to the first embodiment;  
         [0017]      FIG. 9  is a schematic perspective view showing a state in which the flexible wire is grasped with the grasping forceps to release the ligation and the ligature is drawn out of the target tissue after the target tissue is ligated with the ligation treatment device of the treatment system for living tissues according to the first embodiment;  
         [0018]      FIG. 10  is a schematic perspective view showing a state in which two separate tissues are sutured by means of the ligation treatment system for living tissues according to the first embodiment;  
         [0019]      FIG. 11  is a schematic perspective view showing a ligation treatment device of a treatment system according to a second embodiment;  
         [0020]      FIG. 12  is a schematic perspective view showing a ligation treatment device of a treatment system according to a third embodiment;  
         [0021]      FIG. 13  is a schematic perspective view showing a ligation treatment device of a treatment system according to a fourth embodiment;  
         [0022]      FIG. 14  is a schematic perspective view showing a ligation treatment device of a treatment system according to a fifth embodiment;  
         [0023]      FIG. 15  is a schematic perspective view showing a ligation treatment device of a treatment system according to a sixth embodiment; and  
         [0024]      FIG. 16  is a schematic perspective view showing a ligation treatment device of a treatment system according to a seventh embodiment. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0025]     Preferred embodiments of this invention will now be described with reference to the drawings.  
         [0026]     A first embodiment will first be described with reference to FIGS.  1  to  9 .  
         [0027]     A treatment system  10  for living tissues shown in  FIG. 1  is a device for ligating living tissues, and is used for valve formation such that a tissue is ligated and bossed endoscopically, that is, by utilizing an endoscope, for example. This system  10  includes a ligation treatment device  12  for ligation treatment. It also includes a ligation instrument  14  and a puncture needle  16 , which are used individually in combination with the ligation treatment device  12 .  
         [0028]     As shown in  FIG. 2 , the treatment device  12  includes a ligature (ligating member)  22 , cylindrical member (ligature fixing member)  24 , silicone tube (stopper)  26 , proximal-end loop portion  28  formed on the proximal end portion of the ligature  22 , and flexible wire  30 .  
         [0029]     The cylindrical member  24  is provided on the distal end portion of the ligature  22  that is used to ligate the tissue. The cylindrical member  24  bears one end portion that retains a desired position when the tissue is ligated with the ligature  22 .  
         [0030]     The ligature  22  is passed through the silicone tube  26 . The silicone tube  26  is kept in a desired position relative to the ligature  22  by frictional force. It moves on the ligature  22  only when it is subjected to a given or greater force along the ligature  22 . Thus, the silicone tube  26  serves as a stopper that keeps the ligature  22  in a desired position relative to the tissue when the tissue is ligated with the ligature  22 . The silicone tube  26  bears the other end portion that, along with the cylindrical member  24 , retains the desired position when the tissue is ligated with the ligature  22 .  
         [0031]     The flexible wire  30  is connected to the ligature  22  at a region near the distal end portion of the ligature  22 . Although the flexible wire  30  is described as being one in number in connection with this embodiment, a plurality of flexible wires, e.g., two or three, may alternatively be connected to the ligature  22 . If too many flexible wires  30  are connected to the ligature  22 , they may possibly exert a bad influence, such as twining around the treatment device  12  when it is indwelt in a body cavity. Preferably, therefore, they should be one or two in number. Although the flexible wire  30  is described as being a wire rod in connection with this embodiment, it may alternatively be in the form of a belt.  
         [0032]     The flexible wire  30  may be formed of any material that is flexible and strong enough to stand a pull when ligation is released. For example, it may be made of a stretched polyamide-based synthetic fiber, a material for a conventional suture, such as polypropylene, polyethylene terephthalate, or polytetrafluoroethylene, or a bioabsorbable material, such as polyglycol acid. This wire may be either a monofilament or a twisted yarn. The flexible wire  30  has a color that, unlike white, red, and yellow, does not resemble the colors of living tissues and is different from that of the ligature  22 . Thereupon, an operator can favorably enjoy good visibility when he/she observes the flexible wire  30  through the endoscope.  
