Patent Publication Number: US-2011071474-A1

Title: Organ Fixture and Gastric Fistula Catheter Set

Description:
FIELD OF THE DISCLOSURE 
     The present disclosure concerns an organ-fixing instrument and gastric fistula catheter set used when fixing a predetermined organ to a skin wall region with suturing thread in the body of the patient. 
     BACKGROUND OF THE DISCLOSURE 
     Conventionally, an organ-fixing instrument has been used to fix a predetermined organ to a skin wall region with suturing thread in the body of a patient. For example, a gastric fistula catheter has been used to supply fluid food, nutrient agents, or other such fluid food and drink to individuals with diminished ability to consume food through the mouth on their own due to old age or illness; however, such a gastric fistula catheter is installed by forming a hole in the abdomen of the patient. In such an instance, an organ-fixing instrument is used to fix the abdominal wall and gastric wall together in advance in order to install a gastric fistula catheter properly. 
     This organ-fixing instrument (medical instrument) is equipped with two puncture needles disposed parallel to each other to maintain spacing, and when used to fix the stomach, first, the two puncture needles are used to pierce the interior of the stomach simultaneously from the skin surface of the body of the patient. Next, a suturing thread is passed through one puncture needle; a stylet equipped with a rod-shaped member and an annular member secured to the tip of the rod-shaped member is passed through the other puncture needle; and the stylet is withdrawn from the puncture needle in a state wherein the suturing thread is grasped by the annular member inside the stomach. The two puncture needles are then withdrawn from the patient, and fixation of the stomach to the skin wall region is completed by tying both end-portions of the suturing thread protruding from the body of the patient. 
     With a conventional organ-fixing instrument, a suturing thread must be grasped by an annular member within the stomach, and for this purpose, a stylet must be inserted into a puncture needle skillfully, and the protruding direction and shape of the annular member must be correct. But a problem exists in that this procedure is difficult, it is consequently difficult to make the annular member grasp the suturing thread, and reliability is low. 
     The present invention was created in order to address such problems and has an object of offering an organ-fixing instrument and gastric fistula catheter set able to accomplish proper suturing reliably and through a simple procedure. 
     SUMMARY OF THE DISCLOSURE 
     To achieve the aforementioned object, the structural characteristics of the organ-fixing instrument pertaining to the present invention are an organ-fixing instrument equipped with a transversely elastic cylindrical sheath and a body surface installation part attached to the base end part of the sheath, used when fixing a predetermined organ to the skin-side wall area with suturing thread in the body of a patient; wherein the body surface insulation part is equipped with a through-hole communicating with the sheath, and with a pair of needle through-holes enclosing the through-hole and formed at both sides of the through-hole and allowing passage of a puncture needle approximately parallel to the sheath; and wherein the sheath is equipped with a suturing thread catch which is provided at the tip side of the sheath and projected in a transverse direction by application of a force which tends to bring both ends closer to each other along an axial direction and which is deformed when the puncture needles pass into the pair of needle through-holes until said puncture needles reach a puncturable location. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates the organ-fixing instrument pertaining to one preferred embodiment of the present invention; in the figure, (a) is a planar view, and (b) is a frontal view. 
         FIG. 2  is a cross-sectional view illustrating a state in which the suturing thread catch of a sheath projects in a transverse direction. 
         FIG. 3  is a frontal view illustrating a state in which an organ-fixing instrument is inserted into a hole part along a guide wire passed through the hole part. 
         FIG. 4  is a partial frontal view illustrating a cross-section of part of a state in which a dilator is inserted into an organ-fixing instrument, and the diameter of a sheath and hole part are enlarged. 
         FIG. 5  is a frontal view illustrating a dilator. 
         FIG. 6  is a frontal view illustrating a gastric fistula catheter; in the figure, (a) is a planar view, and (b) is a frontal view. 
         FIG. 7  is a frontal view illustrating a state in which a gastric fistula catheter is extended by an extender. 
         FIG. 8  is a frontal view illustrating a cross-section of part of a state in which an extended gastric fistula catheter is inserted into an organ-fixing instrument. 
         FIG. 9  illustrates a state in which a suturing thread catch has been extended in a transverse direction by restoring a gastric fistula catheter to its original state; in the figure (a) is a frontal view illustrating a partial cross-section, and (b) is a bottom view. 
         FIG. 10  illustrates a state in which a pair of suturing needles into which a suturing thread has been passed are inserted from a body surface installation part and passed through a suturing thread catch; in the figure, (a) is a frontal view illustrating a partial cross-section, and (b) is a bottom view. 