         [0033]     As shown in  FIG. 1 , the ligation instrument  14  is provided with a ligation instrument sheath  38 , a hook wire  40 , and an operating handle (not shown). The hook wire  40  has a hook  40   a  on its distal end, which engages the proximal-end loop portion  28  of the ligature  22 , and is passed through the ligation instrument sheath  38 . The operating handle is provided at the proximal end portions of the ligation instrument sheath  38  and the hook wire  40 , in order to manipulate the hook wire  40 .  
         [0034]     The puncture needle  16  is hollowed so that the cylindrical member  24  and the flexible wire  30  including an expanded portion  31  of the treatment device  12  can be stored in it. The puncture needle  16  has a pusher wire  44  in its bore, in order to push out the cylindrical member  24  and the flexible wire  30  from the distal end portion of the puncture needle  16  when the distal end portion of the puncture needle  16  is in a desired position. The distal end portion of the pusher wire  44  has a pusher  44   a  that can advance and retreat along the axis of the puncture needle  16 . The puncture needle  16  is formed having a slit (not shown) through which the ligature  22  can be put into or taken out of the puncture needle  16 .  
         [0035]     The following is a description of operation according to the present embodiment. The operation described below is carried out endoscopically even in cases where no endoscope is illustrated. Described here are cases of ligating the target tissue  60  and releasing the ligation. The case of ligating the target tissue  60  will be described first.  
         [0036]     As shown in  FIG. 1 , the ligation instrument  14  and the puncture needle  16  are combined with the treatment device  12  (see  FIG. 2 ). The proximal-end loop portion  28  of the treatment device  12  is hitched to the hook  40   a  of the hook wire  40  of the ligation instrument  14 . The silicone tube  26  of the treatment device  12  is caused to engage the distal end portion of the ligation instrument sheath  38  of the ligation instrument  14 . The cylindrical member  24  and the flexible wire  30  including the expanded portion  31  of the treatment device  12  are loaded into the puncture needle  16 .  
         [0037]     As shown in  FIG. 3 , the puncture needle  16  of the treatment system  10  for living tissues in this state is brought close to the target tissue  60 .  
         [0038]     As shown in  FIG. 4 , the puncture needle  16  is inserted into target tissue  60 , and the distal end portion of the puncture needle  16  is projected from the target tissue  60 .  
         [0039]     As shown in  FIG. 5 , the pusher wire  44  of the puncture needle  16  is advanced toward the distal end portion of the puncture needle  16 , whereby the cylindrical member  24  and the flexible wire  30  are discharged to the outside of the puncture needle  16 .  
         [0040]     As shown in  FIG. 6 , the puncture needle  16  is drawn out of the tissue  60 , and the ligature  22  is indwelt in the tissue  60 . Since the cylindrical member  24  and the flexible wire  30  are located on the distal end portion of the ligature  22 , the cylindrical member  24  and the flexible wire  30  are anchored to the tissue  60 . If the hook wire  40  of the ligation instrument  14  is pulled with respect to the ligation instrument sheath  38 , silicone tube  26  is pushed by the distal end portion of the ligation instrument sheath  38  as the silicone tube  26  is moved along the ligature  22  toward the distal end portion (or toward the cylindrical member  24 ). The target tissue  60  is held between the cylindrical member  24  and the silicone tube  26  as the tissue  60  is ligated. Movement of the silicone tube  26  relative to the ligature  22  is prevented by frictional force.  
         [0041]     After the tissue  60  is ligated, as shown in  FIG. 7 , an odd of the ligature  22  on the proximal end side of the silicone tube  26  is cut.  
         [0042]     The following is a description of the case of releasing the target tissue  60  from the ligation.  
         [0043]     As shown in  FIG. 8 , an endoscope  50  used has a channel  50   a  through which a grasping forceps  48  can be passed. The flexible wire  30  is grasped with the grasping forceps  48  that is passed through the channel  50   a,  and the flexible wire  30  is pulled with a force that is greater than the frictional fixing force of the silicone tube  26 . Since the flexible wire  30  is connected to the ligature  22  at the region near its distal end portion, the ligature  22  is trailed toward the distal end so that the cylindrical member  24  is moved away from the tissue  60 . The ligature  22  that is connected to the cylindrical member  24  is also drawn out of the tissue  60  and disengaged from the tissue  60 .  