         FIG. 11  is a frontal view illustrating a cross-section of a partial state in which a pair of puncture needles and an organ-fixing instrument have been withdrawn, and a suturing thread has been passed through the skin surface into an organ and made to project from the skin surface. 
         FIG. 12  is a frontal view illustrating a cross-section of a partial state in which implantation of a gastric fistula catheter and suturing of the stomach have been completed. 
     
    
    
     DETAILED DESCRIPTION OF THE DISCLOSURE 
     In the organ-fixing instrument pertaining to the present invention and thus structured, at the body surface installation part, there are formed a through-hole communicating with the sheath, and a pair of needle through-holes allowing passage of a puncture needle, and at the tip side of the sheath, there is provided a suturing thread catch projected in a transverse direction by application of a force which tends to bring both ends closer to each other along an axial direction, and which is deformed until the puncture needles passing through the needle through-holes reach a puncturable location. For this purpose, holes passing form the skin surface side of the body of a patient into an organ are provided, and the suturing thread catch can be inserted from the skin surface side of the body of a patient into an organ and put into a state projecting in a transverse direction in the organ by passing the sheath of the organ-fixing instrument through these holes. In such an instance, the suturing thread catch is projected in a transverse direction by inserting a gastric fistula catheter or other such elastic item from the through-holes in the body surface installation part into the sheath and extending or contracting, etc. within the sheath. 
     When a pair of puncture needles in each of which a suturing thread has been inserted is then inserted from the pair of needle through-holes in the body surface installation part, and the tip thereof punctures the suturing thread catch and the suturing thread is thereby wrapped onto the suturing thread catch, the pair of suturing threads and the sheath assume a nearly U-shaped continuous form passing from the holes made by the puncture needles, into and through the organ, and through the holes where the sheath has been inserted. In this state, when the pair of puncture needles and organ-fixing instrument sheath are withdrawn from the body of the patient with the suturing threads remaining in the body of the patient, the tip portion of the pair of suturing threads projects from each hole made by the puncture needles, into and through the organ, from the holes where the sheath has been inserted, and to the skin surface side. 
     Thus, by tying both sides of each among the pair of suturing threads located on the skin side of the patient, the organ can be fixed to a skin layer of the patient with the pair of suturing threads. In this instance, the tip part of the suturing thread has been given a structure able to wrap onto the suturing thread catch. Thereby, simply by passing the pair of puncture needles, through each of which a suturing thread has been passed, through a pair of needle through-holes in the body surface installation part, the tip thereof punctures the suturing thread catch, and the suturing thread is wound onto the suturing thread catch by pulling the suturing thread in a state in which the puncture needles have been withdrawn from the suturing thread catch. The procedure to wrap the suturing thread onto the suturing thread catch is thereby facilitated, and the suturing thread is also wrapped onto the suturing thread catch reliably. 
     Additionally, because the sheath of the organ-fixing instrument has been formed with a transversely elastic, cylindrical shape, the sheath assumes a narrow rod-shape when inserted into the body of a patient, and once the sheath has been inserted into the body, the diameter of the sheath and the holes formed in the body of the patient can be enlarged by inserting a dilator into the sheath. Subsequent procedures are thereby facilitated; for example, installation of a gastric fistula catheter in the holes formed in the body. In this instance, installation of a gastric fistula catheter and fixation of the stomach can be performed simultaneously. 
     Another structural characteristic of the organ-fixing instrument pertaining to the present invention is that the body of the sheath is structured by a cover part comprising a tube made from a resin and equipped with a webbed locking part, and the suturing thread catch is structured by the provision at the tip of the covering part of a skeletal part with a hinged structure. 
     Because the body of the sheath is structured by a covering part comprising a tube made from a resin equipped with a webbed locking part, the suturing thread wraps easily onto the suturing thread catch. Examples which may be used as such a tube are a webbed tube comprising a web made from a resin, or a webbed tube incorporating a laminate resin and a web made from a resin. Additionally, skeletal parts may, for example, be structured by a pair of rod-shaped bodies or the like with a bend formed at the center in the lengthwise direction, and with the bend made to project toward the outside in each case when compression is applied in an axial direction. In this instance, the skeletal part is made to project not in the entire circumferential direction, but at a location puncturable by the pair of puncture needles, and the covering part is made to spread together with the skeletal part. This covering part may, for example, be given a structure made long and slender by pulling the base and tip parts in opposite directions, or a webbed, cylindrical body spread in a transverse direction by pulling in a circumferential direction. The skeletal part is also structured by an item which bends when a sheath endowed with plasticity is withdrawn to the outside of the body. 
     Yet another structural characteristic of the organ-fixing instrument pertaining to the present invention is that a reinforcing part is provided extending along an axial direction at the base region of the covering part. The strength of the base end portion of the sheath located at holes is thereby greatly increased when the sheath is inserted into holes formed in the body of a patient. Any occurrence of misalignment between the holes provided at the skin side of the body and the holes provided in the organ is thus prevented. The item used as a reinforcing part in this instance is a plurality of rod-shaped members disposed to maintain spacing in the circumferential direction of the sheath, or another such item not impeding extension and contraction of the sheath in a transverse direction. The reinforcing part may also comprise an item endowed with plasticity and able to bend when the sheath is withdrawn from the body. 
     Yet another structural characteristic of the organ-fixing instrument pertaining to the present invention is the ability provided to insert a thread into the sheath, link the tip thereof to the tip of the sheath, and draw the suturing thread catch in a transverse direction by pulling the base side of the thread. Drawing of the suturing thread catch in a transverse direction is thereby accomplished through a simple means. 
     A structural characteristic of the gastric fistula catheter set pertaining to the present invention is that the gastric fistula catheter comprises the aforementioned organ-fixing instrument, and a bumper part attached to the tip of the tube, and once the tube and the bumper part are extended and inserted into the sheath and the bumper part is made to project from the tip aperture of the sheath, the suturing thread catch can be drawn in a transverse direction by restoring the tube and the bumper part to their original state. 
     Installation of a gastric fistula catheter and fixation of the stomach can thereby be performed simultaneously, and the procedure for installing a gastric fistula catheter in a patient is also facilitated. Elongation of the gastric fistula catheter can also be performed, for example, by inserting a rod-shaped extender from the tip aperture of the tube and pressing the bumper part at the tip thereof toward the tip, and restoration of the gastric fistula catheter to its original state can be performed by withdrawing the extender from within the gastric fistula catheter. In this instance, the suturing thread catch can be drawn in a transverse direction by pressing the tip of the suturing thread catch toward the base part only by the length that the tube and the tube-side portion of the bumper part are extended (the amount of contraction produced by releasing the pulling force). 
     A structural characteristic of the installation method pertaining to the present invention is the provision of a process in which a guide wire is passed from the skin surface of a patient to a predetermined organ in the body; a process in which a sheath of an organ-fixing instrument is passed, via the guide wire, from the skin surface of a patient to a predetermined organ in the body; a process in which a dilator is inserted into the organ-fixing instrument to spread the sheath and the holes provided in the body of the patient in a transverse direction; a process in which a gastric fistula catheter is elongated and inserted into the organ-fixing instrument wherein the sheath is spread in a transverse direction, and a bumper part is made to project from the tip aperture of the sheath; a process in which a suturing thread catch is drawn in a transverse direction by restoring the gastric fistula catheter to its original state; a process in which a pair of puncture needles, into which a suturing thread has been passed from a pair of puncture needle holes in a body surface installation part, is in each case made to puncture and pass through the suturing thread catch; a process in which the guide wire is withdrawn; a process in which the pair of puncture needles and the organ-fixing instrument are pulled toward the skin surface of the patient and the tip of the pair of suturing threads is in each case wrapped onto the suturing thread catch, and the tip portion of the pair of suturing threads is also drawn to the outside of the body together with the sheath; and a process in which the tips of each suturing thread in the pair of suturing threads are tied to each other. 
     The sheath of the organ-fixing instrument is thereby passed, via a guide wire, from the skin surface of a patient to an organ in the body, and the procedure for inserting the sheath into the body of the patient is thus facilitated. Additionally, once the sheath inserted into the body of the patient and the holes provided in the body of the patient are spread in a transverse direction by the dilator, an elongated gastric fistula catheter is inserted into the organ-fixing instrument, and the procedure for installing the gastric fistula catheter is thus facilitated. In addition, the bumper part restores the gastric fistula catheter located in the organ to its original state, and the suturing thread catch assumes a state drawn in a transverse direction, and the procedure for drawing the suturing thread catch in a transverse direction is thus facilitated. The tips of suturing threads then puncture the suturing thread catch and are wrapped onto the suturing thread catch simply by passing a pair of puncture needles, through each of which a suturing thread has been passed, into a pair of needle through-holes in the body surface installation part, and the procedure for wrapping the suturing thread onto the suturing thread catch is thereby facilitated, and the suturing thread is also wrapped reliably onto the suturing thread catch. 