         [0044]     As shown in  FIG. 9 , a sutured or ligated state is released, whereupon the silicone tube  26  comes off the ligature  22 . The cylindrical member  24  must have a size such that it can be stored in the puncture needle  16 . If the tissue  60  is released from the ligation by causing the silicone tube  26  to come off the proximal end side of the ligature  22 , therefore, the cylindrical member  24  may possibly be buried in the tissue  60 . If the silicone tube  26  is made large enough not to be buried in the tissue  60 , according to this embodiment, the ligation of the tissue  60  is released from the distal end portion side (side of the cylindrical member  24 ) of the ligature  22 . Thus, the cylindrical member  24  can be prevented from being buried in the tissue  60  when the ligation is released.  
         [0045]     According to this embodiment, as described above, the following effects can be enjoyed.  
         [0046]     In releasing the tissue  60  from the ligation, the flexible wire  30  is grasped with the grasping forceps  48 . Therefore, the flexible wire  30  can be grasped more easily through the endoscope  50  than when the cylindrical member  24  is grasped directly. Thus, the tissue  60  can be prevented from being wrongly influenced. Since the expanded portion  31  is provided on the distal end of the flexible wire  30 , the flexible wire  30  can be prevented from failing to be seized when it is grasped with the grasping forceps  48 .  
         [0047]     The ligature  22  can be drawn out from the silicone tube  26 , as well as from the tissue  60 , without regard to the direction in which the flexible wire  30  is pulled when the flexible wire  30  is grasped with the grasping forceps  48 .  
         [0048]     As shown in  FIG. 10 , the treatment system  10  for living tissues according to this embodiment may be also used to suture, for example, two tissues  60   a  and  60   b  that are separate from each other. For example, it can suture and close perforations such as ulcers in the tissues  60   a  and  60   b.    
         [0049]     A second embodiment will now be described with reference to  FIG. 11 . This embodiment is a modification of the first embodiment. Like numerals are used to designate like members described in connection with the first embodiment, and a detailed description of those members is omitted.  
         [0050]     As shown in  FIG. 11 , a ligation treatment device  12   a  according to this embodiment differs from the ligation treatment device  12  (see  FIG. 2 ) according to the first embodiment in that a flexible wire  30  is connected to a ligature  22  by means of a loop-shaped loop portion  32 .  
         [0051]     The same functions and effects of the first embodiment can be obtained with use of this treatment device  12   a.  Besides, the flexible wire  30  has the loop portion  32 , so that it can be also held by being hooked by the grasping forceps  48 , for example. Thus, the flexible wire  30  can be kept easily graspable. Since the loop portion  32  doubles the flexible wire  30  that is grasped by means of the grasping forceps  48 , pull force that is obtained with use of the grasping forceps  48  can be made greater than in the case where the flexible wire  30  is single (see  FIG. 2 ).  
         [0052]     A third embodiment will now be described with reference to  FIG. 12 . This embodiment is a modification of the first embodiment. Like numerals are used to designate like members described in connection with the first embodiment, and a detailed description of those members is omitted.  
         [0053]     As shown in  FIG. 12 , a ligation treatment device  12   b  according to this embodiment differs from the ligation treatment device  12  (see  FIG. 2 ) according to the first embodiment in a plurality of particulars.  
         [0054]     Two ligatures  22  are passed through a silicone tube  26 . More specifically, the ligatures  22  include a first ligature  22   a  and a second ligature  22   b.  The first and second ligatures  22   a  and  22   b  are connected to each other at their respective proximal end portions, and a proximal-end loop portion  28  is formed on the proximal end portions of the ligatures  22   a  and  22   b.  A first cylindrical member  24   a  is provided on the distal end portion of the first ligature  22   a.  A second cylindrical member  24   b  is provided on the distal end portion of the second ligature  22   b.    