     DETAILED DESCRIPTION OF THE DRAWINGS 
     In the drawings, the following symbols are used: 
       10 ) organ-fixing instrument,  11 ) body surface installation part,  12 ) sheath,  13 ) through-hole,  14 , 15 ) needle through-hole,  16 ) covering,  17 ) reinforcing part,  18 ) suturing thread catch,  18   a,   18   b ) skeletal part,  21 ) dilator,  22 ) gastric fistula catheter,  24 ) tube,  25 ) bumper,  31 , 32 ) puncture needle,  33   a,   33   b ) suturing thread, A) abdominal wall, B) stomach wall. 
     One preferred embodiment of the present invention is described hereafter using drawings.  FIG. 1  illustrates an organ-fixing instrument  10  pertaining to the present preferred embodiment. The organ-fixing instrument  10  comprises a body surface installation part  11  and a sheath  12  linked to the body surface installation part  11 . The body surface installation part  11  comprises a compact of a resin material; its planar aspect is formed as a nearly elliptical, thick sheet; and in a planar aspect passing from the top surface to the bottom surface there is formed an approximately rhomboid, large through-hole  13 . On both sides of the lengthwise direction of said through-hole  13 , small, circular needle through-holes  14 ,  15  are formed so as to enclose the through-hole  13  and assume a fixed distance from the through-hole  13 . The needle through-holes  14 ,  15  are parallel to each other and pass through the body surface installation part  11  from the top surface to the bottom surface. 
     The sheath  12  comprises a covering  16  comprising a transversely elastic body made from a webbed tube incorporating a laminate resin and a webbed locking part made from a resin; a plurality of reinforcing parts  17  formed on the inner circumferential surface of the base portion (body surface installation part  11  side) of the covering  16 ; and a pair of skeletal parts  18   a,    18   b  (see  FIG. 2 ) formed on the inner circumferential surface of the tip portion of the covering  16 . The upper end of the covering  16  is affixed to the inner circumferential surface of the through-hole  13  in the body surface installation part  11 . The reinforcing parts  17  comprise a plurality, for example four, of slender, rod-shaped parts disposed with maintenance of a fixed interval in the circumferential direction of the inner circumferential surface of the covering  16 , and said reinforcing parts  17  are formed so as to extend from the base-end region of the covering  16  to the approximate center of the covering  16 . The skeletal parts  18   a,    18   b  comprise rods in which the central part of each rod is formed in a thin-walled part, and in which said thin-walled part is bendable at the center, and said skeletal parts  18   a,    18   b  are provided opposite to each other at the tip region on the inner surface of the covering  16 . 
     The pair of skeletal parts  18   a,    18   b  are compressed in an axial direction, and as shown in  FIG. 2 , the central thin-walled portion is thus bent so as to project outward. At such time, the covering  16  is pressed and spread by the pair of skeletal parts  18   a,    18   b  and thus spreads while still covering the skeletal parts  18   a,    18   b.  A suturing thread catch  18  is comprised by the tip portion of the covering  16  and the pair of skeletal parts  18   a,    18   b.  The suturing thread catch  18  is designed such that its spreading direction is the same as the direction in which the needle through-holes  14 ,  15  of the body surface installation part  11  are provided. When the plurality of reinforcing parts  17  are brought into proximity to each other, and the skeletal parts  18   a,    18   b  are at the same time brought into proximity to each other so that the covering  16  approaches the central axis in contracting fashion, the sheath  12  assumes a long, slender rod shape; and when the respective reinforcing parts  17  are moved apart from each other and the skeletal parts  18   a,    18   b  are at the same time moved apart from each other so that the covering  16  spreads transversely, the sheath  12  assumes a cylindrical shape. 
     When an organ-fixing instrument  10  structured in this manner is used, for example, when the abdominal wall and stomach wall of a patient are sutured together to fix the stomach to the abdominal wall, first, as shown in  FIG. 3 , a guide wire GW is inserted into the abdominal wall A and the stomach wall B, and this guide wire GW is used to insert the sheath  12  of the organ-fixing instrument  10  into the hole AH in the abdominal wall A and the hole BH in the stomach wall B. When the guide wire GW is inserted, first, the body of the patient is punctured with a cannula (not illustrated) comprising a cylindrical puncture needle, and the tip thereof is brought to the inside of the stomach wall B. Next, the guide wire GW is passed through the cannula, and the tip of the guide wire GW is inserted at the inside of the stomach wall B. Then, with the guide wire GW remaining in the body of the patient, the cannula is withdrawn from the body of the patient. 