         [0055]     Flexible wires  30   a  and  30   b  having an expanded portion  31  each are connected to the central portion (ligature junction) and a side end portion, respectively, of the first cylindrical member  24   a.  Thus, the flexible wires  30   a  and  30   b  are connected to the first cylindrical member  24   a,  not to the ligature  22 . Flexible wires  30   c  and  30   d  having an expanded portion  31  each are connected to the central portion (ligature junction) and a side end portion, respectively, of the second cylindrical member  24   b.  Thus, the flexible wires  30   c  and  30   d  are connected to the second cylindrical member  24   b,  not to the ligature  22 .  
         [0056]     The first and second cylindrical members  24   a  and  24   b  and the flexible wires  30   a,    30   b,    30   c  and  30   c  having their respective expanded portions  31  can be stored in the puncture needle  16 .  
         [0057]     The same functions and effects of the first embodiment can be obtained with use of this treatment device  12   b.  Besides, the flexible wires  30   a,    30   b,    30   c  and  30   d  extend from positions remoter from the tissue  60  when the tissue  60  is ligated, so that the flexible wires  30   a,    30   b,    30   c  and  30   d  can difficulty stick to the tissue  60 , and the flexible wires  30   a,    30   b,    30   c  and  30   d  can be easily grasped with the grasping forceps  48 . Since the flexible wires  30   a,    30   b,    30   c  and  30   d  are connected to the first and second cylindrical members  24   a  and  24   b  that are exposed on the surface of the tissue  60 , the flexible wires  30   a,    30   b,    30   c  and  30   d  can be difficultly buried in the tissue  60 .  
         [0058]     A fourth embodiment will now be described with reference to  FIG. 13 . This embodiment is a modification of the third embodiment. Like numerals are used to designate like members described in connection with the third embodiment, and a detailed description of those members is omitted.  
         [0059]     As shown in  FIG. 13 , a ligation treatment device  12   c  according to this embodiment differs from the ligation treatment device  12   b  (see  FIG. 12 ) according to the third embodiment in that flexible wires  30  have their respective loop-shaped loop portions  32  and are connected individually to respective the side end portions of first and second cylindrical members  24   a  and  24   b.    
         [0060]     The same functions and effects of the third embodiment can be obtained with use of this treatment device  12   c.  Besides, the flexible wires  30  have the loop portions  32 , so that they can be also held by being hooked by the grasping forceps  48 , for example. Thus, the flexible wires  30  can be kept easily graspable. Since the loop portions  32  double the flexible wires  30  that are grasped by means of the grasping forceps  48 , pull force that is obtained with use of the grasping forceps  48  can be made greater than in the case where the flexible wire  30  is single (see  FIG. 2 ).  
         [0061]     A fifth embodiment will now be described with reference to  FIG. 14 . This embodiment is a modification of the third embodiment. Like numerals are used to designate like members described in connection with the third embodiment, and a detailed description of those members is omitted.  
         [0062]     As shown in  FIG. 14 , a ligation treatment device  12   d  according to this embodiment differs from the ligation treatment device  12   b  (see  FIG. 12 ) according to the third embodiment in a plurality of particulars.  
         [0063]     A first distal-side pledget  54   a  is located between a first cylindrical member  24   a  and a silicone tube  26  and near the first cylindrical member  24   a  in a manner such that it is penetrated by a first ligature  22   a.  The first distal-side pledget  54   a  is formed with a hole in its central portion, through which the first ligature  22   a  is passed. Likewise, a second distal-side pledget  54   b  is located between a second cylindrical member  24   b  and the silicone tube  26  and near the second cylindrical member  24   b  in a manner such that it is penetrated by a second ligature  22   b.  The second distal-side pledget  54   b  is formed with a hole in its central portion, through which the second ligature  22   b  is passed.  
         [0064]     A proximal-side pledget  56  is located between the silicone tube  26  and the first and second distal-side pledgets  54   a  and  54   b  and near the silicone tube  26  in a manner such that it is penetrated by the first and second ligatures  22   a  and  22   b.  The proximal-side pledget  56  is formed with a hole in its central portion, through which the first and second ligatures  22   a  and  22   b  are passed. The first and second distal-side pledgets  54   a  and  54   b  and the proximal-side pledget  56  can be stored in a puncture needle  34 . Thus, the tissue  60  is held between the proximal-side pledget  56  and the first and second distal-side pledgets  54   a  and  54   b  when it is ligated.  