     Next, the extracorporeal portion of the guide wire GW is passed from the aperture at the tip of the sheath  12  to the interior and then projected to the outside from the through-hole  13  in the body surface installation part  11 . The organ-fixing instrument  10  is then pressed into the body along the guide wire GW, the tip portion of the sheath  12  is positioned on the inside of the stomach wall B, and the base portion of the sheath  12  is positioned at the hole AH in the abdominal wall A and the hole BH in the stomach wall B. These procedures create the state shown in  FIG. 3 . Next, as shown in  FIG. 4 , a dilator  21  is inserted from the through-hole  13  in the body surface installation part  11  toward the sheath  12 , and the sheath  12 , hole AH, and hole BH are spread transversely, as indicated by the arrow. 
     As shown in  FIG. 5 , the dilator  21  comprises a clasp  21   a  and a transverse expander  21   b  linked to the clasp  21   a;  the transverse expander  21   b  becomes progressively narrower from the base to the tip and comprises a rod-shaped body bent into an arcuate shape at the tip. A through-hole (not illustrated) allowing insertion of the guide wire GW is also formed from the top end of the clasp  21   a  (top end in state shown in  FIG. 4  and  FIG. 5 ) to the tip of the transverse expander  21   b.  Consequently, the dilator  21  can be moved along the guide wire GW with the extracorporeal portion of the guide wire GW in a state passing from the tip aperture of the dilator  21  to the interior and projecting to the exterior from the top end of the clasp  21   a.    
     Insertion of the transverse expander  21   b  into the sheath  12  from the through-hole  13  of the body surface installation part  11  expands the diameter of the sheath  12  and also allows the hole AH in the abdominal wall A and the hole BH in the stomach wall B to spread. At such time, the transverse expander  21   b  in the dilator  21  enters the sheath  12  along the lengthwise direction of the reinforcing parts  17 , thus allowing smooth insertion. Each reinforcing part  17  spreads to nearly equal intervals, with no misalignment to the location of the hole AH in the abdominal wall A and the hole BH in the stomach wall B. It is preferable to provide a lubricating coating to the surface of the dilator  21 . 
     Next, once the dilator  21  is withdrawn from the organ-fixing instrument  10 , the gastric fistula catheter  22  is installed in the organ-fixing instrument  10 . The gastric fistula catheter  22  is structured as shown in  FIG. 6 . Specifically, the gastric fistula catheter  22  comprises an external holder  23 , a tube  24  linked to the center of the bottom endface of the external holder  23 , and a bumper  25  linked to the tip of the tube  24 , with each element made from polyurethane. The external holder  23  comprises an insertion aperture  23   a  formed as a somewhat thick ring, and a pair of protrusions  23   b  protruding outward from both sides of the outer circumferential bottom end of the insertion aperture  23   a.    
     An insertion hole  23   c  passing from top to bottom is formed at the center of the insertion aperture  23   a,  and a check valve  23   d  with a slit formed centrally is provided on the inner circumferential surface of the insertion hole  23   c.  The shape of the external holder  23  as seen from above is the same as the shape of the through-hole  13  in the body surface installation part  11  as seen from above. The external holder  23  can thus be arranged to face the through-hole  13  and thereby allow insertion. 
     The tube  24  comprises a long-slender cylinder wherein there is formed a fluid flow path (not illustrated) for transport of a nutritional agent, fluid food, or other such fluid, and the top end of the fluid flow path communicates with the insertion hole  23   c  in the external holder  23 . The bumper  25  is connected to the bottom end of the tube  24 . The bumper  25  comprises four band-shaped linkages  25   a  extending in every direction from the edges of the bottom end aperture of the tube  24 , and four linkage film parts  25   b  provided between the top portion of each linkage  25   a,  and the tips of each linkage  25   a  are linked to each other. A hole  25   c  (see  FIG. 9(   b ) and  FIG. 10(   b )) is formed at the part of each linkage  25   a  where the tips are linked. The tube  24  and bumper  25  are each elastic. 
     The procedure for installing the gastric fistula catheter  22  in the organ-fixing instrument  10 , as shown in  FIG. 7 , is carried out with the organ-fixing instrument  10  in an extended state, using an extender comprising a rod  26  and a locking member  27 . The rod  26  is provided with a rod body  26   a  made from a stainless steel shaft, and with a plastic clasp  26   b.  A plastic insertion part  26   c  is attached at the tip of the rod body  26   a.  The insertion part  26   c  is formed with a stepped shape having a major diameter at its central portion in a vertical orientation, the diameter of a narrow part of the tip is smaller than the inner diameter of the hole  25   c  in the bumper  25 , and the diameter of the central major diameter part is larger than the inner diameter of the hole  25   c  in the bumper  25 . 