         [0065]     A flexible wire  30   b  is connected to a side end portion of the first cylindrical member  24   a.  A flexible wire  30   d  is connected to a side end portion of the second cylindrical member  24   b.  Flexible wires  30   a  and  30   c  (see  FIG. 12 ) are not connected to the respective central portions (ligature junctions) of the first and second cylindrical members  24   a  and  24   b.    
         [0066]     The same functions and effects of the third embodiment can be obtained with use of this treatment device  12   d.  Besides, the first and second distal-side pledgets  54   a  and  54   b  increase the area of contact with the tissue  60  when the tissue  60  is ligated, so that the first and second cylindrical members  24   a  and  24   b  can be securely prevented from being buried in the tissue  60 . Since the proximal-side pledget  56  increases the area of contact with the tissue  60  when the tissue  60  is ligated, the silicone tube  26  can be securely prevented from being buried in the tissue  60 .  
         [0067]     Since the first and second cylindrical members  24   a  and  24   b  are exposed on the tissue  60  without being buried in the tissue  60 , the flexible wires  30  are not buried in the tissue  60 , so that the flexible wires  30   b  and  30   d  can be kept easily graspable by means of the grasping forceps  48 .  
         [0068]     A sixth embodiment will now be described with reference to  FIG. 15 . This embodiment is a modification of the fifth embodiment. Like numerals are used to designate like members described in connection with the fifth embodiment, and a detailed description of those members is omitted.  
         [0069]     As shown in  FIG. 15 , a ligation treatment device  12   e  according to this embodiment differs from the ligation treatment device  12   d  (see  FIG. 14 ) according to the fifth embodiment in a plurality of particulars.  
         [0070]     Flexible wires  30  are attached to first and second distal-side pledgets  54   a  and  54   b,  individually. The flexible wires  30  have their respective loop-shaped loop portions  32 , which are passed through holes in the respective end portions of the first and second distal-side pledgets  54   a  and  54   b,  individually.  
         [0071]     The same functions and effects of the fifth embodiment can be obtained with use of this treatment device  12   e.  Besides, the flexible wires  30  are connected to the respective end portions of the first and second distal-side pledgets  54   a  and  54   b,  so that they can be difficulty subjected to pressure between the tissue  60  and first and second cylindrical members  24   a  and  24   b.  Thus, the first and second cylindrical members  24   a  and  24   b  can be difficulty buried in the tissue  60 , so that the flexible wire  30  can be kept easily graspable.  
         [0072]     Since the flexible wires  30  have the loop portions  32 , they can be also held by being hooked by the grasping forceps  48 , for example, so that the flexible wires  30  can be kept easily graspable. Since the loop portions  32  double the flexible wires  30  that are grasped by means of the grasping forceps  48 , pull force that is obtained with use of the grasping forceps  48  can be made greater than in the case where the flexible wire  30  is single (see  FIG. 14 ).  
         [0073]     A seventh embodiment will now be described with reference to  FIG. 16 . This embodiment is a modification of the sixth embodiment. Like numerals are used to designate like members described in connection with the sixth embodiment, and a detailed description of those members is omitted.  
         [0074]     As shown in  FIG. 16 , a ligation treatment device  12   f  according to this embodiment differs from the ligation treatment device  12   e  (see  FIG. 15 ) according to the sixth embodiment in that flexible wires  30  having expanded portions  31  on their respective distal ends are connected to first and second distal-side pledgets  54   a  and  54   b,  individually.  
         [0075]     With use of this treatment device  12   f,  compared with the sixth embodiment, the flexible wires  30  are shaped so that they are not space-consuming when the treatment device  12   f  is endoscopically indwelt in a human body. Thus, food or the like being deglutition or the endoscope  50  or the grasping forceps  48  being disengaged can be prevented from catching the flexible wires  30 .  
         [0076]     Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.