     Consequently, when the rod body  26   a  of the rod  26  is inserted toward the inside from the insertion hole  23   c  of the gastric fistula catheter  22 , the narrow-diameter part of the tip of the insertion part  26   c  enters the hole  25   c,  and the large-diameter part of the center of the insertion part  26   c  assumes a state of engagement with the part where the tip of each linkage  25   a  is linked. As a result, when the rod  26  is pressed into the gastric fistula catheter  22 , the tube  24  extends in a lengthwise direction, and the bumper  25  narrows and to some extent elongates. Additionally, on the top portion of the rod  26 , a cylindrical part  26   d  structured integrally with the clasp  26   b  is formed so as to cover the outer circumferential surface of the rod body  26   a,  and on the outer circumferential surface thereof, a plurality of catch parts  26   e  comprising a ring-shaped projection are formed at vertical intervals. A through-hole (not illustrated) allowing passage of the guide wire GW from the base to the tip of the rod  26  is also provided. 
     The locking member  27  is formed by working a stainless steel sheet and is provided with a lower locking part  28  and an upper locking part  29 . The lower locking part  28  and the upper locking part  29  are linked by a square, planar linking tab  27   a  elongated in a vertical direction. The lower locking part  28  comprises a retaining tab  28   a  which is approximately U-shaped in horizontal perspective and which, from the bottom end of the linking tab  27   a,  is formed perpendicular to the linking tab  27   a  and oriented horizontally to the near side of the illustration; and a pair of flanges  28   b  which, from both sides of the bottom end side regions of the linking tab  27   a,  are perpendicular to the linking tab  27   a  and parallel to the retaining tab  28   a  at an interval maintained from the retaining tab  28   a.  The inner portion of the approximately U-shaped retaining tab  28   a  is formed with a size able to admit the base of the tube  24 , and the interval between the retaining tab  28   a  and flanges  28   b  is a size able to enclose the pair of protrusions  23   b.    
     The tip of the retaining tab  28   a  is curved upward to prevent release of engagement with the pair of protrusions  23   b.  The upper locking part  29 , from the top end of the linking tab  27   a,  is formed perpendicular to the linking tab  27   a  and oriented horizontally to the near side of the illustration, and comprises a horizontal portion extending toward both sides of the linking tab  27   a,  Individual catch parts  26   e  and engagable catch recesses  29   a  are formed at the central near portion of the upper locking part  29 , and a pair of projections  29   b  intended to prevent release of engagement with the catch parts  26   e  project downward at both side regions of the catch recesses  29   a.    
     When the gastric fistula catheter  22  is extended using the extender, first, the rod body  26   a  of the rod  26  is inserted into the gastric fistula catheter  22 , and the tip of the insertion part  26   c  is inserted into the hole  25   c  in the bumper  25 . Next, with the protrusions  23   b  on the gastric fistula catheter  22  held between the retaining tab  28   a  and the flanges  28   b,  and the rod body  26   a  positioned inside the catch recesses  29   a,  the locking member  27  is applied to the gastric fistula catheter  22  and the rod  26 . Next, with the clasp  26   b  pressed, the locking member  27  is pulled upward, and the edge of the catch recesses  29   a  is made to engage a predetermined catch part  26   e.  Thereby, as shown in  FIG. 7 , the bumper  25  is stretched straight, the bumper  25  narrows, and the tube  24  and bumper  25  assume a shape nearly that of a single rod. The tube  24  is also elongated. 
     The gastric fistula catheter  22  in a state of extension by the extender, as shown in  FIG. 7 , is inserted into the organ-fixing instrument  10  which is itself inserted in the hole AH in the abdominal wall A and the hole BH in the stomach wall B, and the gastric fistula catheter  22  assumes the state in  FIG. 8 . In this instance, the procedure is performed by passing the guide wire GW into the through-hole of the rod  26 . Next, the catch recesses  29   a  are released from the catch parts  26   e  where the bumper  25  is admitted to the inside of the stomach wall B; the retaining tab  28   a  and flanges  28   b  are also released from the protrusions  23   b,  and the locking member  27  is released from the gastric fistula catheter  22 . The rod  26  is also withdrawn from the gastric fistula catheter  22 . 
     Thus, as shown in  FIG. 9 , the tube  24  of the gastric fistula catheter  22  contracts in the axial direction, and the bumper  25  is restored by elasticity to its original, nearly spherical shape. Consequently, the tip of the sheath  12  of the organ-fixing instrument  10  is compressed upward by the gastric fistula catheter  22 , and the suturing thread catch  18  assumes a pendant state along the lengthwise direction of the body surface installation part  11 , which is part of the circumferential direction. At such time, both ends of the suturing thread catch  18  project further outward than the location directly under the needle through-holes  14 ,  15  in the body surface installation part  11  and the outer circumferential part of the bumper  25 . In this instance, as shown in  FIG. 9(   b ), alignment arises between the orientation along two linkages  25   a  of the four linkages  25   a  on the gastric fistula catheter  22  and the suturing thread catch  18 , which facilitates application of force by the bumper  25  to the suturing thread catch  18 . 
     Next, as shown in  FIG. 10 , the abdominal wall A and stomach wall B are sutured using a pair of puncture needles  31 ,  32  and a pair of suturing threads  33   a,    33   b.  The puncture needles  31 ,  32  comprise a metal, cylindrical body formed with a through-hole (not illustrated) inside, and clasps  31   a,    32   a  are attached to the base. The clasps  31   a,    32   a  are formed as a cylindrical shape with a large diameter toward the top and a small diameter toward the bottom, and a guide hole communicating with the through-hole is formed inside. The tip of the puncture needles  31 ,  32  is also cut across an oblique direction and thus formed such that apertures  31   b,    32   b  are visible from a horizontal orientation. 
     One puncture needle  31  is passed through a needle through-hole  14  in the body surface installation part  11 , and the tip thereof is passed through the abdominal wall A, stomach wall B, and suturing thread catch  18 ; while the other puncture needle  32  is passed through another needle through-hole  15  in the body surface installation part  11 , and the tip thereof is passed through the abdominal wall A, stomach wall B, and suturing thread catch  18 . In this instance, a stopper in direct contact with the body surface installation part  11  is provided movably at a predetermined part of the puncture needles  31 ,  32 , and the insertion length of the puncture needles  31 ,  32  may be adjusted. One suturing thread  33   a  is passed into one puncture needle  31 , and the tip thereof is projected toward the inside of the stomach wall B; while another suturing thread  33   b  is passed into the other puncture needle  32 , and the tip thereof is projected toward the inside of the stomach wall B. These procedures produce the state shown in  FIG. 10 . The shape of the tip of the suturing threads  33   a,    33   b  may be hooked in each case, or the central part of a rod-shaped member may be linked to the tip of the thread to create a shape able to wrap reliably onto the suturing thread catch  18 . 
     Next, the puncture needles  31 ,  32  are pulled out toward the outside of the body, and the suturing threads  33   a,    33   b  are pulled lightly to wrap the tips of the suturing threads  33   a,    33   b  onto the suturing thread catch  18 . The organ-fixing instrument  10  is then pulled out of the body. Thereby, as shown in  FIG. 11 , the sheath  12  of the organ-fixing instrument  10  passes between the circumferential surface of the hole AH in the abdominal wall A and the hole BH in the stomach wall B and the outer circumferential surface of the tube  24 , and the external holder  23  is thereby passed to the inside, and [the sheath  12  is] thus pulled out of the body. The base-side portion of the suturing threads  33   a,    33   b  is also fed out sequentially, and the tip thereof is passed from one hole BH to the other hole AH together with the sheath  12  and is thus pulled out of the body. 
     At such time, the reinforcing parts  17  or skeletal parts  18   a,    18   b  are bent along the gastric fistula catheter  22  together with the covering  16 . In this state, the guide wire GW is withdrawn from the body, and the suturing thread catch  18  is also released from the suturing threads  33   a,    33   b.  The guide wire GW may also be withdrawn before the organ-fixing instrument  10  and puncture needles  31 ,  32  are pulled out of the body. Thereby, once the suturing threads  33   a,    33   b  have each entered the inside of the stomach wall B from the area punctured by the puncture needles  31 ,  32 , the suturing threads  33   a,    33   b  pass through one hole BH and the other hole AH and then extend outside the body. 
     The extending portion of both sides of the suturing threads  33   a,    33   b  is then cut to form a predetermined length, and both ends are tied to achieve the state shown in  FIG. 12  and complete suturing. Furthermore, the organ-fixing instrument  10  may be given a peel-off form to split the body surface installation part  11  and sheath  12  in half. The procedure of withdrawing the organ-fixing instrument  10  from the body is thereby facilitated. 
     As described above, in the organ-fixing instrument  10 , a through-hole  13  communicating with a sheath  12 , and needle through-holes  14 ,  15  allowing passage of puncture needles  31 ,  32  are formed in the body surface installation part  11 , and a suturing thread catch  18  projected in a transverse direction by compression applied in an axial direction is provided toward the tip of the sheath  12 . Consequently, the sheath  12  of the organ-fixing instrument  10  can be inserted into both one hole AH and another hole BH, and the suturing thread catch  18  can be placed in a state projecting transversely inside the stomach wall B. Then, when the suturing threads  33   a,    33   b  are each passed by way of the puncture needles  31 ,  32  through the abdominal wall A and stomach wall B and the tips thereof are wrapped onto the suturing thread catch  18 , the suturing threads  33   a,    33   b  are each passed by way of the sheath  12  out of the holes made by the puncture needles  31 ,  32  and through toward the inside of the stomach wall B, are passed through one hole BH and another hole AH, and assume an approximately U-shaped, continuous form. 
     As a result, by tying both sides of each of the suturing threads  33   a,    33   b  located on the skin side of the patient, the abdominal wall A and stomach wall B can be fixed by the suturing threads  33   a,    33   b.  Additionally, because the sheath  12  of the organ-fixing instrument  10  is formed with a transversely elastic cylindrical shape, the sheath  12  assumes a slender, rod shape when inserted into one hole AH and another hole BH, and once the sheath  12  is inserted into one hole AH and another hole BH, the dilator  21  can be inserted into the sheath  12  to enlarge the diameter of the sheath  12  and the holes AH, BH. The procedure for installing the gastric fistula catheter  22  is thereby facilitated. 
     In an instance where the dilator  21  is used to enlarge the diameter of the holes AH, BH, and the dilator  21  is inserted directly into the holes AH, BH, the region near the circumferential surface of the holes AH, BH becomes pressed into the body. However, as described above, use of the sheath  12  tends to transmit the force of the dilator  21  horizontally, and the force pressing the region near the circumferential surface of the holes AH, BH into the body is diminished. Consequently, adequate transverse expansion of the holes AH, BH is made possible, even if the inserted length of the dilator  21  is short. 
     In the organ-fixing instrument  10 , the sheath  12  comprises a cylindrical covering  16  comprising a tube incorporating a laminate resin and a webbed locking part made from a resin, a plurality of reinforcing parts  17  provided at the base end part of the covering  16  and extending in an axial direction, and skeletal parts  18   a,    18   b  with a hinged construction provided toward the tip of the covering  16 . A suturing thread catch  18  is also formed at both the tip part of the covering  16  and the skeletal parts  18   a,    18   b.  Structuring the body of the sheath  12  in this manner with a covering  16  equipped with a webbed locking part facilitates wrapping of the suturing threads  33   a,    33   b  onto the suturing thread catch  18 . 
     Provision of the reinforcing parts  17  also greatly increases the strength of the base end part located at the holes AH, BH when the sheath  12  is inserted in the holes AH, BH. Any occurrence of misalignment with the respective holes AH, BH is thus prevented. Use of the projection of the suturing thread catch  18  and the skeletal parts  18   a,    18   b  also allows construction of the suturing thread catch  18  with a simple structure. Additionally, the present preferred embodiment allows simultaneous performance of a procedure to install the gastric fistula catheter  22  in the holes AH, BH and a procedure to suture the abdominal wall A and stomach wall B and also facilitates the procedure to install the gastric fistula catheter  22  in the holes AH, BH. 
     The organ-fixing instrument pertaining to the present invention is also not limited to the preferred embodiment described above, which can be implemented with changes as suitable. For example, in the preferred embodiment described above, a rod formed with the center part as a thin-walled part is used as a skeletal part  18   a,    18   b  of the suturing thread catch  18 , but a skeletal part is not limited thereto, and another acceptable item is one equipped with a hinged structure which is projected in a direction perpendicular to the axial direction by application of a force tending to bring both ends closer along the axial direction. An item is also acceptable wherein a thread is inserted into the sheath  12  and the tip thereof is linked to the sheath  12 , and the suturing thread catch  18  can then be pulled in a transverse direction by pulling the base side of the thread. 
     The reinforcing parts  17  of the sheath  12  may also be omitted, and the number thereof may be established as desired. For example, a large number of very fine parts may be provided. Depth marks may also be provided on the surface of the sheath  12 . Other needle through-holes additional to the needle through-holes  14 ,  15  described above may also be provided with different spacing. Additionally, in the preferred embodiment described above, the covering  16  of the sheath  12  comprises a webbed tube incorporating a laminate resin and a webbed locking part made from a resin, but the covering  16  may also be structured by a mesh-form tube comprising a mesh made from a resin. Aspects such as the shape of the body surface installation part  11  or the gastric fistula catheter  22  may also be changed as appropriate.